Permit at . ~ , BUILDING PERMIT
C ITY OF TIGARD PERMIT #: BUP2004 -00471
1° DEVELOPMENT SERVICES DATE ISSUED: 10/1/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134BC -00500
SITE ADDRESS: 12388 SW SCHOLLS FERRY RD
SUBDIVISION: PP1993 -057 ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: A3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 55,000.00
Remarks: Customer service remodel w /new dessert shop, exterior facade modifications, repaint.
Owner: Contractor:
MCDONALD'S CORPORATION JOSEPH HUGHES CONSTRUCTION, INC
036/0002 7035 SW HAMPTON ST
PO BOX 66207 TIGARD, OR 97223
CHICAGO, IL 60666
one:
Phone: 503 - 624 -7100
Reg #: LIC 45645
FEES REQUIRED INSPECTIONS
Description Date Amount Electrical Permit Required
[TAX] 8% State Surcharl 10/1/2004 $39.85 Framing Insp
[BUPPLN] Pln Rv 10/1/2004 $323.80 Gyp Bn
[FLS] FLS Pln Rv 10/1/2004 $199.26 Final Inn spespe ctLioion
[BUILD] Permit Fee 10/1/2004 $498.75
Total $1,061.66
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1 -: 0- 332 -2344.
Issued By: -�t:NIL.'
Perm Mee � 2
Signature: ' V
Call 639 -4175 by 7 p.m. an inspection the next business day
II
Building Permit Application FOR OFFICE USE ONLY
City of Tigard Received Date/By: / / -iQ ) Permit No.:'gG , aa V j4t j 1 I
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 A"" a� Date/By: 1 .. 1' y /�fff Other Permit:
Inspection Line: 503.639.4175 �_ „ Date Ready/By: 3uris: ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1 - AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the newest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling [Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12 ,84 M( realty / New dwelling area: square feet
City /State /ZIP: � C � �n r AD • g 72 t . 5 � ""� Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: /(oleced444 Covered porch area: square feet
Cross street/directions to job site: t 1. L, euip . Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
4 Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the newest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
14 Valuation: $
& 4fA AIM A I MGDa i Wei.• NEW 14Cheer
%) 6 di - 0444 AuDiAtioetifrie, 4 Repa+nar Existing building area: square feet
New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: mcDowort crop _. Aiae wpi7' iaate4 Type of construction:
Address: 10 740 ft i A( 1'QI 6 Z ' . aoO Occupancy groups:
City /State /ZIP: 4121,0„470 f we.. 98053 Existing:
Phone: (L 27. 4 -m v Fax: ( 04 ) liter q s New:
A PPLICANT ❑ CONTACT PERSON NOTICE
Business name: lAttisiveltd,, cY _ t J & j t J I M r i J J - aisie4 All contractors and subcontractors are required to be
Contact name: LO ti ��� licensed with the Oregon Construction Contractors Board
- under ORS 701 and may be required to be licensed in the
Address: 1 1445 ME i,� 4• S SE A 3 jurisdiction in which work is being performed. If the
City /State /ZIP: YttiCOvvgL A 9 9 /„/_ Z applicant is exempt from licensing, the following reasons
��vv�1PP apply:
Phone: (360) gct2 • .3 31,2? Fa ( ) 3 7- a 3(v&
E -mail: l0 u . -4aylo ✓� M(C . I /, IAN
1 CONTRACTOR
Business name: ����� ■_L .� 9, I 4�,Ursto �rB,lcm`fr
/.+*'r It 0y
x BUILDING PERb1IT FEES*
Address: 11/7-1 * t r am t (
'{ �J Please refer to fee schedule.
/
City /State /ZIP: �Q
`,� 1 �� O. � a Fees due upon application
Phone: (503) 62.44 . floc I Fa x: (603) ( o�64" 5245
Amount received
CCBlic.: ! c 8�
Date received:
Authorized signature: / This permit application expires if a permit is not obtained
JJJ ��� within 180 days after it has been accepted as complete.
Print name: L., i T � I Date: a . 1 5 I • Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building \Permits\BUP- PermitApp.doc 12/03 4404613T( 11/02/COM/WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION • Business Line: (503) 639 -4171 MST
BUP aao g 4 / 7/
Received Date Requested 3 / AM PM BUP
Location / 3 8 g' Suite MEC
Contact Person Ph ( ) S/ 1 gS5 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner —"Yn C r)Gly) ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall •
Fire Sprinkler
Fire Alarm �1
Susp'd Ceiling
Roof
•
d 4 ,
A "&
C PAS • PART FAIL
• LU BING I
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please cal for rei pection \ \ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date • ® Inspect() ` • Ext
Other:
Final O NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
Sep 30 04 01:24p I- 5 Signs, Inc. 3604560415 p.5
DEPARTMENT OF LABOR AND INDUSTRIES
LICENSED AS PROVIDED BY LAW AS ,
ELEC:CONTR SIGN,
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I FIVE SIGNS INC
8751 COMMERCE PL DR NE
LACEY WA 98516 -1326
F625.ft ! 000 (8N))
State of Washington
County of Thurston
I certify that this is a true and correct copy of a document in the
p ossession of 1 -5 Signs, Inc. (IFIVESI15103), as of this date.
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'■ � 0 ,A i: State of Wa -� . n
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Sep 30 04 01:24p I- 5 Signs, Inc. 3604560415 p.4
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REGISTERED AS PROVIDED BY LAW AS
. CONST.CONT GENERAL
• "REGIST. # • EXP: DATE
CQ1... ISDESM *971JH 04/16/2005
F?FE'CTIYE DATE 04/16/2003
.. t.: 1�D� �rn�i
I -5 DESIGNl &MANUFACTURE .•
. 8751 COMMERCE._ PLACE DR NE
OtYM '98516
Signature V /� ��
Issued by DEPARTMENT OF LABOR AND INDUSTRIES
. State of Washington
County of Thurston
I certify that this is a true and correct copy of a document in the
possession of 1 -5 Signs, Inc. DBA: 1 -5 Design & Manufacture -
(I5DESM"971JH), as of this date.
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`g` "', Residing in y�x .L I �/I7`
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My appointment expires d /L/ Q �
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Sep 30 04 01:24p I— 5 Signs, Inc. 3604560415 p.3
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UNDERWRITERS LABORATORIES INC.
INSPECTION REPORT - Type L Service
E10497510408181037
Date 08/18/2004 File Number E104975
Responsible Office Santa Clara Volume 1
Inspection Center 969 Account /Order Number 0048 - 11
CCN UXYT UL Rep Name Larry M. Petruzzi
Product Category SIGNS UL Representative ID 12457
Subscriber- Factory 725790 -001 Factory Representative: Joe, John, Dave
Number
Manufacturer Name I -FIVE SIGNS INC Factory Rep Phone 800 -459 -2967
ManufacturerAddrese8751 COMMERCE PL NE
LACEY WA 98516
Nature of Visit First of Quarter Listing /Classification/Recognized
(Unlisted) Component Marks Used
Since Last Visa
Variation Notice ❑ Listing/Classification/Recognized ' _
Issued (Unlisted) Component Marks
Removed
Data sheets Sent r
Comments After
Submission
PRODUCTS EXAMINED
Seaton/ Mutdple
M�eJ l Q KIN Lied
McDonalds Neon 9g n • 11 1 No
If samples are required to be sent to UU Laboratory, indicate below. If required samples are not sent, explain In the Comments
area.
SAMPLE DOCUMENTS
Ca' i.I r.i�'. ,.am: ...:: n:;.B IE .q °iic' Slir,?p:_ ._ �fli .•.
No Samples
Tune in Factory: 2.00
Additiotlal Conenen's:
.
Sep 30 04 01:24p I- 5 Signs, Inc. 3604560415 p.
A+ WELDING AND CERTIFICATION
WELDER CERTIFICATION TEST REPORT
WELDER QUALIFICATION DATA SHEET
(ONLY TO BE USED WHEN WELD TEST IS ACCEPTABLE)
COMPANY NAME: I-S SIGNS DATE: 5 -21 -04
NAME DANIEL P. SCAMMAN STAMP: DSR and DSF
QUALIFICATION IN ACCORDANCE WITH: AWS ALUMINUM WELDING CODE D1.2 •
BENDS YES PIPE TEST NA SCH: NA PLATE TEST: 1
BASE MAIL: 5053 H32 DIA. NA NOMINAL THICKNESS: .375 "
TEST POSITION(S): 1G THICKNESS RANGE: .125" - .750"
WPS No/REVISION No:: AWS PRE - QUALIFIED WPS
WELD LAYER PROCESS FILLER METAL UPHILL or DOWNHILL
ROOT PASS GMAW -S ER -5356 .045" NA
FILL AND CAP GMAW -S ER -5356 .045"
typical total nominal deposit thickness for root & 2nd pass Is 0.125° or 0.0625°
NOTE If a single process is used make 1 line entry on root pass and line thru the
BACKING - YES TYPE OF BACKING MATERIAL: SAME AS BASE METAL
IF NO BACKING WAS USED - WAS THE BACKSIDE BACKWELDED? BACKING STRIP USED
SHIELDING GAS: 100% ARGON BACKING GAS: N/A
GMAW /FCAW TRANSFER MODE: SPRAY CURRENT- POLARITY: DCRP
XRAY TESTS 4
LAB NAME: N/A LAB TEST #: N/A • e ft!
tiJA''
TECHNICIAN: NIA DATE: N/A
BEND TESTS
ROOTS & FACE BENDS: YES SIDE BENDS: NA LAB TEST #: 2004 -11
BENDS PERFORMED BY: Mike Driscoll / AWS -CWI DATE: 5-21-04
WELDING WITNESSED BY: Mike Driscoll 1 AWS -CWI DATE: 5 -21 -04
VISUAL INSPECTION BY: Mike Driscoll I AWS -CWI DATE: 5 -21-04
COMMENTS: Excellent Workmanship
Welding Inspector
10'==t 1:'•1101 iC:===N 101 1G==I1C_11C_N1C:Z=I 11:71
STATE OF:ORE CONSTRUCTION CONTRACTORS BOARD
. LICENSE CERTIFICATE
This certifies that the person named hereon
is licensed as provided by law as a
S pec °alv.
t.. toftrector /A1.1
'..: fiON EXEMP:T: • • ' • License
CoCorporation : Number: 64900
in
-a : License 114i,..0.;.'-1 Expires: 03/09/2005
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2 : : I- S SI.GNS: .
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. L4,CE DR . NE
c� L ACE�Y..... W:A: `�`8` i]�I 26
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.:' ' SIGNATURE OF L '" N EE
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ELECTRICAL SECTION
ui C L:Icif e as: No.: 37- 515CIS
O0 LTD. SIGN CONTRACTOR LICENSE
co
DBA
15 SIGNS INC
., : 8751 COh1iERCE PLACE DR NE
LACEY WA 98516
ISSUED 823/ , EXPIRES 07/01/06
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