Permit 'CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00042
� DEVELOPMENT SERVICES DATE ISSUED: 3/3/04 •
13125 SW Hall Blvd., Tioard, OR 97223 (503) 639 -4171 PARCEL: 1S135BD -01100
SITE ADDRESS: 09780 SW SHADY LN
SUBDIVISION: ZONING: C -G
BLOCK: LOT: • JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS 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: B 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: $ 7,774.00
Remarks: Fire protection.
Owner: Contractor:
SHADY LANE COMMERICAL BUILDING AMERICAN SECURITY ALARMS, INC.
9780 SW SHADY LANE 5411 SE MCLOUGHLIN BLVD
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: 503 - 244 -1682
Phone: 503 - 231 -0303
Reg #: LIC 58640
FEES REQUIRED INSPECTIONS
Description Date Amount Electrical Permit Required
[BUILD] Permit Fee 2/9/04 $120.10 Fire Alarm Insp
[TAX] 8% State Surchart 2/9/04 $9.61 Smoke detector insp
Final Inspection
[FLS] FLS Pln Rv 2/9/04 $48.04
Total $177.75
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 t. e : • - rules adopted by the Oregon Utility Notification Center. Those rules'are set forth in OAR
952 -001 e 110 through OAR 2 -001 -0 11. You may obtain a copy of these rules or direct questions to OUNC by
callin; 503) 246 -6699 or 1- 800 -32- 344.
Iss - d By: ' .� _=, , 4 1 / / ;. /
Permitt- -
Signature: ,
Call 639 -4175 by 7 p.m. for an inspection the next business day
7p-80 f Al f AMP Y LANE - - •
Fir Protection System p � r9''�s -2) _ � 'I•
• Tai c Yin Permi A lieat' 5) . FOR OFFICE USE ONLY
Received Building Da te/3yA -C%--0 M Permit No.: 0 (,( Da>
City of Tigard RE P Approval . Other
p D U ' 1 0 4 Date/By: Permit No.: ,`
13125 SW Hall Blvd.
Tigard, Oregon 97223 FE Plan Rc' ie Date /By: !I-e /P p_
/ Other
'V
Permit No.:
Phone: 503 -639-4171 Fax- 503 - 598 -19f>, -r r'` ~°'r:':11RU�;i' ; • N Post- Review / � Land Use
Internet: www.ci.tigard.or.us Y ,-.!►,• • :.I � Date/By: / Case No.
�.s1�1L� Contact Juris,: j81 See Page 2 for
24 -hour Inspection Request: 503- 639 -418.) Name et o : W/ It) 1 / Supplemental Information
: D ��'. .
. ... .. � .�11�'•:I:.I'��:• = eat „I..P,: „r,' i!' •;I '1.7.IH::�:p.'•.7,';c..,�aaep�, _ �.,^ �: :I;'•;�:�
;': aRE ' 1� t ''rJtiT)Afi ;':I 1:'';: 4 . r ..1: ; 1utj;.tlp ry 'l
New construction 11;y0;;!' " 51i1 : 1: "t; '.r: a•. .;,,.,_ ,iy ,,,I
❑ truction 1 Demolition ; -: :,s ' �:: ,;; :.' ;, , , ,,,.;,
r
:; : i :7: i. • :- 1f ,IZ ip , t 1: Y TAYAkiP, ING ,± : - !•:i t _ :i .11u. ; ::.:,6
la Addition/alteration/replacement ❑ Other: !: „.j;... .1: -.,. �.I:I..., , . , , ;
4 ' `• - : • 'P O " '6' O I1j) . star a i9! • e • I as•I!:d ni ;;.i!;_':;;;: ': ::1• Note: Permit fees• are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling 1,i1 Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building • Multi- Family
❑ Master Builder lj Other: • Valuation :s
°:a' r,! 'tg.,!:: U..Ci1f'Sli'I1Ei'!CNFORMAT' hfiandliLlatlii'f' O No. of bedrooms No. of baths:
' Total number of floors
Job site address: •tS k ►.. • A. . .t:..i r New dwelling area (sq. ft.)
Suite #: B Id. . /Apt. #: Garagc /carport arca (sq. ft.)
