Permit BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2002 -00218
4 DEVELOPMENT SERVICES DATE ISSUED: 6/10/02
-- X11 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 08770 SW SCOFFINS ST PARCEL: 2S102AA -02800
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: 026 JURISDICTION: TIG
REISSUE: f /�, FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: fl' r/ 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: E2 TOTAL AREA: 0.00 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: $ 18,391.00
Remarks: Install of Fire Alarm.
Owner: Contractor:
TUALATIN VALLEY MENTAL HEALTH PROTEC INC
8770 SW SCOFFINS RD 720 NE FLANDERS STREET
TIGARD, OR 97223 PORTLAND, OR 97232 -2763
Phone: 503 - 524 -5411 Phone: 503 - 235 -4000
Reg #: LIC 55414
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Fire Alarm Insp
PRMT CTR 5/31/02 $225.70 27200200000 Fire Alarm Insp
Final Inspection
5PCT CTR 5/31/02 $18.06 27200200000
FIRE CTR 5/31/02 $90.28 27200200000
Total $334.04
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 2V -6699 or 1- 800 - 332 - 344.
_ Li
Pe ee
Si ature: ) A
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I sued By: k -_ mtl � /.�' /
Call- • • -4175 by 7 p.m. for an inspection the next business day
TO'd :<2.6 096 T66520 0t7:80 Z007.- EE -AbW
- - , 80 Pe0s - °coos i l e El e..-7 .
Building Per 1 1 0 _ I� : on
wi ' •
g. :134 ll_
- w -- Datereccivcd."-; Penni'no TO
— City o f Ti gar r• • l'j
,41- •... 'Ig � Project/appl. an Expire date:
Ciryof7iigarQ Address: 13125 SW Hall Blvi
Phone: (503) 639 -4171 Ir' 11 ''�'
Date iewcd: Rccciptno.:
. . )� Fax: (503) 598 -1960 city
Z Case file no.: Payment rypc
Land use approval: B J1ID G� err 18:2 family: Simple Complex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi - family 0 New construction 0 Demolition
0-Addition/alteration/replacement 0 Tenant improvement Fire sprinkler /alamt 0 Other.
J OB SITE INFORMATION
Job address: ' S co S' Cd4F/iis 5Y7,Pe- Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: Tu A 10 ✓3 //47 • ,t da pot Ce Hal'
Description and location of work on premises/special conditions: A 5-1 /.e .4414rryt
OWNER / FOR SPECIAL INFORMATION. USE CIIECKLIST
Name: % j 7/0 CP6fY ( Fluodpla in. septic capacity, solar, elle.)
Mailing address: j 4 A/� pi N / 4, y4 1 44P-1 I & 2 family dwelling:
City: Po/ 41 I State: ,Pt. IZIP: q7 Valuation of work • $
Phone: 5'b 011 3 32.l IFax: 1 -mail: No. of bedrooms/baths
Owner's representative: °A i e 4 i „i l - (,V��,n � A Total number of floors _
Phone: Fax: E -mail: New dwelling area (sq. ft.)
Ga agc/carport area (sq. ft.)
Name: )2-- iec Covered porch area (sq. ft.)
p �j/g'F/ p, s. e Deck area (sq. ft .)
Mailing address:
City:
Po .--6 c l s tate: ,0 I ZIP: F7 go 2 Other structure area (sq. ft.)
Phone: 9)3 235 '/00o Fax: — 03 c,3 E-mail: R-v-iec Secu ' . 64., ConimerciaUmdnmiaUmulti family:
' a ' r . OR Valuation of work $
Business name: Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.)
Address: • Number of stories
City: State: I ZIP:
Pho --- - _ 1 Fax: I E -mail. Type of construction
CCB no.: 55 Occupancy group(s): Existing:
/ New:
City/metro tic. no.: Notice: All contractors and subcontractors are required to be
ARCIIIIR•'CTIDLSIC NLR licensed with the Oregon Construction Contractors Board under
Name: A t.a A...VG•V provisions of ORS 701 and may be required to be licensed in the
Address: 3 z.,.? .S 4j Nw - /f� f�A /,fya, jurisdiction where work is being performed. If the applicant is
City: � � f 5 ; I Z�; /9.� I exempt from licensing, the following reason applies:
Contact person: NA/I, s �, r J.s `Plan no.: •
Phone: S03 -L '06 10 Fax: E - mail:
Name: Contact person: Fees due upon application • $
Address: Date received:
City: (State: IZ1P: Amount received S
Phone: 1 Fax: I E -mail: _ Please refer to fee schedule.
I hereby certify I have read and examined this application and the Net an jurvdictioar aexpt audit cards. plutac call Jtsiedieuon for snort iafonrudoa
attached checklist. All provisions of laws and ordinances governing this C visa 0 MasterCard
work will be complied with, whether specified herein or not. Ctrdit card number: � � r L .
. Authorized signature: Date: Namc of cardholder as shown co ao0tt card
$
Print name:
Cmdhet&f upuuurc Atnmuat
Notice: This permit application expires if a permit is not obtained within 180 days after it hag been accepted as complete. ', 440-4613 (6000ut
T00[A tIdY9I1 30 .(.LID 096T86SCOS XV3 60:80 ZOOZ/ ZZ'S0
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received Date Requested 9- -it" AM PM BUP
Location g - 7 0 Suite L MEC
'
Contact Person Ph ( ) 3 -s " 7 000 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: , 'ISrn .d SIT
Post & Beam
Shear Anchors rL44-
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
der: nJy /
PASS 4:1'T FAIL
PLU - , . ..� � . _, e _A
-
•os " Beam
Under Slab
Rough -In SO414 e
Water Service
Sanitary Sewer V t ( Su 7 • 14 N'
Rain Drains /
Catch Basin / Manhole Plt-IZO-_ � -
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 call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
Approach/Sidewalk Date _ 3 Inspector r / Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL