Permit - ITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00393
pc DEVELOPMENT SERVICES DATE ISSUED: 12/3/02
'� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12390 SW SCHOLLS FERRY RD PARCEL: 1 S134BC 00600
SUBDIVISION: PP1993 -057 ZONING: C -G
BLOCK: LOT: 002 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: NONE : sf N: S: E: W:
OCCUPANCY GRP: NONE 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: $ 30,000.00
Remarks: Add additional Antennas to existing monopole
Owner: Contractor:
SPRINT PCS SKYLINE NORTHWEST INC
7001 NE 40TH AVE.
VANCOUVER, WA 98661
Phone:
Phone: 360- 635 -6006
Reg #: LIC 145135
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUPPLN] Pln Rv 9/9/02 $208.52
[FLS] FLS Pin Rv 9/9/02 $128.32
[BUILD] Permit Fee 12/3/02 $320.80
[TAX] 8% State Tax 12/3/02 $25.66
Total $683.30
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.
r /�
Issued By: X . -a7,00
Perm ittee
Signature: — 2.(,
all 639 -4175 by 7 p.m. for an inspection the next business day
9 / 3 a.
.. Building Permit° ication
Date received : 'Ri`t /(7y Permit no.Tt' l7 ,� - - 3
,re ., City of Tigard �+C oh 2_002
Address: 13125 SW Hall Blvd,S g?rd, 9 Prolect/appl. no.: Expire date:
City of Tigard 1 ,
Phone: (503) 639 -4171 �ui ut i a; 1-,f -� Date issued: By�j� Receipt no.:
Fax: (503) 598 -1960 w _ :{1, V ' t r Ca se file no.: Payment � � �i �,i•..' Ym type:
Land use approval: tA,MD2oo2- 000zl 1 &2 family: Simple Complex:
ll'I'E OF I'ERiII "I"
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi -family ❑ New construction ❑ Demolition
❑ Addition /alteration/replacement p(Tenant improvement 0 Fire sprinkler /alarm 0 Other:
.1013 SITE I !NFOR1i1A LION
Job address: -1%1 t > S Stcuao ws sect ' _ Bldg. no.: Suite no.:
Lot: Block: Subdivision: L ._ L. Tax map /tax lot/account no.: 004
Project name: •r .. -L _ �a - _ _ -O • XC. .. -
Description and location of work on premises /special conditions: AaO 1 wte Co M. 't w t .,a,g a (02' TO
. -■ EX \!-rr-i i-L to ± Ead M O t4 OPCI£ Val / Gay ‘1=. M Fa►AT \wi, A c Ew.er) .6vR\:A .
OWNER FOR SPECIAL I \IORiNI:\IIOiN. IJSF CIIFCKLISI
Name: ( Fluud pl :tin. septic capacity.soIar.etc.)
Mailing address: 1 & 2 family dwelling:
City: State: ZIP: Valuation of work $
Phone: Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
' : I' I' F I CA tN f Garage /carport area (sq. ft.)
Name: (_, - - - - - Covered porch area (sq. ft.)
Mailing address: 2,10 t N . _ _ S.., ►r kg. Deck area (sq. ft.)
EZEI State: p _ ZIP: - O Other structure area (sq. ft.)
Phone: 2:14-1 too Fax: it _1Bo3 EfEZIaleffera fSo�merciaUindusMal/malti- family:
te.o4e. ne�1-
r- COiNTRACIOR Valuation of work $ 30 , aao
Existing bldg. area (sq. ft.)
Business name: c ` Li r ►.t( r /1.1 . I New bldg. area (sq. ft.)
Address: • f/ 0 A-UG Number of stories
City :' /) i . Stag)¢ ZIP:• .
Phone: 3(cdi &35 - a .Fax: E -mail: I Type of construction
CCB • no.: Occupancy group(s): Existing:
City/metro lic. no.: New:
J Notice: All contractors and subcontractors are required to be
:1 R C l l I T E C I7 6 f•_ S I (; \ E R licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: - t Sv _ jurisdiction where work is being performed. If the applicant is
City: Po r_ _ . State: p .. ZIP: - d.
exempt from licensing, the following reason applies:
Contact person: D , e L _ _- Plan no.:
Phone: 60.a,_Z.-14 _- Fax: 2,14_1 ea E -mail:
ENGINEER OFFICI :. t;SL ONLY
Name: ,11„0 1 g - _ EN (o Contact person:-r,... 0 - Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this 0 Visa o MasterCard
work will be complied wi • ethe pecified herein or not. Credit card number / /
_ _ _ _ �._ i _ _ _ __ Expires
Authorized sly • ture ' / _ Date: , Name of cardholder as shown on credit card
(Print name: 1 A / Wal - ; lare ��,�_l.)(. $
Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6 /00/COM)
OCg . 5 �-�$ 3e gr
r OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
I NSPECTION DIVISION Business Line: (503) 639 -4171 MST
1 BUP D 393
Received Date Requested I J g AM PM BUP
, Location // � AL. = to MEC
Contact Person ( / ) �7� ' c�-Co � 9 PLM
Contractor Ph (_ ) SWR
BUILDING Tenant/Owner � ELC
Footing �L-1
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Inspection Notes: 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:
'. 4110 PART FAIL 0 ' °
• BING
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 call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line ` i
ADA Date / 8 o Ins ector i' ' Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL