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9385 SW GREENBURG ROAD STE 100 i cti w x X m I z 00 O X O A v U a 0 i 9385 SW GREENSURG ROAD #100 CITYOF T I G A R D CERTIFICATE OF OCCUPANCY_ DEVELOPMENT SERVICES PERMIT#: BUP2003-00632 13125 SW Nall tfl*vd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/28/2003 PARCEL: 1 S 126CA-00300 ZONING: C-G JURISDICTION: TIG SITE ADDRESS: 09385 SW GREENBURG RD 100 SUBDIVISION: LES SCHWAB TIRE CENTER BLOCK: LOT: CLASS OF WORK: ALT TYPE OF USE: COM TYPE OF CONSTR: 5N OCCUPANCY GRP: M OCCUPANCY LOAD: 31 TENANT NAME: BILLARDS & MORE REMARKS: Tenant Improvement-this suite shares the building with Les Schwabe Owner: WASHINGTON SQUARE INC P0BOX 21545 SEATTLE, WA 98111 Phone: 541-416-5162 Contractor: LES SCHWAB CONSTRUCTION PO BOX 667 PRiNEVILLE, OR 97754 Phone: 541-416-5162 Reg#: LIC 61280 This Certificate issued 1:151-1 03 grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected lior compliance with the State of Oregon Specialty Codes for the group, occupanc•,r, an 5r under wh h the referenced permit wji� iss71, BUILDING INSPECTOR BUILD OFFICIAL POST IN CONSPICUOUS PLACE CITY OF TIGARDBUILDING PERMIT PERMIT#: BUP2003-00632 DEVELOPMENT SERVICES DATE ISSUED: 10/28/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 1S126C0-00300 SITE ADDRESS: 09385 SW GREENBURG RD 100 SUBDIVISION: LES SCHWAB TIRE CENTER "ZONING: C-G 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: 1\1 TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 31 BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: _ REQD SETBACKS _ _ REQUIRED_ FLOOR LOAD: psf LEFT: v�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. $ 21,600.00 Remarks: TI New bill*ds4sta441efe. Owner: Contractor: WASHINGTON SQUARE INC LES SCHWAB CONSTRUCTION P O BOX 21545 PO BOX 667 SEATTLE,WA 98111 PRINEVILLE, OR 97754 Phone: Phone: 541-416-5162 Reg#: LIC 61280 FEES REQUIRED INSPECTIONS Description Date v Amount Electrical Permit Required Plumbing Permit Required [BUILD1 Permit Fee 10/28/03 $254 50 Framing Insp TAX] 8",,State Surcharl 10/28/03 $20.36 Gyp Board Insp �B11PPLN I Pln Rv 10/28/03 $165.43 Final Inspection AFI SI I-I.S I'In Rv 10/28/03 $101.80 Total $542.09 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 (.:quires 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 obiain a copy of these rules or direct questions to OUNC by calling (503) 246-6699 or 1-800-332-2344. Issued By: Pe nn it tee Signature: Call391/4170 by p.m. for an inspection the next business day r» Building Permit Application ' ' Received Buildm@ C(� Date/B �� e 6 Permtt Nu.: � •-n Jt City of Tigard �E C F I fir/E 1..�' Planning J sprue Other g DatcTly Permit No.: 13125 SW Nall Blvd. Plan Review other Tigard,Oregon 97223 Date/BY:10-21-0.110511PermitNo.: Phone: 503-639-4171 Fox: 5QQT5JA _ Post-Reviv%k land Use Internet: www.ci.tigard.or.usV11 Y UV i IUA I Date/B% I Case No Contact J 's.: 0 See Pope 2 for 24-hour Inspection RequestBOLONGONISIAN Name/Method Supplemental Information TYPE OF WORK REQUIRED DATA: E-New construction I EJ Demolition 1&2 FAMILY DWELLING Addition/alteration/replacement 1 ❑ Other: CATEGORY OF CO TRUCTION Note: Permit Ibes'are based on the total value of the work performed. Indicate I & 2-Family dwelling__ M t'ommercial/Industrial the value(rounded to the nearest dollar)of all equipment,materials,labor, Accessory Building Multi-Family overhead and profit for the work indicated on this application. Master Builder Other: valuation......................................................... JOB SITE INFORMATION and LOCATION No.of bedrooms: No.of ba'1ms:-- Job site address: �j — Total number of floors.................Suite _. .......... Bldg./Lk New dwelling area(sq. ft.).. ........... - --.— Garage/carport area(sq. ft.).............. . Project Name: O111Covered porch area(sq. ft.).................. ....... . ,—_— ross street/Directions to job site: Deck area(sq. ft.)............................................ tw I LL. B04D Other structure area I sq. A.)............................ X945 Dux::, In/Lef, '`5a� REQUIRED DATA: COMMERCIAL-USE CHECKLIST Subdivision: Tax map/parcel #: Note Permit fees*are based on the total value of the work performed. Indicate DESCRIPTION,OF WORK the value(rounded to the nearest dollar i tit all equipment,materials,labor, ILD MiViad overhead and profit for the work mdicuted on this application F0!4 oftExisting building area(sq. ft.).........................New building arca(sq. fl.)............................... —� Number of stones._ _ . ......_.. .... . .... ...... PROPERTY OWNER TENANT Type of construction,......... ....... Name: (' It � c4r II Occupancy group(s). E.isting: New: _ Address: EJ:% --� City/ tate/Zi : 0_px�n4 !971 Phone: �,2, Fax: tG,-G( NOTICE: All contractors and subcontractors are required to be APPLI N CONTA PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the business Name' jurisdiction where work is being performed. if the applicant is exempt Contact Name: LtYA _— from licensing,the following,reason applies: Addresses lwy A �lr `'1.G� ---- - ---— Cit Phone: .224:5"` ltli — �� -� BUILDING PERMIT FEES* E-mail: Please refer to fee schedule. CONTRACTOR — — 1 Business Name: 4� tppe ,,E^_ Fees due upon application._....... .. ...... .... .. ti Address: gyp, eL, ad& Cit /State'ZiN �j7► _ 5 Amount received..... . Phone: Fax_FW_+�&• &�3 Date recetscd: CCB Llc. #: _ —/` -'" -- -- Authorized Notice: Thls permit application expires If a permit Is not obtained wlthin Signatute _ �j CCII Date _ IRO dais aft.r It has been accepted as complete. 'Fee methodology set by Tri-Count) Building Industry Sersice Word. (Please rint nam ) t:\,Dsts`,Permnt Pomis\BldgPermit,\pp,doc 01/03 4 {I 7 I I A Flan Submittal Requirement Matrix Commercial & Multi-Farnily City of Tigard New, Additions or Alterations TYPE OF SUBMITTAL # of Plans (Includes New, Additions or Alterations) Required at Submittal Site Work 4 (must include location of all accessible parking) Plumbing - Site Utilities 2� Building 1* Fire Protection System 3** Mechanical 2 i Plumbing - Building Fixtures 2 Electrical 2 Plan review is dependent u; on 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 & Resale). *f-or over-the-counter commercial tenant improvements, submit 2 sets of plans ""New" fire protection systems require that plans be `.he original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i:lBuilding\Forms\PlanSubMatrix.doc 04/03 CITYOF T I C A R D MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2003-00650 13'125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/12/03 PARCEL: 1 S 126CA-00300 SITE ADDRESS: 09335 SW GREENBURG RD 100 SUBDIVISION: LES SCHWAB TIRE CENTER ZONING: C-G BLOCK. LOT: JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: 1 OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: FUEL TYPES _ 0 3 HP DOMES. INCIN: 3 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 Fie: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + lie: CLO DRYERS: FURN < 100K BTU: AIR HANDL,INC, UNITS _ OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Extend ducts& grilles Im nm ICn-1111. ;iJtl i I 1 11, li c111 11-111. III-oject akw Owner: FEES SFP-B LIMITED PARTNERSHIP Description Date Amount PO BOX 667 frail c ll� I'riniit I rc 11/12/03 $249.05 PRINEVILLE, OR 97754 I"l i\\J `i"o titch:tiurch-1rt 11/12103 $19.92 Total $268.97 Phone: Contractor: RONALD E. WHI FAKER 13400 SW 17TH STREET BEAVERTON, OR 97008 REQUIRED INSPECTIONS Phone: Mechanical Insp Duct Inspection Reg#: LIC 131187 Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTIONS Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 15sued By: Permittee Signature: _ i Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day Mechanical Permit Application EOR OFFICIF USE ONLY Keceivcd r Mechanical Datei B / �� d- _ Permit No.: --QK(DSS� City of Tigard Planning Approval Building Date/By Permit No.: 13125 SW Hall Blvd. Plan Review I Other Tigard,Oregon 97223 DatciB : Permit No.: Phone: 503-6394171 Fax: 503-598-1960 Post-Review Land Use Internet: www.ci.tigard.or.us Date/By: Case No.: 24-hour Inspection Request: 503-639-4175 Contact 1 0 See Page.1 for NamdNlethod 11Supplemental Information. TYPE OF WORK COMMERCIAL FEE'SCHEDULE-USE CHECKLIST New construction I El Demolition Mechanical permit fees*are based on the total value of the work ❑ Addition/alteration/re lacement I LJ Other: performed. Indicate the value(rounded to the nearest dollar)of all CATEGORY OF CONSTRUCT ION mechanical materials,equipment,labor,overhead and profit. El-& 2-Family dwelling 11 Commercial/Industrial Value: S - dA See Page 2 for Fee Schedule Accessory Buildin _ Multi-Famil RESIDENTIAL E UIPMENTISYSTEMS FEE-SCHEDULE Master Builder (:)then. Description Qty Fee ea. Total Henle cooltn JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning"H 14.00 it Job site address: G� 7 i ✓ ,t/ v'/. :/V 7_li� as heat um 14.00 Suite#: ? T$ldg./Apt.#: Duct work 14.00 Project Name: L.�y -Sclw b �'>i titif t , T;>,,•;,�t _ . t! dronic hot waters stem 14.00 Cross street/Directions to job site: I K rd c Residential boiler for rad;ator or h dronic system) 14.00 Unit heaters(fuel,not electric) in wall,in-duct,suspended,etc.) 14,00 Flue/vent for any of above) 10.00 Subdivision: Lot #: Repair units t 12.15 - — Other Fuel A tl4nca Tax ma / arcel #: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 C n 6 C r G✓.Ae Flue vent(water heater as fireplace) 10.00 T✓ /�t�- Log lighter as 10.00 Wood/Pellet stove 10.00 Wood fire lace/insert 10.00 Chimney/lineriflueivent 10.00 PROPERTY OWN R TENANT Other: 10.00 Name: iu ty ' _�� Environmental Exhaust&Ventilation Address: Ave J Range hood/other kitchen equipment 10.00 r�2 Clothes dryer exhaust 10.00 Cit /State/Zt GL� Single duct exhaust Phone: Fax: (bathrooms,toilet compartments. EJ APPLICANT _CONTACT PERSON utility rooms 6 80 Natne: Attic/crawl space fans - 10,00 Address: ---- - — other: +— l0,00 Fuel PIPIntit City/State/Zip: _ _ **($5.40 for first 4,$1.00 each additional Furnace,etc. •• Phone: . Fax: Gas(teat um I •• E-mail Wall/suspended/unitheater •• CONTRACTOR Water heater �• Business Name: 'c&�/'4-L-Q C 6_10 t ere MA Fireplace Address: 13-3/I s w- i9ht t_pL✓ ( Range •• City/State/Zip: >��vazu-rani , 7p� nn �• Clothes der(gas) •• Phone: `a3 Yc41zl Fax: - - Other: - •• CCB Lic. #: 13 Y7 Total Authorized`' -e J 9, Mechanical Permit Fees* Signature: l`r-�t _ itXUIDati: V12,2ti'; Subtotal. $ pMinimum Permit Fee$72.50 S Plan Rcvicw Fee 25 of Permit Fee) S (Please print name) State Surcharge Baa of Permit Fee) S TOTAL.PERMIT FEE c `office: 'This perndt application expires if a permit is not ohtained withlt: 'Fee ntethodoing; set h�Tri-Counh Building Industry Service Board. IAO do%s after It has been accepted as complete. **Site plan required for exterlor Vic units. iDsts',Pemtit I:urnu MccPcmntApp dtx 01 03 CITY OF T I GA R D ----- PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2003-00570 13125 SW Hall Blvd., Tigard, OR 9722:1 (503) 639-4171 DATE ISSUED: 11/4/03 SITE ADDRESS: 09385 SW GREENBURG RD 100 PARCEL: 1S126CA-00300 SUBDIVISION: LES SCHWAB TIRE CENTER ZONING: C v BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing tenant improvement, adding (1)sink, (1) lav, (2)water closets and (1)water heater. FEES Owner: -- Description Date Amount SFP-B LIMITED PARTNERSHIP --' PO BOX 667 II'Ll'Mli1 I'crniil Fee 10131/03 $83.00 PRINEVILLE, OR 97754 I t'',XI !i 1tutc tiurchart 10/31/03 $6.64 Total $89.64 Phone Contractor: LITCH PLUMBING INC PO BOX 2756 OREGON CITY, OR 97045 REQUIRED INSPECTIONS Phone : 503-657-9000 Rough-in Insp Final Inspection Reg #: I IC 15008 III \1 3-49811111 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 rules adopted by the Oregon Issued By:, Permittee Signature Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Oct 31 03 11 : 05a Litch F' IurrhinC, Inc: . 15031 657-2971 Q. Plumbing Permit Application all Date received: %/ Permit no.: City of Tigard sewer _ Address: 13125 SW Hall " .1,Tigard,OR 97223 pemut�0^ Uwlding permit no.: ' rvq/Tigard phone: (503) 639-4171 Project/appl.no.: _ Expire date: Fax: (503) 598-1960 Date issued: By: Rxeipt no.: Land use approval:________ Case file no.: Paym,•m type: I &2 family dwelling or accessory �ommereial/industrial U Multifamily U Tenant improvement U New construction )X\ddition/alteration/rcplacement U Food service C-1 ether: MUM rm! Jobaddress: $ S ly GireLov,Le 0 �.�. _ Desctiption Qh. Fee(ea.) Tolal Old& no.: Suite noir p�0 New 1•and 2-fandiv dwellinRc only:— � - Tax trap/tax lot/account no.: (includes 1011 ft.for each Willy connection) ----- SFR (])bath Lot Block: Subdivision: SFR(2)bath Project tame: _ 173 r l I dd-e-did .4 yyka U'e_ SrR(3)bath City/county I &JA-&& ZIP: al 7a z 3 Vach additional bath/kitchen - -` Description and cation of work on p miser: Siteutliities: /few t +e✓ a - k s !.� Catch basin/area drain Est.date of'complction/inspection: Drywel s/lcach line/trench drain Fonting irrain Manufactured home utilities Business name: L if -I,` p 1 uhn loi p. Attie Manholes Address: p - 2 Rain drain connector city: v P7p ySanitary sewer noin. ft.) P11one:Sb3.&S - *n6 F iia)-GS7-iM7 E-mail:np �b;t-pt torm Sewer(no.lin.ft.) \\' CCB no.- 15fi-7 ID Plumb. bus.icg.no: 3- PB CSM Water service(no.lin,ft.) t^ City/metrolic.no.: 2 75q :,I ,�; Fixture or item: Contractor's representative signature yrs Absorption valve I'nnl Warne. a L. L,'t�<t hate: /o ,t/o r3 Dact ow rcventer Ila,'-Voter V Vl' 13aJ1. '/lavatory Name. P��f �� Clothes washer Address: _ ,� --- �- - Dishwasher Cit Y: State: ZIPDrinkingfountain(s) : G'ector:s/sum Phone: _ 7 Fax: E-mail: _ Expansion tank Fixt ire/sewer cap Namc(print) `:Lt �rt� t �K1i c 'i//�/ oor drains! oor sins u - Mailinl;address: / ,' ;� G. t3ar age i oral Host bi State:f A ZIP: Icc.nakcr I'honc Fax: E•rnail: Interceptor/grease trope Owner instal lot ion/residcntial maintenance only: The actual installation Primcr(s) will be made by me or the maintenance and repair made by my regular Roofdrain(commercia�- employee on the property I own as per URS Chapter 447. Sink(s),basin(s),lays(s) f 3'3.20 Ownces si ature: Datc: Sum Tu s/shower/s ower pan Nance: urinal Address: Water closet Water heater Cit _ Y� _ State: ZIP: __ other: Phone: Fax Email: Total5 2 P.» Not ell turf.-A xcept credit cads,pkue cell pmtidictlnn for nwrc mrmmwtwa M1n1111Um fee................ _ Vutxx ❑Mastc Notice: This permit applica'.xl c expires if a petmit is not ob ained Plan review(at Credit�.rt numhet: within 180 days nftcr it has been State surcharge(8%).... S _ 6•G y� 1�Ier�� L. f_. Rpn" u N me ofa�ntholderee .h ttno dltcent p TOTAL.......... ••••••••••••• $acx accepted as rnmplete. 4� fW Mtnunt -- 440,4616(60arC0M1 ^ V !'Y OF TIGARD —� ELECTRICAL PERMIT / \ ! PERMIT#: ELC2003-00667 DEVELOPMENT SERVICES DATE ISSUED: 11/4/03 13125 SW Hall Blvd., Tiaard. OR 97223 (503) 6394171 PARCEL: 1S126CA-00300 SITE ADDRESS: 09385 SW GREENBURG RD 100 ZONING: C-G SUBDIVISION: LES SCHWAB TIRE CENTER BLOCK: LOT : JURISDICTION: TIG Project Description: Electrical tenant Improvement, (21)branch circuits&(1)sign lighting RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 200 amp: PUMP/IRRIGATION EACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG- I LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMI SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10): _ SERVICE/FEEDER BRANCH CIRCUITS _ ADD'L INSPECTIONS 0 200 amp; W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp. 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: '(i IN PLANT: 601 - 1000 arnp: PIAN REVIEW SECTION '1000+ amp/volt: 41 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: _ SVC/FDR>=225 AMPS: CLASS AREAISPEC OCC: Owner: .)r: WAaH;NGTON SQUARE INC LL_j SCHWAB WAREHOUSE CENTER P O BOX 21545 PO BOX 667 SEATTLE,WA 98111 PRINEVILLE,OR 97754 Phone: Phone: 541-416-5219 Reg #: I 01280 I 11 7-18C _ FEES 11 32965 Description Date Amount Required Inspections ([?L.PRM I I Lc Pcrmu 11 4 ui $233.25 Rough-in [-!AXI R",Stutc Surchurvc 11 4 w $18.66 _ Elect'I Final Total $251.91 This Permi!is issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialty Codes and all other applicable laws. 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 e-days,ATTENTION: Oregon law requires you to follow rules adopted by the Oreoon Utility Notification Center. Those rules are set forth,i AR 952.001-001(i through OAR 952-001-0100. You may obtain copies of these rules or direct ncesdons to OUNC at(503)246-6699 or 1-8 -332-2344. Iss d By: /v - Permit Signature: _ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, of rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: 1 ��- -� __^ DATE: _ LICENSE NO: --- Call 639-4175 by 7:00pm for an inspection the next business day 11iO3, 001" 13:17 FAX 541 416 5133 LS CONSTRUCTION fjowi :11/03/2003 12:36 FAX 5035981960 CITY OF TIGARII li7 (102 Electrical Permit ti'M vs FOR-OFFICL LISEON' LY. xrc:r.lve,j Electrical �/" PermitNo.; Ll"Ca00.4 &I()4ye7 City of Tigard PlaaningApproval ---- Sip 13125 SW Hall Blvd.! Plan Review — Yetmit N` .: — ` Tiga*d,Oregon 9 223 Datr/Fi PetrmitNo.:k � 0(J&-15,� Phone; 503-639-4171 Fax; -59B-19G0 Pott-Review Land Use Inter met: www,ei.tigard.or.us I)are/Bv: ca5c No.. 24-hour Inspection Request: 503.639-4175 r - Contact see rage z for Natne/Method:a 011! - / Supp?emeutallnforroatlon. -- _I ]New construe _ 5erviee over 225 am s- � �1�� ll)Il�_ pC111011t1OI1 p l,]Itealrh care'Caciltt• Addivn /alteration/re IaCCH1ClIL Uiher; — commercial p Haranlcus lacatian -+ ^* -- Q Serv(ce aver 320 en>ri-rating of Q Building o�er 10,000 squat a;'rot, 1 � � I &2 faullly dwellir,Rs tour Or more tr,sidrnrial units in ❑ 1 &2-FtlaW TYC11Mri ComaerciaHndusti ial ❑dYRem over 600 volts nominal Otic 6rru�ttrte building over three stariea Accessory Builditi [- Multi-Family O Feeders,400"rips or mare �8------�.--_� ---y----�.._ Oreupent load over 99 peraotre ❑Manufaotured structures or RV park I 1 M1lster Bulkier Other: Egmss/lightingplan ❑ntber. Submit seta of pinm with any of the above. I'lle.above,aro nor o plicable to tern orsr rontitruchon service. Jab site address: -- ,lig. a Suite#: O O Bldg./A t.#: _f _ �: - ; - Q _" _ Number of las ectlons�er wrmit allurved ftIo ect Name: yl�In'r" Descrl den Pea(an.) Total Crass street/Duectiotls to job site: NeW rts►deutial-iiogle or multi-om y per dwaltiog unit.include°attached garage. Service loeludcd: 1000 9�it o 145.15 14 Each additional 500 a .ft ar ovrtlon thereof 33-40 Subdivision: Lot#: Limited energy,ro+ oriel 75,00 1111,, -- Limited Doer non residendal 75.00 Tax 1118 / ircel 11. h mtmufactttred ltomr or modular dvre g ervi eand/or feedrs 90.90 2 ` Services or fender-iottsiletfou, ✓IG�tr of •-a l/ !,A f - �1 '►r alteration or rclacatioa: 200 amps at In% 80.30 2 201 ar kpl to 400 tun - ,Qtt•,�i' GC-A r �/� ,n 401 wags to 600 ampa� 1ti0.60 2 Wjls+s 11 11,. - r 1L 5111 amPe to 1000ae�+pZ 240.60 2 Natut; y / �,� - Over 1000 or vol _4.54.65 2 Lv 1 '!11'x•_ Recututecton dG.BS Address: rJ , �/ Temporary serviem or feeders-installation, Lit /State/Zi . _/. , t^i/r/A, ��► e ' �it alteration,or relocation: 200 ams or less 66.85 1 Phone: � ' : ,ri,�±JJ F aX; 1 1// ./-- 2 to 0 amna � 100.30 2 401 to 600 alnps 133.7 a - 1 "� 1 d a - Branch circuits-sew,alteration,or Name extension per panel: Address: A Pea for Manch circuits with purchase of -- service or feeder fbe cub!ranch cfrtuit 6.65 2 City/State/Zip: 9 Fee for b--iu-na circuits without purchase of _--—- gervice or heder fee,Cast brunch eireoft 46,85 44 ,Ir2 Each additional heanch circuit 51155 0 E-mai I Mises(Service or Calder nut included): or irrit;abou circle i c Alt ar. +nIP^ L ar. --"Rion 0r alteration, _ 53.40 2 -' Each ei outJlnu II ti / S s0 Sa o 2 JUb No. _ _ Signal circuit(s)or a limited ceer y panel, - � / 1 F°ti��'`/ Business Name: Leir P.e 2 z Address: Deeeripdan city/state/zip: �,+. Each additional Ins ecdon over the allowable l0 an of the above: ° r' r 11(. f,�� I'.5 Per his ectinTn par Auto fmtn• 1 hour) 42.50 Ir11011C: -'f/•' 4o ;W1 )'ax: /�+j,Si� ve4gaatlonhe�_ - "" CCB Lia #: /g2�d u Lic. #: 7a&' °ib`" --- — - Supervising electrician t //ff /a Subtotal S s.a, 11 si lature±re uire d: �� Gsr1t BIZ Plan Review(25%of Pe Print Names: .( Q,}/a_s_ State Surchar a 8%o_f Pern it Fee $ TOTAI.:P)ERMU FEE S ZS). Authorized y Notice: This psrrntt application expires If a permit is not obtains l witbill Signature; y 9z"Gt+t!4_ Data: /�� • 180 days after It his beta accepted as complete. *Fee methodology set by Tri-Conary Btdldion Industry 9PrAte Board, (please print name) i:MgtslPerndt Fonnsll`•ItPermitApp.doc 01/03 CITY OF TIGARD SEWER CONNECTION PERMIT DBIEL )P'MENT SERVICES PERMIT #: SWR2003-00383 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/4/03 SITE ADDRESS; 09385 S`N GREENBURG RD 100 PARCEL: 1S126CA-00300 SUBDIVISION: LFS SC lI`;.'AB TIRE C'FNTFR ZONING: k -t; BLOCK: LOT: _ JURISDICTION: FRI T".r4ANT NAME: BILLIARDS & MORE USA NO: FIXTURE UNITS- 17 CLASS OF WORK: ADD DWELLING UNITS: TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: 1.1 EDU i ±crease. Previous fixture values were 38.4, this permit adds 17 values for a new total of 55.4fixture values or 3.5 EDU's Owner: -- SFP-B LIMITED PARTNERSHIP FEES — --_ PO BOX 667 Description Date Amount PRINEVILLE, OR 97754 W't'SA urC'onncct 11/4/03 I��SI•�S $2,640.00 [SWI ISAI Swr Connect 11/4/03 $0.00 Phone: To'al $2,640.00 Contractor: Phone: Reg#: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount paid will be forfeited if ttie permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm Issued by: ,�; �``-•�,Lr ._arc � Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day ACCl1nlulative Sewer Tally Tenant Name: Billiards& More _ This SWRt2003-00393 _ Site Address: 9385 SW Greenburg Suite 100 This PLM# 2003-00570 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off .alue added added total total _ count off#s count # value #s values Baptisery/Font 4 0 0 _ 0 _ 0 0 Bath - Tub/Shower 4 0_ 0 0 0 0 -Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash- Each Stal; 6 1 0 _ 0 0 0 0 _ - Drive through 16 0 0 0 0 0 Cuspidor/Water Aspirator 1 _0 0 _ 0 0 0 Dishwasher- Commercial 4 0 0 v' 0 0 0 - Domestic 2 0 0 0 0 0 Drinking Fountain 1 _ 0 0 _ 0 0 0 Eye Wash 1^ 0 0 0 0 0 Floor Drain/Sink-2 inch 2 0 e 0 A 0 0 0 3 inch 5 0 0 _ 0 0 0 _ 4 inch 6 0 0 0 _ 0 0 Car Wash Drr 6 0 0 0 0 0 Garbage Disposal Domestic(to 3/4 HP) 16 0 0 _ 0 0 0 _ Commercial (to 5 HP) 32 0 0 0 0 0 Industrial (over 5 HP) 48 1 0 0 _ _ 0 J 1 _ 0 Ice Machine/Refrigerator Drain 1 0 0 _ 0 0 0 Oil Sep (Gas Station) 6 0 0 0 0 0 _ Rec. Vehicle Dump station 16 0 0 0 0 0 Shower-Gang (per head) 1 0 0 0 _ 0 0 _ -Stall V 2 0 0 0 _ 0 0 Sink- Ba./Lavatory _ 2 0 0 1 2 1 2 Bradley 5 0 0 _ _ 0 0 Commercial 3 0 0 1 3 1 3 Service 3 0 _ 0 _ 0 0 _ 0 _ Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 _0 _Water Closet-Toilet 6 0 0 2 12 _ 2 12 Urinal 6 _0 0 0 0 0 Previous EDU Count 2.4 38.4 38.4 Capped FDU Credit 0 TOTALS 0 38.4 0 0 1 4 1 17 4 55.4 Current Fixture Value 55.4_ divided by 16 = 3.5 Current EDU 1 EDU - Q Previous Fixture Value 38.4 divided by 16 = 2.4 Previous EDU Change 17 divided by 16 = 1.1 over (under) $ 2,640.00 Enter EDU Change Here 1.i HISTnRY Nods_ PLM# _ _ _ EDU# SWR# _ 10/31103,2.4 EDU's per Ali PLM# _ EDU# SWR# # EDU# SWR# Nam, Date: �C 911,1_5 nature of p son that l6,teds tally sheet and date perfro ed is required CITY OF TIGARD 24-Hour B"11LDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BLIP Received 3 ') I(Ov" Date Pgqueste _. �� 2 �q►M __- PM _ -- BUP Location SuiteMEC Contact Person Llix PLM Contractor_ -_-- --- — Ph(—) MR _---_-- BUILDING Ten.ant/Owner _ _ _ -_ ELC> _00 6 r-ooting -ELC Foundation Access- Ftg Drain ELr, ----- Crawl Drain Slnb 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. - - Final _ PASS PART FAIL 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 5ampers Final PA" ART FAIL - - - -- - -- --- -- - - ELE IC L Service — -- -- Rough-In UG/Slab Low Voltage - ,Fu Reinspection fee of$ regljlred before next inspection. Pay at City Hell, 13125 SW Hall Blvd. PART FAIL SITE - Fiaase call for reinsp tion RE:— - Unable to Inspect-no access Fire Supply LineADA o Approach/Sidewalk Date' /� -��- Inspecto �^ —_- Other: . Final DO NOT REMOVE this Inspection record fr6m the Job 'site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP _ Received __ .!— Date Regi, sted 0 3 AM PM_ `— BUF Location _ 3 Suite MEC — Contact Person Ph( q7 Z ) Contractor _ __—_ ___ ___._ _— Ph SWR ) SWR —_ BUILDING Tenant/Owner _ �1dy�______ _ ELC Footing Foundation ELC Fig Drain Access: ELR _— Crawl Drain Slab Inspection Notes: SIT Post& Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear raming ---- Insulation Drywall Nailing - - - - - - -----.. -- - - ---- - - ---- .. Firewall l=ire Sp,:nkler --- -- - ---- ----- - �.__ - Fire Alarm Susp'd Ceiling -- -- ----- - - ----- ----- - --- _-- Roof Other: , f PA 7 r••�c-- —� -- -------------�— SS PANT FAIL PLUMBING Post&Beam Under ---- --- - Under Slab -- —- -- Hough-In Water Service -----. - ---- ---- - -__------- - — Sanitary Sewer lain Drains ---_ _ -------- -------------- -- -- Catch Basin/Manhole Storm Drain - - - - - ------- -- `- Shower Pan Other: - - - - -- - - ------- - t \ PART FAIL ---_-- ---- _•CHANIC_AL Post&Beam - - Hough-In - -- Gas Line Smoke Dampers - -__ -- - --- ---- - - Final 0ASS PART FAIL - - --- ELECTRICAL Service -- Rough-In UG/Slab Low Vcitage Fire Alarm Fin3l Reinspection fee of$ required before nex!inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL_ L SITE — ] Please call for reinspection RE: __ - __ _--___-- _- - _ Unable to inspect c;no access Fire Supply Line _ / y ADA East ;,nproach/Sidewalk Data Inspector ' _ tither: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY QF TIGARD i-H tion Line: (503)639-4175 our BUILDING P MST INSPECTION DIVISION Business Line: (503)639-4171 BUP Received ��'-�t &*nwa- Date Requested �23, ANA_ _ PM____.__—__ BLIP Location - U 3 _ _� - Suite— ___ MEC DD(G 5D , Contact Person ..—_ -�-Ph( PI.M Contractor __ _,- -----._--- -- ----- Ph(--) - -- SWR BUILDING Tenant/Owner _. --. ELC - -- -- Footing ELC Foundation Access: Ftg Grain ELR -- Crawl Drain — Slab Inspection Notes: SIT Post&Beam Shear Anchors Ext Sheath/Shear -- - — Int Sheath/Shear Framing - -- Insulation �� / Z ,7 --- Drywall Nailing - ---� Firewall Fire Sprinkler Fire Alarm SusF'd Ceiling Roof Other: - Final PASS PART FAIL PLUMBING — Post& Beam Under Slab -- Rough-In Water Service -- - - - - Sanitary Sewer Rain Drains — -- ( --- - --- _ - - - Catch Basin/Manhole ` Storm Drain — - -- Shower Pan Other: --- — — - -- - - i-inal _ PASS PART FAIL Rough-In — Gas Line — — - y� e pampers 1 "P<► PART FAIL -RI CAL 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 rein;pection PE: [� Unable to inspect-no access Fire Supply Line ADA LL.-�� Inspector N Ext _ Approach/Sidewalk Damao- Other Final — DO NOT REMOVE this inspection record from the Job site. PASS PART %[L CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 (BUS Received Re uested t2/ M--- PM— BUIP Location Suite MEC 2 PLM Contact Person Ph(, c50�e Contractor---__---- -- ___.___ Ph(_) SWR BUILDING Tenant/Owner C EL Footing -7 ELC Foundation Access:, 7 1�e6 Ftg Drain ELF! Crawl Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - ----- Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Coiling Roof F' SS ART FAIL qpu�NWIG 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 F-1 Reinspection me of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: E] unable to inspect-'no accoss Fire Supply Line -5—_ o3 Ext Approach/Sidewalk r7f/� � ADA Date 2 Inspector Other. Final Do NOT REMOVE this Inspection record from. the job site. PASS PART FAIL