Permit 1 -
A C'TY O TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00647
���� DEVELOPMENT SERVICES DATE ISSUED: 12/15/2005
- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S12600 -00300
SITE ADDRESS: 09779 SW WASHINGTON SQUARE RD D -11 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: TI - wall
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: 3N : sf N: S: E: W:
OCCUPANCY GRP: M TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 88 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: $ 45,000.00
Owner: Contractor:
WASHINGTON SQUARE LLC JAMES J DERLETH
BY THE MACERICH COMPANY 2547 ST CHARLES WAY
9585 SW WASHINGTON SQUARE RD MEDFORD, OR 97504
TIGARD, OR 97223
Phone: 503 - 639 -8865 Contact #: FAX 541 - 774 -9812
PRI 541- 840 -2680
Reg #: LIC 149693
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 12/15/200f. $433.30
[TAX] 8% State Surcharq 12/15/200f. $34.66
[BUPPLN] Pln Rv 12/15/200: $281.65
[FLS] FLS Pln Rv 12/15/200`, $173.32
Total $922.93
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 da s. ATTENTION: Oregon law
req . - you o : ow the rules adopted by the Oregon Utility Notification Cent-r. Thoules are set forth in OAR
9; - 001 -0010 throu h e ' 952- 001 -0100. You may obtain a copy of these ru -s or di :questions to OUNC by
ailing 503-246-6699 : ' 32 -2344. , ►
Issued By•i it l, % ' Permittee Signature 1 111 Mani RI Pi
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application �� / �/ roll c)fl IcI: USE ONLY of Tigard ���U `� Re�e'ved p �l' =Erg
Date/B . I /y, MISTY
i 1 i
13125 SW Hall Blvd., Tigard, .11Z-PE
23 Plan Review
t ,rt . Other Permi
Phone: 503.639.4171 Fax: 503.598.1960 y o0 4s• :' I ' Date/By.
Inspection Line: 503.639.4175 DEC 1 J _ _ .. - , Date Ready/By 1a' ® See Attached Checklist for
Internet: www.ci.tigard.or.us -IGMID Notified/Method: 6 Supplemental Information
CITY lic. nNIS10N BU'1 OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
I3 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family
Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address. 977 9 k)A . 1 New dwelling area: square feet
City /State/ZIP: ,7 /1 /,4j 7,e 9' z8 `/ Garage /carport area: square feet
Suite/bldg. /apt. no.: —T)- jj Project name: �!`''G ,0/7 /417 ev , Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
c Valuation: S 1/, 000 —
Existing building area: square feet
�( New building area: square feet
�1/PROPERTY OWNER I ❑ TENANT Number of stories: / \
r`
Name: / r& � „7 gO/ / /�/gi1// Ave. Type of construction: AIL) i
Address: 50,/91/1- 6,/ /11/6 ! J- t) r TOO Occupancy groups:
City/State/ZIP: 7 ...<,e, 7 -- 7 Wog. Tr/ / 76/07 Existing: H
Phone: (87/ ? ¢"7 2-7 O Fax: (r /' P77 —5-0 New: H •
❑ APPLICANT "OONTACT PERSON NOTICE
Business name: 6 , Zr� j - / /TS Gds, All contractors and subcontractors are required to be
Contact name: // /`!' -7O/SITefQ/j75j(. licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: �Z 'P "� 6 jurisdiction in which work is being performed. If the
y p applicant is exempt from licensing, the following reasons
City/State/ZIP: O / � TL41 O,O qqZ--/ 7 Q apply:
Phone: ( Z-'2- - Z26 I Fax: ( ) 7-8/ -Z.79'�(
E-mail: /77,,<e--,--,7e- / / /7- • Go/7
CONTRACTOR
Business name: �Q �/ O BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City /State/ZIP: -
Phone: ( ) I Fax: Fees due upon application
( )
CCB lic.: Amount received
Date received:
Authorized signature: 2( This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: I Date: I • Fee methodology set by Tri-County Building Industry
Service Board.
i.\ Building \Pennits\BUP- TI- PenntcApp.doc 12/03 44 0- 4613T(II /02/COM/WEB)
Building Division
/ /Tr,' "'F L 6' I 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.
i \Building\prnnib\BUP- T1- PetmitApp doe 12/03 4104613T(11/02/COM/WEB)
•
CITY � F TI ARD
C OF G ,
BUILDING DIVISION PERMIT #: BUP2005-00S17
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/15/2005
Phone: (503) 639 -4171 A ll h
Inspection Requests (24 Hrs.): (503) 639 -4175 . '_.
INSPECTION WORKSHEET FOR DATE: 2/9/2006 TIME: 7:04AM PAGE: 67
SITE ADDRESS: 09779 SW WASHINGTON ON SQUARE RD D-11 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: THE BOMBAY COMPANY
DESCRIPTION: TI - wall
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 - 639 -0865
CONTRACTOR: JAMES J DERLETH PHONE #: 11- 64p.2680
Inspection Request Scheduled For: Date: 2 /9J2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 026559-01 626-890.7358 N
Corrections /Comments /Instructions:
.---- S _
l \
A.,,____
(-)..
[ ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIO AL F ES ASSESSED sr
C_ �f
Inspector:
i4 r ' Date: ` 66 Phone #: (503) 718- 24:2-3
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: BUP200&00&17
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/15/2005 • -
Phone: (503) 639 -4171 "w'9 �1\
Inspection Requests (24 Hrs.): (503) 639 -4175 � ' R'II�
INSPECTION WORKSHEET FOR DATE: 2/3/2006 TIME: 7 :02AM PAGE: 51
SITE ADDRESS: 09779 SW WASHINGTON SQUARE RD D CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: THE BOMBAY COMPANY
DESCRIPTION: TI - wall
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503
CONTRACTOR: JAMES J DERLETh PHONE #: 541 - 840 - 2680
Inspection Request Scheduled For: Date: 2/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 02623401 541-8402680 N
Corrections /Comments /Instructions:
F ---,, ,. � _ Itia.
� �
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL II CALL FOR INSPECTION ❑ ADDIT ONAL FEES ASSESSED
tolA I
Inspector:
0 .
7447 Date: v 3 lin:7 Phone #: (503) 718 - v Z