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• A
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT TEMPORARY CER'TIF ICATE
.3125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)639.4171 OF OCCUPANCY
P'E'RMIT #., . . . . . . : MST93-1114`
1 ;35 4171 D')TE T SSUED:
PARCEL.- 2E,11114CA-1 .1600
51 TL ADDRESS. . , 13249 SW 1 3671-1 PL
5UBUIVISION. . . . : HILLSHIRE: Z014ING: R-7
BL.00K. . . . . . . . . . .I LOT. . . . . . . . . . . . . 1116
CLASS OF WORK. :NEW
TYPE OF UC;E. . . :aF
OCCUPANCY GRP. :R.,
OCCUPANCY LCjAD:2.'9 4
TENANT NAME.. . . :
Remar^ks : 7LMPURARY OCCUPANCY FOft1_a� nAYC> rROM DATE GF' ISSUANCE.
Pii'm I
Owner :
MICHAEL. HUMPHRE.Y
12.385 SW 121ST AVE
TIGARD OR 97223
Phone #1:: 590--13737
Contr-,actor.:
1v1 14LJIVIPHREY R05EWOOID DEVE1. OPMCNT CO
12385 SW 121ST AVE
T IGARD OR 97223
P'hoTip #: (444--0737
Reg ##. . : 461,566
Ocr-r_Ipancy of the above referent--,ed bu.i. ldiny i. g hereby given, arid r_erti.fac
the compliance with the State Of Oregon Specialty CQJ0. 15 for the group,
occupaTluy, and use under- which the refpreyived permit waF issued.
G'CA
BUILDING INSPECTOR
l;U1LDING OFFICIAL.
POST IN CONSPICUOUS PLACE
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DUILDING PERMIT
PERMIT #. . . . . . . . SIJ�IIDG--1011.16,3,
CITY OF T IGARD DATE ISSUED: 02/07/96
COMMUNITY DEVELOPMENT DEPARTMENT -
13125 SW Hal;Blvd.Tigard,Oregon 97223*8199 (503)639.4171 PARCEL, .-S
k 1,. ".)W l it V i I PL
SUBDIVISION. . . . F-ILLSHIRE ZONING: R--7 PD
LALOCI. . . . . . . . . . . . LG I.. . . . . . . . . . . . . . I
REY UE: EXTERIOR WALL CONSTRUC'T I Oh'i
r.LASS OF WORK. : REP FIRST. . . . . 0 s f N: 0 E: W:
TYPE OF USE. . . :SF GECOND. . . : 01 s PROTECT OPEN I NGS?
TYPE OF CONST. :5-1HR : 0 5f N: E: W:
ROOF CONSI : FIRE RE T";'
OCCUPANCY UMZ. '. R--" TOTAL---__—: 0 5 1
L)CGUPANCY LOAD: 0 BASEMENT. : 0 5f AREA SEP. RATED:
;TOR. : 0 IAT: 0. fit GARAGE. . . : 0 s f OCCLJ SEP. RATED:
Bsryrr,): MEZZ') : REOD REPUI RED--
FLOOR LOOD. . . . : Z psf LEFT: 0 rt RGHT. 0 ft FIR SPKL: SMOK DET. . .
DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM: HNDICP ACL:
BEDRMS: 0 [,A,r H 1"i. 0 IMP SURFOCE: 0 PRO CORR PARKING:
VALUE. $ . 0
Hemar*,b : REPAIR TO ROOF FROM 12/13/95 C.')T 0 R lyl DAMAGE: 10 ROOF TRUSSES,
REMOVE/REPLACE INGULAT ION, SHEATHING, DRYWALL AT MASTER OEDROOM
Owner: ......- ---- FEES
NICKLES type amount by date recpl.
133,2'49 SW 13c;"n-i PLACE PRMT 0. 00 J*MF1 02/0'7/96 FUND
OR
lw:Tiane #:
.ntrautor:
HORIZON RESTOROTIONS
16176 SW TEND AVENUE
T'IGHRD OR 97224
A)rle #: 502- 6;20-2215 7 0. 00 TOTAL
y #. . : 460q
REQUIRED INSPECTIONS
.s permit is issuto subject to the regulations contained in the f- til-tndatiun Insp
,&rd Municipal Code, State of Ore. Specialty Codes and all other P l m top-uLtt InsL.
Aicable laws, All work will ba done in accoriance with Fr,,AminW ITIS
.roved plans. 'his permit will expire if work is not startso Insi.ilatiori Insp
:ran 160 dans :f issuance, or if work is suspended for more Gyp Doard Insp
180 dais. Rain di-ain Insp
F i n I I T1-.i pect i on
0-
CX t.f-- 04
............
far- inspection 6..9-417`5
AOM d JALtL4,1, (S�V-tA Ox�
L
0.* LBuilding Permit AwAication
,ity of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(5013) 539.4171
Jobsite Address:
Tenant: Suite# Office Use Only
Valuation: Planck/Rec #
`` rr� Fermit#
Owner: hII , l .i_x_ Map & TL. # _
Addiass: `� L�Ciy <<x� �� pprovals Required
---4F
Planning _
C
Phone: _ ,1 �• 7 �� Engineering
j Other ^_
Contractors ? t^
Address: (A 176
r Type of const:
Occupancy class:
Phone: �-�/�: ,.,�,�I ��
I j 1�l Sprinklered? Yes No
Contractor's license # �"
Cgttach copy of current Oregon license) Sq. ft. of projec': _
Contact name & phone: tc�) h "0 t �Z �� ( /�7_J` 7�y�Story (1st, 2nd, etc.) _
r
Proposed use:
Architect/Engineer: g'0r)>
_ /� Previous use:
Address � fl F �_k61 Jt t 161, Ely -- —
Note: Plumbing & mechanical plans
must be submitted at time of
-� building permit application.
Phone:
)OB DESCRIPTION.
i
Applicant Signature & Phone number
•
Received by: Date Received:
Permit ;* Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mecn. Permit (MECN)
State Tax (TAX)
Bldg: _
Plumb:
Mech: �
Plan Check (PLANCK)
Bldg:
Plumb:
h;ech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-P)
Mass Transit TIF (TIF•MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional 1 IF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL)
LL
�- Water Quantity (WQUANT)
Fire Life Safety (FLS)
f-
-� Erosion Cntrl Permit (ERPRMT)
� `d
�L Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS:
CITY OF TIGARD BUILDING INSPFCTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath Framing -Mech.
Plbg.Und/Fir/Slab Plbg. Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: -
Date: �� — A.M. _P.M. Entry:_
Address: / -2) ._-��► --
Tenant:_ Ste: _ MST: T—
BUP: X07
Con/Own: Ce Z.-O MEC:
rj�ip,,L /n �Lr PLM: — --
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
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Insp or: _ Date:
PPF OVED DISAPPROVED/CALL FOR REINSP. CF CO
1 INSPECTION NOTICE
City of Tigard Building Department
13125 SQ Ball Blvd_ Tigard, Oregon 97223
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:- _--- — _ —•- — �—_----_
Footing Pl.bq. Underalab Mech. Rough-in Appr/Sdwlk
Pound. Plbg. Top Out Gas Line •AINACi
Pont/Beam Struct. San. Sewer Framing -- ldg,
Post/Beam Mech. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. Bd.
late Requested:_ , Z 1 '� `� Times AM PM
\Permit ft �C
Builder:_ �� - W � _ wL� "�-�C ✓].
THE FOLLOWING CORRECTIONS APF. REQUIRED:
---------� — — __� ---------- v
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Inspector: —` _ _ Datet / /J
i
--z PPROVIM �- DISAPPROVED �- APPROVED SUR.MOT TO ABOVF
For Reinep.
1 i INSPECTION NOTICE
r
�
City of Tigard Building Departtor_nt
13125 SW Ball Blvd_ Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)t 639-4175 Businean Phone: 639-4171
Inspection:
Footing Plbg. Underslab Mach. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Use Line eV NAL
Poet/Beam Struct. San. Sewer Framing -Bldg. / -
Poet/Beam Mach. Rain Drain Insulation -Plumb.
Plbg. Underfloor Water Line Gyp. ed. wch
Date Requested: /� Timer AN pm
Address t ! _-3a!j 9 7 3 lC' -k^:i�f^ _ Permit M:
Buildert C3
THE FOLLOWING CORRECTIONS ARE REQUIREDt \� �. 1 r 72---
av\ e
LL
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Inspector: �/ �' Datet ` 1 Ij
APPRMD DIs11 "MM APPrOM SUBJICT TO AMM
2` V/
* Cali Por Noinap.
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW yell Blvd.Tigard,Oregon 97223.8199 (503)839-4171
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CITY OF TIGARD CONNEuim
COMMUNITY DEVELOPMEN'T' DEPARTMENT
13125 SW 4all Blvd.Tigard,Oregon 97223.8139 (503)639-4171 . ... . . . .
I L L
TU ,
FREDUIRED TNS`EC"JIUNS
lj� P�Ppllca ill the VAe!i and rejulatIoU SeWOV- ICTI
'Bit C-.PII'Ei IN days frcm
'he e ::^al nzjrt paid will be forfeited ;f the
parantel trs 4,-curacy the
later Is. is not located at the measuresent
,
fm in al, airntio.-,s frog
ne 311 ri:;,, locatf.d, the instalo'er shall P,rchasf
--y S111 I- tell a later'-_i.
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»>uswH,uan�e PLNCK/RECT #CITY OF TIGARD
COMMUNM DEVELOPMENT DEPARTMENT
Ti�cd,Ores«,9rzv PERTIIT #
(503)6'""" DATE ISSUED
S / yfyeq //&oo
JOB ADDRESS: i s.�` J c� l.7 I'C TAX MAP/LOT _
SUB: /-/1 //15l L e LOT, _1 ! LAND USE: ''I�plJJ
VALUATION:
OWNER l SPECIAL NOTE'
NAME: 1h , C- C( � I�h rc REISSUE OF: _
ADDRESS: 1-2.s k' + LAST REISSUE:
FLOOD PLAIN/
PHONE: OJ6 —9 3 7 SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: Rvscwoa 4)eC) �H / -'u. PLANNING: ST ?C�ISTl� --
ADDRESS: 5G14-1S uj Q bum ENGINEERING:
_ FIRE. nEPT:
PHONE: i _ OTHER: _
CONTR. BOARD #: `I G EXP DILTt:
ITEMS RE UQ IRED
SUBCONTRACTORS:. Pl_U49: Fca r GJ es { vli ��ti , _ LIST/SUBCONTRACTORS:
MECH: _ u y L` � _ BUS TAX:
C9 ARCH/ENGINEER CALCULATIONS:
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NAME: �� �_�/r �<�� TRUSS DETAILS: _
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE:COMMENTS:
APPLTCANT SIGNATURE
Received By: __ __ Date Received: _ 9
PERMIT ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
rn5 3_p �G 10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees
.;70,Lo
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5x) 3S.7,Y —7e-
Building
e3uilding o-.i.0
Plumbing Y.SO
Mechanical
I0-433 00 Plans Check Fee
Building
Plumbing
Mechanical
10-230 06 Fire
)w 3.00 30-202 00 Sewer Connection &v ZLvy
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-.,q Ivcvstrial TIF Fees
25-448-06 Institutional TIF Fees
25-1,18-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC)
s 24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
wTOTAL 5"12- �� , 1 L•�fj
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nm/3587P.WP