Pro•ect Name: ,_ ,,,,,, ,. . . s j ai Covered porch area (sq. ft.)
Cross street/Directions to jo. site: Deck area (sq. ft.)
Other structure area (sq. ft.)
}t , !;I 'I •:L ".I,- .` ',['Pf : � n,, a . ... .,,,.e' a<
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; •s ; . i'I �' `� >
�y �� ��l' � :dl "I� ,,,,y r. r . 'eri:f �': IJ
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Subdivision: Lot #: ',IP:a','',v. „4.i! i;!!F.l� . :•, :... ' .. ^ � :l..::..
Tax ma./ • arcel #: Note: Pennit fees ale based on the total value of the work performed. Indicate
” " ”` ' '''' I'' "'I'' ° i i' : J the value (rounded to the nearest dollar) of all equipment, -•.�<�.::::..I; ..: t. DF. �1, C � "�i:;�:;::; h l dd h d
) meet materials, labor, 9 P
•
' overhead and profit for the work indicated on this application. •
it I 1_ l.+ ►f111 iA t�L Valuation 1 1 17 OV
'�� Existing building area (sq. ft.)
`• 1 X11 � `' �-' *��`+ 1 New building area (sq. ft.)
• M • - . .. I Number of stories
: b '-R0 ' • ' '1'L�t' a,.i.Tork •. 1'j': ! ::i '18f i I's`;> ::
' t i l za..;
t P�4��ILiiR 1 I, IM `tPa4,;, �>;�ji�„ •... Type of construction
. Name: ' 1 � , Occupancy. group(s); Existing: .
Address: • New:
`12
Phone' + ' 1) »; NOTICE: All contractors and subcontractors arc required to be
� . • o :.,,,, ' , •`' i ; licensed with the Oregon Construction Contractors Board under
15.°71: �
F1., 1 ®' 6..1. ''� t I • ' I " provisions of ORS 701 and may be required to be licensed in the
G u 1 ess N. e: tam,, jurisdiction whcrc work is being performed. If the applicant is exempt a
Contact Name: lk ry from licensing, the following reason applies:
Address: 6'y1 5E M VI liV1 L3 •
Ci /State /Zi .: t,. • • ` Ag ty :. • r - -
— _
Phone: �S. - , � �� — ! � < �I;1:� :; ,; 't� I�':;: ::'I:!t ,.,t:r,�.s � � •I. ,,•:Il
E -mail: (� ( . CMS T�/�/� .i•:,•: - : ' >a 1 �{� , )r Ire; �t;,11:li1 I,;•:.,:t:i :ta; ?
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;; :�::... = 'i >;..< .. ltd :,1: :,•.
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Business Name: j[/(J( _4 41 - _ • id L. Fees due upon application 7; \11. 1
Address: G,■Y\2_ OS ani)V a,.t
City/State /Zip: -- t Amount received ';
Phone: Fax: / Date received:
CCB Lic. #: ,�'8(pL f ( y 23 p
Authorized
Signature: Date: Notice; This permit application expires ifs permit Is not obtained within
180 days after It has been accepted as complete.
*Fee methodology act by TrI County Building Industry Service Board.
(Please print name)
1 :\DatAPersnit Forms\BIdtPermitApp.doc 01/03
Tn A rot
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503 • MST � 1 60� • sk.A_
Received n � Date Req / uested g- f " • BUP
` � ? t U 5b.L S dt-- C Location c Suite MEC
Contact Person Kp ■h( 5 3 ) 23 I r v 3 03 PLM
Contractor h ( ) r SWR
�U ILDj Tenant/Owner CS d ELC
Fooling
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors = ' •
Ext Sheath/Shear q- q )
Int Sheath/Shear YV� � .k Gf' • 0
Framing l
Insulation p, , Q Q S w G (,� Lt Z
Drywall Nailing V��-"
Firewall
Fire Sprinkler
- _ . .3
Susp'd Ceiling
Roof
Ot er:
4 PART FAIL
• L ING ! i
Post & Beam
Under Slab \
Rough -In
0/
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
t r/
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: LI Unable to inspect - no access
Fire Supply Line /
ADA
Approach/Sidewalk Date ( ` 1 b � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL