Permit 11,1! CITY OF TIGARD l ' BUILDING PERMIT
PERMIT #:
COMMUNITY DEVELOPMENT DATEISSUED: 11/26 2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09502 SW WASHINGTON SQUARE RD J -3 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: CINGULAR WIRELESS. Add /relocate (9) heads.
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: M 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: $ 2,454.00
Owner: Contractor:
WASHINGTON SQUARE LLC WYATT FIRE PROTECTION INC.
BY THE MACERICH COMPANY 9095 SW BURNHAM
9585 SW WASHINGTON SQUARE RD TIGARD, OR 97223
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 684 - 2928
FAX 503 - 684 -9657
FEES Reg #: LIC 64077
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 1/26/2007 $72.10
[TAX] 8% State Surcha 1/26/2007 $5.77
Total $77.87
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. Y • ay obtain a copy
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: - 74 _ / � Permittee Signature: - �/
Call 503.639.4175 by 7:00 a.m. for an inspection th .t 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.
: Fire Protection System
Building Permit Application FOR OFFICE USE ONLY
ray of Tigard BEGEWEDA bitiamtsrm .ermit No.')( / O I 7
13125 SW Hall Blvd., Tigard, OR 972B., Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 J AN 2 6 2007 jl Date /B : Other Permit:
Inspection Line: 503.639.4175 4 e Date Ready /By: )uris: 0 See Page 2 for
Internet: www.ci.tigard.or.us CITY OF T IGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
n New construction n Deroolitiop Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- and 2- family dwelling commercial /industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
9. JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: U 1 5'1,44 tAdA.$ a ! 5Q. 303 New dwelling area: square feet
City/State/ZIP: • ; 6/4-g_ 0 / D 9"7 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name:Cl44vZA--g_ WI/ L S 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.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
ADD DD f� DESCRIPTION OF WORK
�G WORK work indicated on this application.
A ,/
/k-NO /OIL R61 -0c-�} l G� r — �5 , Valuation: $ !�, `T5j4 •
N ��� /t7" 1r Z- /ms "`-' y � . s 4 -g i i �i - � Existing building area: square feet
/�L New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: l4A /4/, w 77)iU .5Q t NA-L,C Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: tj e5 d Al albIt- All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/ State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone:( ) I Fax::( )
E -mail:
CONTRACTOR
Business name: W tiA.TT F/46 _6 ; � , .Di -� .7j 0 BUILDING PERMIT FEES*
Address: 9 D 95 5 i e./ W kAi `--I --Arm
� Q ^� 9 7 Z-2. Please refer to fee schedule.
City/ State/ZIP: l/
1 Fees due upon application
Phone: (503) 6784 — 29 Z.6 Fax: ( 5O3) 6 84- - 96s-7 4
CCB lie.: & 40 7 7 Amount received -7 , O 7
Date received:
Authorized signature: / " `iC.Q_� This permit application expires if a permit is not obtained
/7 within 180 days after it has been accepted as complete.
Print name: i-va 6Nil AA—M-14-11) Date: O i — U., - 67 * Fee methodology set by Tri- County Building Industry
Service Board.
i:\Building \Permits \FPS - PermitApp.doc 12/03 440-4613T(II /02 /COM/WEB)