Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00642
A DEVELOPMENT SERVICES DATE ISSUED: 11/6/03
+` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15822 SW UPPER BOONES FERRYRD BLD.0 PARCEL: 2S112DD -00701
SUBDIVISION: OREGON BUS. PARK II ZONING: I -P
BLOCK: LOT: 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: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 26 BASEMENT: sf AREA SEP. RATED:
STOR: 1 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: TI New walls & storefront. •
Owner: Contractor:
PACIFIC REALTY ASSOCIATES C.A. GREEN
15350 SW SEQUOIA PKWY #300 -WMI 15350 SW SEQUOIA PKWY. #300
PORTLAND, OR 97224 PORTALAND, OR 97224
a
Phone:
Phone: 503 - 624 -7717
Reg #: LIC 156496
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 11/6/03 $320.80 Electrical Permit Required
[TAX] 8% State Surchart 11/6/03 $25.66 Plumbing Permit Required
Framing Insp
[BUPPLN] Pln Rv 11/6/03 $208.52 Insulation Insp
[FLS] FLS Pln Rv 11/6/03 $128.32 • Gyp Board Insp
• .Susp Ceiing Insp
Total
$683.30 Final Inspection
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:G
7
Pemiittee
Signature: ,A /. AY , Ak■r / /�Aa '
/ Call 639 -4175 by 7 p.m. for an inspection the next business day
4 f/zp v c2 /,- 6 - o3 55 I - • - - -
. Building Perm it Applicatio - _ -
I �R ' . Datereceived: Il p o- Permitno.:1� , ' .
City- of Tigard" .� r • � " �� ,
�r Project/appl.no.: Expire date:
City o gard Address: 13125 SW Hall Blvd, Tigard, OR 97223 �
Phone: (503) 639 -4171 Date issued: EMI Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1&2 family: Simple Complex:
_ TYPE OF PERMIT
Cl 1 & 2 family dwelling or accessory 0 Commercial/industrial U Multi - family 0 New construction 0 Demolition
0 Addition/alteration/replacement , Tenant improvement 0 Fire sprinkler/alarm 0 Other. -
JOB SITE INFORMATION • '
Job address: , ./O � %��/�� % igar Bldg. no.: ei,M Suite no.:
Lot: Block: Subdivisio . ' Tax map/tax lot/accoun no.:
Project name: . „ /�Jg -
Description and 1. • us of work on pre r . special conditions: ' ' .%i 0 - r
'/∎ .1 /- -/ .!A. A
OWNER FOR`SP)CIAL INFORMATION, USE CHECKLIST
• Name: PacTrust (Floodplain, septic capacity, solar, etc.)
Mailing address: 15350 SW Sequoia Pkwy. , #300 1' & 2 family dwelling:
City: Port ant . State: OR ZIP: 97224 Valuation of work $
503 Phone:5624 631300 Fax6.24' - 77<TS_ ' No. of bedrooms/baths
0"1 a :. r .rr ' . D. P , i Total number of floors
Phone: Same E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft) •
Name: P a c T r u s t , Covered porch area (sq. ft)
Mailing address:15 3 50 SW Se. u o i a Pkw ., #300 Deck area (sq. ft)
city: Portland State: OR ZIP: 97224 Other structure area (sq. ft)
503 Phone{ 2 4 - 6300 Fax6 2 4- 775 ' E -mail: Commerciallindusstrfallmulti- family:
CONTRACTOR Valuation of work $ ���J_ /� ��
� r; , Existing bldg. area (sq. ft.) ,i. / ✓4
Address: r5 3 0 SW Se. u o i a Pkwy., 11300 New bldg. area (sq. ft)
City: Portland State: OR ZIP: 97224 Number of stories
5031 Phones 2 4- 7 717 Fax: E-mail: Type of construction /Ew 4
CCB no.: ' �p Occupancy group(s): Existing: �� - .'
New: G
City/metro lie. no.:
Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: John R o m i s h provisions of ORS 701 and may be required to be licensed in the
Address 15 3 5 0 S W S e t U 01 a Pkw k W 300
jurisdiction where work is being performed. If the applicant is
City: Portland State: OR ZIP:9 7 2 2 4 exempt from licensing, the following reason applies:
Contact person: Plan no.:
503 Phone: 62' -6300 Faxf24- 775' mail: 'ohnr @tact,ust1t.com
ENGINEER
Name: Contact person: 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 acce credit cards, please call jurisdiction for ranee information.
attached checklist. All provisions of laws and ordinances 'governing this 0 visa 0 MasterCard
work will be compli . wi • wheth• s led he 'n : not. credit card number: / /
/" Expires
Authorized sign. tr?i I / -X //r • e: Name of cardholder as shown on credit card
Print name: i? .47 S0 i 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 (603/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
MST
INSPECTION DIVISION Business Line: (503) 639 -4171
i1 BUP DD• , L�t,
Received Date Requested ( AM PM BUP
Location / C17-7 - Suite £ MEC 7'" DU ZZ
Contact Person . ' 1— Ph ( ) L) ' g&o' / PLM — DU'O
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain �/ � � ELR
Crawl Drain
Slab Inspection Notes: — SIT
Post & Beam
Sr Sh ea Anchrs
th /SSh ear 1 34 ����/
Ext eahlh ,
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
'IMPART FAIL
• - :ING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
•.
PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
! "ASS PART FAIL
• RICAL
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line / 7 ADA Approach/Sidewalk Date / ✓ /Q L / Inspector 7Z Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL