Permit A CITY OF TIGARD BUILDING PERMIT
- �,L PERMIT #: BUP2004 -00490
DEVELOPMENT SERVICES DATE ISSUED: 10/29/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102AA -02800
SITE ADDRESS: 08770 SW SCOFFINS ST
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: 026 JURISDICTION: TIG
REISSUE: h'',( FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: GeTT 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: E3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 71 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: $ 2,000.00
Remarks: Change 4000 SQ FT of existing E2 to E3.
Owner: Contractor:
COMMUNITY ACTION ORGANIZATION
1001 SW BASE LINE ST
HILLSBORO, OR 97123
Phone: 503 - 969 -7231
Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 10/29/2004 $62.50
[TAX] 8% State Surchari 10/29/2004 $5.00
[FLS] FLS Pln Rv 10/29/2004 $25.00
Total $92.50
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- 800 - 332 -2344.
Issued By: ,U
Permittee
Signature: /C /i ✓y
Call 639 -4175 by 7 p.m. for an inspection the next business day
rf / 0 ,- .,
Building Permit Application FOR OFFICE USE ONLY
City of Tigard 0 r , Received / �� o el —o0 9d
13125 SW Hall Blvd., Tigard, OR 97223 e DateB : AI ;� Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 %�• ro �'; 7 /�s�
Date/By: 0 Z
Other Permit:
_ n� alt�
Inspection Line: 503.639.4175 �{+i• F' � I� mo , Date Ready/By:
• ® See Attached Checklist for
Internet: www.ci.tigard.or.us �� ? Notified/Method:Af -f ov 14, Supplemental Information
NI 0 TYPE OF W\ - - :: _ .. REQUIRED DATA: 1'- AND 2- FAMILY DWELLING
El New construction Demolition Permit fees* are based on the value of the work performed.
J1 ( Indicate the value (rounded to the nearest dollar) of all
ddition/alteration/replacement Other: 2 -»-' C/t,v,,,� _ i ,? y0 , 3 equipment, materials, labor, overhead, and the profit for the
. . . CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $
El Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder [;tither: T rVe .. .54 A Ap j Number of bathrooms:
-- JOB , SITE INFORMATION A ND LOCATION Total number of floors:
Job site address: g 7 70 Sm i7 / S 6°41-45 New dwelling area: square feet
City/ State/ZIP: -I- i G Q a d Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: 1.14,7, p C Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:'CO,MMERCIAL -USE CHECKLIST•
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
. DESCRIPTION OF WORK - work indicated on this application.
/ Valuation: $
cl aNyc (4,5e 7'12.97-1 Fa 4v 7-
J
es ee...u. 13Cy Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ' TENANT Number of stories:
Name: C m yt ley aN /qG j/ r D A/ o Type of construction:
Address: / )& / .5‘4 jc, 5C 4/ivy Occupancy groups:
City/State/ZIP: Ai/ /15 Jp 7-Z U 0 4_ 9 7/ f.' n
Exi sting: L+ d`
Phone: � 910 ?? - Z3 Fax: (5 � � Y g V I New: E. 7J'
e
. _ APPLICANT Ir"cONTACT'PERSON • NOTICE
Business name: < dJ ryl ,, / „lc Ii O 40 2 y All contractors and subcontractors are required to be
Contact name: / h N SAS l .J licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: / Qd ! 5 w 3 uSe A / .- e- 3 jurisdiction in which work is being performed. If the
City/State/ZIP: 1/ � �3 Q CU a 9 7/ Z3 applicant is exempt from licensing, the following reasons
apply:
Phone: (5' 4 3 ) 613 3 2 63 Fax:: fi".3 6 yg hi/ 75
E -mail: /s 0' 1iSee% L L$ 6 • e2Q
CONTRACTOR ` / .
•
Business name: 4 /9. .. - • ',. °',BUILDING PERMIT FEES*
Address:
• Please refer to fee schedule ,
City/State/ZIP:
Phone: ( ) Fax: Fees due upon application
( )
Amount received
CCB lic.:
Date received:
Authorized signature:��_ This permit application expires if a permit is not obtained
/ within 180 days after it has been accepted as complete.
Print name: G / N
� je ' ... Date: //e5)4.71 O 5 • Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building \Permits \BUP- PemutApp.doc 12/03 440- 46I3T(I1 /02/COM/WEB)
' n
Building Division
'` "ve, � Plan Submittal Requirement Matrix
Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at .
Submittal -
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
•
Fire Protection System 3 **
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
. additional sets of plans for distribution purposes (for contractor, City of Tigard,
• Washington County, and Tualatin Valley Fire & Rescue)
• * For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
is\ Building \Forms \COM- P1anSubReq.doc 12/24/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Liner (503) 639 -4171 _ /
6 01 Received �� Date Requested 1...0 AM PM UP 7 '
Location o 7 7 0 -1 11 S ST Suite MEC
Contact Person Ph ( ) 96 70 PLM
Contractor Ph ( ) ) R
ILDI� Tenant/Owner Tl � e �f' «D l� 6 �
� LC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: "100 /OLZ ad _ _ � 3 SIT
Post & Beam �/
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Ina •
PART FAIL
ING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains l
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 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA 7b (
I, 7z
Approach/Sidewalk Date Inspector L,,,\ Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL