9473 SW WASHINGTON SQUARE ROAD ADDRESS:
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- CITY OF TIGARD
-fi
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223(503)(39.4171
CE.FST I F 1 CA"CE:. OF
OCCUPANCY
PERMIT #. . . . . . . :
PATE t GUECI: 11/10/98
PARCE:I_ : ° Slr6 CO-01 107
ITE ADDRE•SS. . . :09473 1,3W WASI•IiNGTON SQUARE. RD
UBDIVISION. . . . a Zi_'NINC .C;.-a
'•L..00 V%. . . . . . . . . . . LOT. . . . . . . . . . . . . a JURISDICTION: TIG
LA a> OF WORK. :AL.T
F YPE OF' USF.. . . :COM
CYPF OF CONISTR:5N
)CC UIPANCY GRP. :0
►CCUPANCY LOAD: 4
E:NANT NOME. , :L I NNABON & Z UKA JUICE
:emark,4e tenant improvement : cr-eate new space by adding partition w,111 between
innabon and Zt.akA .Juice.
WASHINGTON SQUARE INC
'O BOX 2194;
ZATTI_E WA 91111
'.,hone #:
4ESTE'RN CONSTRUCTION yERVICE S
16 1 Z' NE: M I NNEHAHA ST
-0 BOX 5768
ANCC?l1VE:R WA 98668
: ,hone #C 360-609-5317
000637
This Ger,tificate gr-ants occupancy of the Above r~efereirc�eci building or- portion
; her-eof and confirms that the building has been inspected for compliance with
ne Gtate of Or-,qon Specialty Godes frr• the group, occupgnr_.yl and use under
shi+:h the refer-enced permit was i s}i.ted. i
'L)IL DING INSPECTOR BUILESI146 Cif=F IGIAl_.
'OST IN COW33P I CUOUS PLACE
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24,-Hour Inspection Line-. 639-4175 Business Line: 639-4171 ---"% (-?g,
��) _
Date Requested G AM_ PMIX gLC
Location qq73 3W ( )Q_, &f _ Suite
Contact Person Ph PLM _
Contractor L65 Ph 3&Q, " 7qAiq SWR _
BUILD� Tenant/Owner _ (d, �-a_ "C�:�, ELC _
Retaining Wall ELR _
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection !Votes: - —
Slab SIT
Post& Beam n�PC,55
C /J 07 /V�CEA-1
Ext Sheath/Shear /"i JJ /v
Int Sheath/Shear -
Framing
Insulation 2
Drywall Nailing _ �' / >
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling —
Roof
isc: - --
PASS PART FAIL -
PUMBING
Post& Beam -_�-
Under Slab
TopOut _---- - --- ---- -----------_--_.
Water Service
Sanitary Sewer -_.---- - -��-.r-
Rain Drains
Final
PASS- PAIRT FAIL
CHANICAL
Post& Beam - - - ._.._..- --- -- ----- -
Rough In
Gas Line
oke Dampers
PASS PART FAIL
ELECTRICAL - _- - -_ -_-------- - -- ---- ---
Serviup
Rough In
UG!Slab
c Low Voltage
Fire Alarm
Final
PASS PART FAIL
J SITE
Backfill/Grading -� -- -- - -'
Sanitary Sewer
Storm Drain [ ] Reinspection fee of$ required before next inspection. Pty at City Hall, 13125 SW Hall 81vd
Catch Basin [ ] Please cart for reinspection RE: A� [ ]Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other -
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
w __
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4176 Business Line: 639-4171 --
BLIP
—Date Requested�� -1a� -ZE AM PM BLD —
Location � _� �k/ s �� � Suite MEC
Contact Perso:-i Ph PLM
Contractor ���le�c Ph SWRp--
BUILDING _ Tenant/Owner �� — -4 —
R0aining Wail ELR
Footing kxess:
Foundation FPS
Ftg Drain SGN
Crawl Drair. Inspection Notes: --- --
S:ab _ — — SIT
Post&Beam -`-- '
Ext Sheath/Shear
Int Sheath/Shear —
Framing - ----— -- --- --
Insulation
Drywall Nailing
Firewall ---
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof ?i
Misc:
Final � J
PASS PART FAIL
PLUMBING
Post& Beam ---------
Under
-----Under Slab
Top Out ---- ----- - —
Water Service
Sanitary Sewer
Rain Drains _
Final
PASS PART FAIL
MECHANICAL _
Past& Beam _.-----_..--
— �
Rough In
Gas Line
Smoke Dampers
Final -- --- -- -----------�—�._ _.—
P FAIL
Ser)ice ------_-. ---- -------- -- - —_ ��_�
Rough In
UG/S!ab ___-----_.--------- _�__�— _ ---
L ow Voltage
,riS PART FAIL ---- ----.._.__.------__._- ------ ___--- --
Backfill/Grading —
Sanitary Sewer
Storm Drain ]Reinspection fee ct$— _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin I ]Please call for reinspection RE: [ ]linable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date '
Other 1 �Inspector_ �! Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
-Hour Inspection Line: 639-4175 Busines- Line: 639-4171 --��--
BLIP
'( _Date Requested ( � �O' AM PM _— BLD
--
tocation—`�� 7� C(JQa7u�' 'V e� Su
ite - MEC
Contact Person 13�(� �C- Ph 614a^73 2. PLM � r
Contractor _An LAe &&Pd— Ph _ SWR
BUILDING Te-naftt QWneru- ELC _
Retaining Wall � C-007-WAX ELR
Footing -
Foundation Access: FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN _-_-
Slab - SIT
Post& Beam -
Ext Sheath/Shear -�
Int Sheath/Shear
Framing - — — -
Insulation
Drywall Nailing _ -
Firewall
Fire Sprinkler -- --- --- ----------- --- ---
Fire Alarm
Susp'd Ceiling ----- ---------- - - --- - --
Roof
Misc: -- --- --- --
Final
_P1"---PART FAIL ------- --------- - ----- ---
PLUMBING
Post& Beam
Under Slab
Top Out
Water Service
Sanitary Sewer -- - - --- --- -------------------_.__ __---_.____-__-_—
Ra n-9cains
JF'
ASS ART FAIL
--------- ---
NICAI.
Post& Beam - _ - -- - - -- -
Rough In
Gas Line I -- - - -
Smoke Dampers i
,,. ;=final ____ _, --- - - - ---- --- ------ -------------
PASS PART FAIL
MEM—
EL JTRICAL _.
Service�
Rough In
UG/Slab -_------ ----------,...�__.__� -_-_ _
Low Voltage
i� Fire Alarm --- _—_ ____--- - -^.-- -- - -------.--_---
Final
r PASS PART FAIL -- ---- - --- -- --- - -- - --- ---
J SITE
t Backfill/Grading -------- --- _ ----__� _ --
cJ Sanitary Sewer
LU Storm Drain ( ]Reinspection fee of$. required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( ] Please call for reinspection RE: _„_. Unable to inspect- no access
Fire Supply Line
ADA '
Approach/Sidewalk
Other Date 1 (J ' Inspector Ext
Final V
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
1�
CITY OF TIGARD BUILDING INSPECTION DIV SION MST
24-Hour Inspection Line: 639-4175 Business Line: 539-4171 --
BUP
—W�—�X- Date Requested d AM PM _ BLD
Locationq 73 S(� tea �N� pl Suite _ _Y MEC
Jt, " _
Contact Person L ?t Ph PLM _
Contractor ,/ CC _ _ Ph IJ-1L. 7 SWR —
fBUILDING Tenant/Owner 7�{,-k C
Retaining Wall
Footing ACC
Foundation (1 y FPS
Ftg Drain SGN
Slab Crawl Drain Inspection Notes: / �/ ---SIT
--
Post&Beam —
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation — —
Drywall Nailing —_ �e-
Fireviall �
Fire Sprinkler
Fire ',farm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL ---- - ----- -�- _ _
PLUMBING
Post&Eeam —�- - --- _
Under Slab
Top Out - -------- --- - — -
Water Service
Sanitary Sewer -
Rain Drains
Final - -- ------ - --- --- -
PASS PART FAIL _v—_ -- - _
MECHANICAL
Post& Beam - — - - - - --- —— - --
Rough In
Gas Line -- - - - - - - ---
Smoke Dampers
Final ---__._ _- _-- -- -- -- -- -
-rjA-s s PART-- FAIL
ELECTRICAL — -----___—. _—_ -- -- — —__--
Servicg� - - ---- - ------ ----- -- —
ou h I ��. -►�
L UG/Slab
c Low Voltage
~ Fire Alarm
-
�- PART FAIL
J
BarkfilliGrading --- - -- '- - ----
w Sanitary Sewer
,-j Storm Drain [ ] Reinspection fea of$ required before ner inspertion Pay at City Hali, 13175 SW Hall Blvd
Catch Basin [ ]Please call for reinspection RE: - [ ] Unable to inspect- nc access
Fire Supply Line
ADA
Approach/Sidewalk Date inspector �f7 Ext
Other _ - -
Final
oASS PAPT FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD ELECTRICAL ELL PERMIT
4
DEVELOPMENT SERVICES DATE ISCED: 11/98--0669
05/98
1312.5 SW Hall Blvd.,Tigard,OR 97223(503)639-4111
PARCEL: 15126CO-011.07
SITE ADDRESS. . . :09473 SW WASHINGTON SQUARE RD
SUBDIVISION. . . . : ZONING:C—G
BLOCK. . . . . . . . : LOT. . . . . . . . . . . . . . JURISDICTION: TIG
Project scription: Each sign or outline lighting.
UNIT---- ---TEMP SRVC/FEEDERS---- -----MISCELLANEOUS-----
1000 SF OR LESS. . . . : 0 0 — 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADDIL 5005F. . ., : 0 201 — 400 amp. . . . . . . : 0 SIGNI/OUT LINE 1 T3. . : i
uIMITED ENERGY. . . . . : 0 401 — 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . : 0
MANF. HM/ SVC/:=DR. . : 0 601+amps-1000 volts. : 0 MINOR LOBEL ( 10) . . . : 0
----SERVICE/FEEDFR---- ----BRANCH CIRrUITR----- ---ADDIL INSPECTIONS—-
0 — 200 amp. . . . . . : 0 W/SFRVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
201 — 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 0 PER HOUM . . . . . . . . . . : 0
401 — 600 amp. . . . . . : 0 FA ADDIL BRWCH CIRC: 0 1 N PLANT. . . . . . . . . . . : 0
601 — 1000 amp. . . . . : 0 -----------------PLAN REVIEW SECTION----------------
1000+ amp/volt. . . . . : 0 )=4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR ) = 225 AMPS_ : CLASS AREA/SPEC OCC. :
(1-4119r. FEES ----------------
CINNABON type amount by date rf.cpt
9473 SW WASHINGTON SQUARE PRMT $ 40. 00 GEO 11 /05/98 9E.-310604
TIGARD OR 97223 5PCT $ 2:,. 00 GLC 11/05/98 9f,-310604
Phone #:
Contractor: --------------------------------
MULTI—LIGHT SIGN CO. $ 42. 00 TOTAL.
3255 NE BROADWAY
REQUIRED INSPECTIONS -----
PORTLAND OR 97213 Elect' l Set-vice
Phone #: 281 -3083 Elect' l Final
Reg #. . : 000641
This peroit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes aid all other
applicable laws. All work will be done in accordance with approved plans. This peroit will expire if work is not started within 180
days of issuance, or if work i, suspended for sore than 180 days. ATTENTION. Brigon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those Fs re set forth in BAR 952-0014010 through DAR 952-901-1987., You say cbtain a copy
of th, ,e rules or direct questio -to ON c h g (583)246-1987.
Permittee Signature: Issued By rsx
__--.------_.._--_--_--___.__--_.____OWNER 'INSTALLATION ONLY---------------------------------
The installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER' S SIGNATURF: DATE:
—_.__CONTRACTOR INSTALLATION ONLY-----------------------------
z;- e'--
L& SIGNATURE OF SUPR. ELECIN: DOTE:
LICENSE NO: ........ .
+++++++++++ 1 +++++++4-++41 +++++4+++++++++++4-++4.++++++ ++-4.........4-4-4.++++++++++++++
Call 639-4175 by 7:00 p. m. for an inspection needed the next business day
. ................................................................................
CITY OF TIGARD Electrical Permit Application Plan Check a
13125 SW HALL BL`!n. Recd By
TIGARD OR 97223 Date RecdDate to P.E.
F,tone (503)639-4171, x304 Date to DST T
r Inspection (503) 639-4175 Print or Type permit ft���(/
Fax (503) 684-7297 Incomplete or illegible will not be accepted called
1. Job Address: 4. Complete Feo Schedule Below:
Name of Development__ _ __ Number of Inspections per permit allowed --T
Name(or name of business) Li Service included: Items Cost Sum
Address-91141 ')'5-W.- Ws ,a 4a. Residential-per unit
1000 sq.ft.or loss $110-00 4
City/State/Zip- . _ Each additional 500 sq.ft.or
Commercial El Residential ❑ Limited
thereof $25.00 1
mited Energy � $25.00 _
Each Manuf'd Horne or Modular
2a. Contractor installation unly: Dwelling Service or Feeder _� $68.00 _ _ 2
(Attach copy of all current)[c 4b.Services or Feeders
Electrlral Contractor o sNa V �,�,IInstallation,alteration,or relocation
200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City State Q( Q Zip_ ` _ 401 amps to 600 amps $120.00 2
Phone NO., _ 601 amps to 1000 amps $180.00 2
Job No. I Over 1000 amps or volts $340.00 _ 2
Elec.Cont. Lice. No cjjj.A1 C,Exp.Date -Jffo" Reconnect only $50.00 _ I_
OR State CCB Reg. No.. I0-1Exp.Date 71�C.�_- 4c.Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date _ Installation,aW3tation,or relocation
200 amps or less $50.00 _ 2
Signature of Su r. Elec'n 201 amps to 400 amps $75.00 2
Si
g p (s1 401 amps to 600 amps $100.00 2
el 600 amps to 1000 volts,
License No. I _ _Exp.L rte_ see"b"above.
Phone No. ► _ �. _�__
4d.Branch Circuits
New,alteration or ex,insion per panel
2b. For owner installations: a)The fee for brand I circuits with
purchase of service or
Print Owner's Name _ feeder fee.
Address Each branch circuit $5.00 2
b)The fee for branch circuits
City State,_ Zlp, _ without purchase of
Phone No. _ service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit_ $5.00 2
intended for sale, lease or rent. 4e.Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or Irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s)ora limited anergy
panel,alteration or extension � 40.00 _ p
Mlnol Labels(10) $100.00
n.
Please check appr,priate Item and enter fee In section 5B.
_ 4 or more residential units in me structure 4f.Each additional Itrspection wer
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
> _ _Classified area or structure containing special occupancy Per hour $55.00
F- as described in N.E.C.Chapter 5 In Plant $55.00
J
p *Submit 2 sets of plans with application where any of the above apply. 5• Fees: u/'00
4 Not required for temporary construction services. 5a.Enter total of above fees $ -
C-1 5%Surcharge(.05 X total tees) $
-� NOTICE Subtotal $
5b.Enter 25%of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review it reguir (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ -IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. Trust Account tt_
Total balance Due S
I OSTSTLC96 APP nev 9/96
CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 PERMIT #. . . . . . . . PLM98--0384
DATE 113SLIED:
PARCEL: IS126CO-01. 107
SITE ADDRESS. . . : 094731 SW WASHINGTON SOUORE RD
SUBDIVISION. . . . : ZONING: C—G
PLOCK. . . . . . . . . . .. LOT. . . . . . . . . . . . . JURISDICTION: TIG
-------------------------------------------------- -----------------------------------------
CLASS OF WORK. . :ALT' GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. 0'
TYPE OF LISE. . . . .COM WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . 0
OCCUPANCY GRP. . .21 FLOOR DRAINS. . . . . . : 5 TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FIXTURES-------__--._.— LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . : 0 URINALS. . . . . .. . . . . . : 0 GREASE TRAPS. . . . . . . . 0
LAVATORIES. . . . I OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . 0 SEWER LINE (ft ) . . . : 0
WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0
D I SVIWAS14ERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : Tenant improvement to add pli-imbing f i)(t i-tre s.
Owner,: -------------------------------------------------- FEES ---.___----__—_
WINMAR PACIFIC, INC type arnot.int by date re(,,pt
700 5TH AVE PRMT $ 51 ItO DEB 10/21/98 98-310205
SUITE 2600 !TJPCI $ 2. 70 �.-:.B 1171121198 '38-310205)
SEATTLE WA 98104
ANCTIL PLUMBING INC
16900 SW MERLO i'\D
BEAVERTON OR 97008
Phone #: 503--642-73P3 $ E6. 70 TOTAL
Reg #. . : 000002
REOUIRED INSPECTIONS
T'iis permit is issued subject to the regulations contained as the Rol.igh—in Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Top—ottt Insp
aL,plicable laws. All work will be done in accordance with Final Insper-tion
approved plans. (his permit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
U. than 180 days. ATTERTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR through OAR 952-00014080. You may
obtain copies of these rules or direct questions to IXW by calling
(5@3)
7c'
CI S s�_t d B y Pet-mittee Signati-ty-e -
4 4 +++++•++++++++++++++++++4•+++.++++++++.4-++.+++++-F+++++++++I ++++++++++++++++++.4+
'all 639-4175 by 7:00 p. m. for an inspection needed the next bl-is iness day
++4........4...........4.................... ................. ...................
CITY OF TIGARD
DEVELOPMENT SERVICES SEWER CONNECTION
ANIVU&M 13125 SW Hall Blvd., rigard,OR 97223(503)639-4171 PERMIT
PERMIT #. . . . . . . : SWR98--0289
DATE ISSUED: 10/21/98
PARCEL: 19126CO-011 ,17
SITE ADDRESS. . . :0947", SW WASHINGTON SQUARE RD
SUBDIVISION. . . . - ZONING: C--G
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . JURISDICTION: TIG
-----------------------------------------------------------------------------
TENANT NAME. . . . . : ZUKA JUICE
USA NO. . . . . . . . . . : FIXTURE UNITS. . . : 12
CLASS OF WORK- . . :ALT DWELLING UNITS. . : I
TYPE OF USE. . . . . :COM NO. OF BUILDINGS: 0
INSTALL TYPE. . . . :BUSWR IMPERV SURFACE: 0 Sf
Remark s : Re - PI-1198-0384
Owner-: -------------------------------- ---------------------- FEES
WINMAR PACIFIC, INC type amoi.�nt by date recpt
700 5TH AVE PRMT $ 2300. 00 GEO 10/21/98 98-310182
SUITE 2600
SEAT'T'LE WA 98104
Phone #:
Contractor-: ---------------------------------
OWNER
-----------------------------------------------
Phone #: $ .300. 00 TOTAL
Reg #. . : REQUIRED INSPECTIONS- --------
This Applicant agrees to comply with all the rules and regulations
of the Unified Sewage Agency. The permit expires 180 days from
the date issued. The total amount paid will he forfeited if the
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" Permit and the Agency will install a lateral.
ATTENTION: Oregon law requires you tp rule, adopted by the
Oregon Utility Notification Ca-tir. Those rules are sEk forth in DAR
952-00I-98I8 through DAR 952-008IA080. You may obtain copies of
these rules or direct questions to Oft by plina (503)246-1987.
A: / ��
T ,;,.;1led b Permittee Signature :
............ ............4-++4............+++++....................... ............
Call 639-4175 by 7:00 p. m. for an inspection needed the next bi-isiness day
-4 .................4......4..........................................4-++4........
CITY OF TIGARD Plumbing Permit ApplicationPlan Check#/Q
13125 SW HALL BLVD. Commercial and Residential Rec'd By elt -
'TIGARD, OR 97223 Date Recd /ct
(503) 639-4171 Date to P.E. _
Print or Type /' ' ' Date lc UST1
Incomplete or illegible applications will not be acce ted Permit# P411 -D 8,
pq
Related SWR#=GJ�E'9 Z" /
Name of Development/ProjectFIXTURES (individual) QTY PRICE AMT
Job Li S(� r;A%9 Sink RNA 9.00
Address Street Address Suite Lavatory 9.00
_ Tub or Tub/Shower Comb. 9.00
- Bldg# City/Stale Zip Shower Only 9.00
Name Water Closet 9.00
Dishwasher 9.00
Owner MA'icng Address Suite Garbage Disposal T 9.00
Washing Machine 9.00
City/State Zin Phone
Floor Drain/Floor Sink 2" 9.00
Nanta 77 �7 3" 9.00
4" 9.00
Occupant Mailing Address Suite Water Healer O conversion O like kind 9.00
Gas piping requires a searate mechanical permit. _
City/Slate Zip Phone Laundry Room Tray 9.00
Urinal 9.00 -
Name r- -i- -
� uy Other Fixtures(Specify) 9.00
Contractor Mailing Address 'e 9.00
r� (,.1i, t')1 -- 9.00
Prior to permitty/State Zip Phone Sewer-1 st 100' 3000
issuance,a copy Qfit 6
Sewer-each additional 100' 25.0;
of all licenses are Oregon Con3t.Cont.Board Lic.# Exp. �Qat:
required if 9/ - Water Service-1st 100' 30.00
expired In COT Plumbi-tg I ic.# Exp Date Water Service-ear h additional 200' 25.00
database _ 116 (0 30 Storm&Rain Drain-1s1 100' 30.00
Name Storm i3 Rain Drain-each additional 100' 25.00
Architect Mobile Home Space 25.00
or Mailing Address Suite Commercial Back Flow Prevention device or Anti- 25.00
Pollution Device
Engineer City/State Zip Phone Residential Backflow Prevention Device' 15.00
_ I I (irrigation timing devices require a separate
Describe work to be done: restricted energypermit.)
New)1�- Repair O Replace with like kind. Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00
Residential O Commercial,_ Catch Basin 9.00
Additional description of workInsp.of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
_ e,/hr
Rain Drain,single family dwelling 30.00
Are you capping, moving or replacing any fixtures,
Yes O No 11 G C Grease Traps 9.00
If yes, see back of form to indicate work performed by nUANTITY TOTAL
n fixture. FAILURE TO ACCURATELY REPORT FIXTURE I!ometricorriser diagram isrequired KQuanlityTotal is >9
r WORK COULD RESULT IN INCREASED SEWER FEES. "SUBTOTAL Sy
t I hereby acknowledge that I have read this application,that the information
J given is correct,that I am the owner or authorized agent of the owner,and 5%SURCHARGE 7(7
s that-Plans submitted are in compliance with Oregon State Laws.
J Signature of Ow .o.-'Agent Date "'PLAN REVIEW 25%OF SUBTOTAL
�7
/ Required only It fixture qty total is-9
JZ TOTAL -G
Contact Person Name Pt one r
,(X / / 3 'Minimum permit fee is$25+5%surcharge,except Residential Backflow
cr 7 (DY J Prevention Device,which is$15+5%surcharge
"All New Commercial Buildings require plans with Isometric or riser diagram
ffand P!,111 review
I tlststplwnapp dot 7/2/98
PLEASE COMPLETE:
Fixture Type _ Quantity by Work Performed _
_ New Moved Replaced Removed/Capped
Sink_ _
Lavatory
T ub or Tub/Shower Combination ^�y
Shower Only _
Waiter Closet
Dishwasher _
Garbage Disposal _
Washing Machine
Floor Drain/Floor Sink 2"
Water Heater___ u
Laundry Room Tray
Urinal � -
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I k1sls\+1umaPP dor 7/7198
CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC98-O628
13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 DATE ISSUED: 10/14/98
PARCEL. 1 S 1: 6CO-01 10/
SITE ADDRESS. . . :094'713 SW WASHINGTON SQUARE RI]
SUBDIVISION. . . . ZONING-C--G.
BLOCK. . . . . . . . . . .. LOT. . . . . .. . . . . . . . . JU.2 I SD I CT I ON: T I:G
Project Description : Tenant improvement: of electrical service. Srd13 NO 5Y(- /8
SRV(_'/FEEDERS----- ----.--M I SCELLANEOUS--------
i.000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 1 PUMP/I RRIGA T ION. . . . : 0
EACH ADD' L_ 5OOSF. . . r 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . „ 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL.. . . . . . . : 0
MANF. HM/ SV(-'/FDR. . :: 0 601+-amps---1000 volts. . 0 MINOR LABEL ( 10) . . . : 0
-----SERV I CE/FE F_DE:R------- ---- BRANCH CIRCUITS-- ---ADD' L INSPECTIONS—-
0
NSPECTIONS—-
0 - 200 amp. . . . . . 0 W/SERVICE OR FEEDER: 10 PIER INSPECTION. . . . . : 0
201 - 4.00 amp. . . . . . : 0 I st W/O SRVC OR FDR. : 0 PER HOUR. . . . . . . . . . . : 0
401. - 600 amp. . . _ : 0 EA ADD' L BRNCH CIRC : 0 IN PLAN1-. . . . . . . . . . . . 0
601 - 1000 amp. . _ :. . : kr RFV I FW SECTION------------------
1000+
ECTION--------------__--
1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . . ) 600 VOLT NOMINAL. . :
Reconnect on l k,. . . . . : 0 SVC/FDR ) = LLCM AMPS. . : CLASS AREA/SPEC OCC. :
Owner: --_ __...__._._._._.._..____.__._-_—___— _______.__..__ __._._._.._____-..._.._._._.--.__-.-- FE=ES
WINMAR PACIFIC, INC type amol_int by date recpt
700 5TH AVE PRMT $ 110. 00 Dl_H 10/14/9B 98--309981.
SUITE 26OO SPCT $ 5. 5O Dl-H 10/14/98 98-309981
SEATTLE WA 98104
Phone #:
Contractor: -------------------------------
FRAHI._ER ELECTRIC CO E 115. 50 TOTAL
1. 1.860 SW GREENBURG RD
-------- REQUIRED INSPECTIONS
- --
TTr;(aRD OR 9722n Ceiling Cover Elect' 1 Service
f'F,one #: 639-46i-:,'7 Wall Cover Elect' 1 Final
e g #. . : 000374
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 IN days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules aoi set forth in OAR through OAR 952-e01-1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246-1987.
permittee Signati-ire : /(LC -- _�� Issl_ied By :
-----------------------------OWNER INSTALLATION ONL.Y___-------------- ----------.___._..___..
,r The installation is being made on property I own which is not intended for
liale, lease, or rent.
)]WNE R' S SIGNATURE: N _ DATE:
a
- ------------CONTRACTOR INSTAI_1nTION
f 5NATURF OF SUPR. EL.EC' N: _ d711 'f'L/��} T//ON DATE:
LICENSE NO:
-4 +++++{-++-++f-+++++++t++++++++++++4•++++++++++++++1++++4•++++4-4-++4...........4.......
Call 639-4175 by 7:00 p. m. for an inspection needed the next bi_isiness day
+++++++F+++++++++•4+++++4-+.4•++++++++++++++++++++++++++++++++++++++F++++++++++. +.
J
CITY OF TIGARD RECEIVED Electrical Permit Application Plan Check#_
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 of 1 I "' 199f` Data Recd /b:
6- Date to P.E.
Phone (503)639-4171, x3
Inspection (503) 639-4175���1�e'UiJ11Y 0€VFIOPMENi Print of Type ./� Permn Date toDST
Fax (503) 684-7297 Incomplete or illegible will not be accepted Called _
t. Job Address: 4. Complete Fee Schedule Below:
Name of Development WASI-I I NGTON SQUARE Number of Inspections per permit allowed
Name (or name of business)_ ZU KA JUICE Service Included: Items Cost Sum
Address 9473 SW WASHINGTON SQUARE ROAD' 4a. Residential-per unit
City/State/Zip TIGARD, 0
1000 sq.It.or less $110.00 4
R 9122.3 Each additio�„il 500 sq.ft.or
Commercial !❑ Residential ElLimited
thereof $25.00 1
Llmih3d Energy $25.00
Each Manut'd Horne or Modular
D
2a. Contractor installation only: welling Service or Feeder $68.00
(Attach copy of all current licenses) 4b.Services or Feeders
Electrical Contractor F RA I I L_E R ELECTRIC Installatinn,alteration,or relocation
Address 118TT-SIT GREE14BURG RT75 200 amps or less 3 $60.00 Abu.UU 2
y T GARD - 201 amps to 400 amps i $80.00 _ _ 2
Cit
State O R Zi�2 3 401 amps to 600 amps $120.00 2
Phone No. 5U3 639-4627 601 amps to 1000 amps $180.00 2
Job No._ i p rl/ �j Over 1000 amps or volts $340.00 2
Ele(,,. Cont. Lice. No. 34-13C Exp.Date Reconnect only $50.00 2
OR State CCB Reg. No. 3 741 U Exp.Date 712199_A--- 4c.Temporary Services or Feeders
COT Business Tax or Metro No._1 7 Exp.Date--L2/1 f 91; Installation,alteration,or relocation
200 amps or less $50.00 201 amps to 400 amps $75.00 2
_ 2
Signature of Supr. Elec'n C U' �-� 401 amps to 600 amps _ $100.00 2
34S Over 600 amps to 1000 volts.
License No. 2334S 34S Exp.Date.� see"b"above.
Phone No.
-- �- --�- 4d.Branch Circuits
New,alteration or extension per parcel
2b. For owner installations: a) I lie lee for branch circuits with
purchase of service or
Print Owner's Name feeder fee. $50.00
Address Each branch circuit I Q_ $5.00 2
-- b)The toe for branch circuits
Ciry� State Zlp_ _ without purchase of
Phone No.� _ service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit, $5.00 2
intended for sale, lease or rent. 4e.Miscellaneous
Owner's Signature (Service or feeder not included)
g Each pump or irrigation circle $40.00 _ 2
Each sign or out rine lighting - $40.00 2
3. Plan Review section (if required):* Signal circuit(s)or a limited energy
panel,alteration or extension $40.00 _ 2
Please check appropriate Item and enter fee in section 5B. Minor Labels(10) $100.00
4 or more residential units in one structure 4f.Each additional Inspection over
Service and feeder 225 amps or more the allowable In any of the above
H- System over 600 volts nominal Per inspection $35.00
n M _Classified area or structure containing special occupancy Per hour $55.00
>- as described in N.E.C.Chapter 5 In Plant $55.00 _ _
*Submit 2 sets of plans with application where any of the above apply. 5. i ees:
t Not required for temporary construction services. 5a.Enter total of above fees $ 111- '30
w5%Surcharge(.05 X total fees) $
Uj NOTICE Subtotal $ -
5b.Enter 25%of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required(Sec.3) $
NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Arrount
Total balance Due s
I\DSTS%ELCM;APP Rev Vlfi
CITY OF TIGARD
DEVELOPMENT SERVICES BUILDING PERMIT
13125 SW Hall Blvd., Tigard,OR 97223(503)639-4l"I P,ERMIT #. . . . . . . : BUP98-0433
DATE ISSUEL . 10/06/96
PARCEL: IS126CO-011.07
51 FE ADDRESS. . . : 0947-3 SW WASH ING-1*01\1 SQUARE RD
SUBDIVISION. . . . :
ZONII\IG:C-G
BLOCK. . . . . . . . . . .. LOT. . . . . . . . . . . . . JURISDICTION:TIG
--------------------RENS SUE- FLOOR AREAS------------- EXTERIOR WALL CONS T RUCT I ON-
CLASS OF' WORK. 1pd-T FIRST. . . 0 sf N. S: E- W.
TYPE OF USE. . . :COM SECOND. . . * 0 sf PROTECT OPEN I
TYPE OF CONST. : . . . . 0 sf N: S: E: W:
OCCI..)PANCY GRPI. -.B TOTAL-----------: 0 sf ROOF C019ST: FIRE RET? -
OCCUPANCY LOAD: 0 BASEMENT. : 0 sf AREA SEP. RATED:
STOR. 0 FIT: 0 ft GARAGE. . . 0 sf: OCCU SEP. RATED.
BSMT'? MEZZ?: REOD SETBACKS-------,-- REQUIRED------
FLOOR LOAD- -- 0 r)F-,f LEFT: 0 ft RGHT: o ft FIR SPKL: SMOK DET. . :
DWELLING UNITS: 0 FRNT: 0 ft REAR- 0 ft FIR ALRIYI: HNDICP ACC:
BEDRMS: 12) 0 PRO CORR: PORKING- 0
BATHS: 0 IMP SURFACE:
VALUE. $ : 500
Rpmar,ks : tenant improvement: Add three (3) sprinkler heads between Cinnabon and
Zuka Juice.
Owner: FEES
WINMAR PACIFIC, INC type, aniatint by date )-eept
700 5TH AVE PPM"- $ 25. 00 GEO 1.0/06/98 98-309737
SUITE 2600 5PCT $ 1. 25 CPEO 10/06/98 98-3097,317
SEATTLE WA 98104
Phone #: 206--o'?23-4500
WYATT FIRE PROTECTION 1NC.
9095 SW BURNHAM
TIGARD OR 97233
Ffione #: 684-2928 $ 26. 25 'TOTAL
Ren #. . .- 000640
--REQUIRED ACTIONS or INSPECTIONS--
This permit is issued subject to the regulations enntained in the Spr-in!,, ler RoLigh-
Tigard Municipal Code, State of Ore. Specialty Codes and all other Spr-inf(ler Final
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 the -------------
rules adopted by the Oregon Utility Notification Center. those
rules are set forth in DAR 952-001-0010 through DAR 952-00I01987.
You many obtain a copy of these rules or direct questions to 0 UNC
by calling (503)246-1987.
permittee 9ignati-tre: By :
++++++++++++•+++++++.++++++++++++++++++++++++++++++ ...4-4.........Ogr++++++++++++++
Call 639-4175 by 7:00 p. m. for an inspection needed the next bi.tsiness (Jay
.4-++4-+++4++++++++4..............4..............4-++++-f........+.................1-+++
Fire Protection Permit Application Plan Check# _
CITY O:= TIGARD Commercial or Residential Redd By
13125 SW HALL BLVD. M.s Re4d _
TIGARD, OR 97223 Print or Type Date to P.E.
(503) 639-4171, x. 304 Incomplete or illegible applications will not be accepted Date to DST
Permit#`'U/�
Called
i Job Name of De elopmen�U\G�F H\O
2s.�11 Type of System (Complete A or B as applicable)
_
Address Address A.)Sprinkler Wet
X141 S.vJ, Wp64 Q (3W0. Dry o
Name Standpipes
Ui I N yY\NZ �a�:kt_ --IDJC. _
Owner Mailing Address Hazard Group
70U F;_4A. Aye *7_6o0) Additional
City/State Zip Phone Information Density
Name Design Area
G I N tJA Pm(.)0
Occupant Mailing Address K.Factor
_qA_1 5_ W 14
Citr/tate Zip Phone A.1) Sprinkler Project Valuation $
Contractor Name ',-\\ B.) Fire Alarm
(Sprinkler or W IF� l_� \ oA
Alarm Company) Mailing Address Submittal Shall Include Battery Calculations YES[]
Prior to permit q -W, (y\IXCw-V\
issuance,a City/State Zip Phone Individual Component YES 0
copyCut Sheets
of all licenses 1(�A(LQ 6� (? B.1) Fire Alarm Project Valuation $
are required if State Const.Cont. Board Lic.# Exp.Date
expired in COT
64c) -1 I 7– Project Valuation Subtotal (A i or B) $
database _
Name Permit fee based on valuation _
Ow
Architect Mailing Address (see chart on back) Z-5
5% Surcharge $ Z j
City/State Zip Phone � — I
FLS Plan Review 46%of Permit $
ascribe work A.)New O Addition O Alteration A Repair O TOTAL $ 7/ Zs
to be done Ll7
B) Modification to sprinkler heads only: Plans required: Submit three sets of plans,including a vicinity ma and
1. 1-10 heads=No plans required q P 9 tY P
2. 11+=Plan review required the location of the nearest hydrant.
I hereby acknowledge that I have read this application,that the information given is
Number of sprinkler heads 3 correct.that I am the owner or authonzed ag3nt of the owner,and that plans submi'ted
------� are in compliance with Oregon State laws.
Additional Descript'on of Work:
Signaturef ner/Ag,:_r# Date
A.)In Existing Building New Building
Building Contilict P o� ame Phone Lt
cc ll
Data B•1 Commercial Residential p _
FOR OFFICE USE ONLY:
No. of stories: Pit'# { i�'' MapfTL#- ' 'i" r
r Sq. Ft. r
Notes y
LU I Occupancy Class Type of Const, -iton
c\firesupr.doc
CITY OF TIGARD
BUILVNG PERMIT FEES
TOTAL
STATE BUILDING
VALUATION OF PERMIT F.L.S. TAX PERMIT
PROJECT FEES (40%) (5%,) FEES
1-1500 25.00 10.00 1.25 36.25
1,501-1600 26.50 10.60 1.33 38.43
1,601-1,700 28.00 11.20 1.40 40.60
1,701-1,800 29.50 11.80 1.48 42.78
1,801-1,900 31.00 12.40 1.55 44.95
1,901-2,000 32.50 13.00 1.63 41.13
2,001-3,000 38.50 15.40 1.913 55.83
3,001-4,000 44.50 17.80 2.23 64.53
4,001-5,000 50.50 20.20 2.53 73.23
5,001-6,000 56.50 22.60 2.83 81.93
6,001-7,000 62.50 25.00 3.13 90.63
7,001-8,000 68.50 27.40 3.43 99.33
8,001-9,000 74.50 29.80 3.73 108.03
9,001-10,000 30.50 32.20 4.03 116.73
10,001-11,000 86.50 34.60 4.33 125.43
11,001-12,000 92.50 37.00 4.63 134.13
12,001-13,000 98.50 39.40 4.93 142.83
13,001-14,000 104.50 41.80 5.23 151.53
14,001-15,000 110.50 44.20 5.53 160.23
15,001-16,000 116.50 46.60 5.83 168.93
16,001-17,000 122.50 49.00 6.13 177.63
17,001-18,000 128.50 51.40 6.43 186.33
18,001-19,000 134.50 53.80 6.73 195.73
19,001-20,000 140.50 56.20 7.03 203.73
20,001-21,000 146.50 58.60 7.33 212.43
21,001-22,000 152.50 61.00 7.63 221.13
22,001-23,000 156.50 63.40 7.93 229.83
23,001-2.4,000 164.50 65.80 8.23 238.53
24,001-25,000 170.50 68.20 8.53 247.23
25,001-26,000 175.00 70.00 8.75 253.75
26,001-27,000 179.50 71.80 8.98 260.28
27,001-28,000 184.00 73.60 9.20 266.80
28,001-29,000 188.50 75.40 9.43 273.33
29,001-30,000 193.00 77.20 9.65 279.85
30,001-31,000 197.50 79.00 9.88 286.38
31,001-32,000 202.00 80.80 10.10 292.90
32,001-33,000 206.50 82.60 10.33 299.43
J 33,001-34,000 211.00 84.40 10.55 305.95
34,001-35,000 215.50 86.20 10.78 312.48
35,001-36,000 220.00 88.00 11.00 319.00
36,001-37,000 224.50 89.80 11.23 325.53
37,001-38,000 2.9.0(, 91.60 11.45 332.05
i:\firesupr.doc
CITY OF TIGARD
DEVELOPMENT SERVICES BUILDING PERMIT
Lalum13125 SW Hall Blvd., rgard,OR 97223(503)639-4171 PERMIT #. . . . . . . : BUF'98..-.0 4
HATE ISSUED: 10/01 /98
PARCEL.: 16126C0-01 107
SITE ADDRESS. . . : 09473 SW WASHINGTON SQUARE RD
SUBDIVISION. . . . : ZONING:C -G
BL.00K. . . . . . . . . . . L.OT. . . . . . . . . . . . . . JURISDICTI0N:1'10
REISSUE. FLOOR AREAS-------•-_.-.__._. EXTERIOR WALL CONSTRUCTION—
CL-ASS OF WORK. :Al__r FIRST. . . . : 879 sf N: S: E: W.
TYPE OF USE'. . . :COM SECOND. . . : 0 sf PROTECT OPENINGS?-•---___.___
TYPE OF C0NST. :5N . . . . 0 sf N: S: E: W:
OCCUPANCY GRP. :B TOTAL-------: 879 sf ROOF CONST: FIRE RET? :
OCCUPANCY LOAD: 4 BASEMENT. : 0 sf AREA SEP. RATED:
STOR. : 0 I-IT: 0 ft GARAGE. . . . 0 sf OCCU SEP. RATED:
DSMT" : MEZZ" : REDD SE:TP0CKS----•--__--_._-.- REQU7
FLOOR LOAD. . . . : 0 ps f I.-EFT: 0 ft RGHT: 0 ft F.T.R SF'KI-:Y SMOK DET. . :
DWELT--ING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR AI_RM: HNDICr' ACC:Y
BFDRMS: 0 BATHS: 0 IMP SURFACE: 0 F'RO CORR: PARKING: 0
VALUE. $ : 50000
r?e m a rl-(,s : Tenant improvement: create new space by adding partition wall between
Cinnabon and Zuka Juice.
Owner-: __._..______.____.___.._.________._._-_.... . ...._______._ .._________ FEES
WTNMWR PAm If', INC type amol-rnt by date recpt
700 5TH AVE PRMT $ 283. 00 DL.H 10/01/38 98-309660
SUITE 2600 SPCT $ 14. .15 DLH 1Q/01./98 98-309GE0
SEATTLE WA 98104 PL-CK $ 183.. 95 DLH IQ /01 /98 98--•309660
Phone #: 206-223--4500 FIRE $ 113. 1_0 DL.H 10/01/98 98-309660
Contr'ac'tor': _.____.____..______.__.__._.___.--•--.____._
WESTERN CONSTRUCTION SER''ICES
4612 NE MINNF_HAHA ST
PO BOX 5768
VANCOUVER WA 98668
Phone #: 360-699-5317 $ 594. 30 TOTAL
Reg #. . : 000637
- - REG?LI I RED ACTIONS or, INSPECT I ONS__.__..___.
This permit is 'slued subject to the regulations contained in the Framing Insp
Tigard Municipal Code, State of Orr.. Specialty Codes and all other Gyp Board Iris
applicable laws. All work will be done in accordance with _._-�4 /�5 •
approved plans. This permit will iexpire if work is not started
within lb0 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 Oreqon Utility Notification Center. Those
rules are set forth in OAR 952-101-00le through OAR 95240101987.
You many obtain a copy of these rules or direct questions to RINK
by calling (503)246-1987.
r1 e r m i.t t e e S i g n a t wr e: I s s 1_r e d 13 y : _ ------- -- _.
++++t++++++4-++++++-r+++++++++•F 4++++++4-++++++++++++++4-+4++++++++•F+++++++++++++++
Cal 1. 639--4175 by 7:00 p. m. fog an inspection needr(I the next bt.rsines s day
++++++++++++++++++++++++1-++++++++++++++++++++++4.++++++++++t+++++•++++++++++++t+
10/01"98 Tell 08:29 FAX 503 598 1960 cin 01" �1tU +��-#---_111 002
Dy
ITY OF TIGARD Commercial Building Permit R:�r'd Gy
1125 SIN HALL BLVD. Tenant Improvement //11 Dade to P.E. / 0 9 OTC-
,CARD, OR 97223l/ DatotoDST___
.03) G39-4171 �� Permil t 09 ' :Qv S 2
Print or Type I rtetoled SwR _
Incomplete or illegible applications will not be acce ed caved
- - Name of uovt�oPmonuPrn ci - ---- -�-- - Existing BtHlr ing- 4 NewBulldingLl
Job
I
Address Street Address Building
Data
E-Ix`istang Use ofBu[ding of ProPpelt l
�/�L•V41fr0.✓a7.✓�s/R� T Ali
Proposed Ilse of Building or Property-
Proporty li- S,r•,er etld-
Owner
Halling Addmss - �"� �
No. Of Stories:
S.
01VIStatn Lip Phunc jp r(i
L6 Sq.T.Of Project:
-
Accupant �rne-- Lli /� / Occupancy clans(es)
Contractor �$Sj.C�X/lr CD���ic�clJ�G� rype(s)of ConstrurtionTl��`✓N
3AIr�N ��
Prior to penrYt Melling Address Suite -
imuarim a ropy `` �}y Wail this project have a Fire Suppression Systom? r
or all licenses /^D Gc//� -- YG"3 Q` N_n_ .,
are required if Eork-grivionst
bZip Pnoar jGo A�dcans with Disabilities Act(ADA)
explred In c 0 T. Partici sition
databnsr ' 91Gb�1 3/J Valuation x 25%=$_-_-- p
cont t3osro ur F.xp.Data Complete Accessibility Form
--_ — —
Protect $
-- - — �-
Valuation.-
Architect
aluation Architect Plrns Requited: See Matrix for number of sets to submit
Mailing Addrese - Slade on back
�Glty/5tate %lP Phone ZOIp I heretry eckruvled
ope that I have read Ihls application,that the infartnetion
given is correct,that i em the owror or ith Oregon
agent of the ownoa.and
_ _ that plans submMterl aro in cr w
[lanae with Ore on Slate Laws.
Engineer Name` _—_-..-
Signature of Ownv.rlAgettt I Date
----
Cont-,i Petso►Name Phone
cllyrstele Zip Phalle �,.1 ebt,)AR -'s 9 Zq b
FOR OFFICE USE ONLY
Indican r type of work: New O Addlt'on O nerrmlHen r) Meprf LA /-- -- 1-and Use.
u. ArcessorySlrurture O r -otmdG101Only O Alterwine)( /y/.2
Notes: _��y�� �- ` •
Repair O _Othe, O
hlssorip6n of work:�Jl/7L' '/D•C S L C- --_ __.-----.-
,reL Tv Ere/ �✓�f ,it
J PaNts: F-stimalM t ani EApaloy�s
NOW: Site work permit mn m
it Applicstloust preeWo or accompany SuNdlny
--� Perttnit Appllem"on
1-%COMNEW DOC, (DST) A197
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OVER-THE-COUNTER (OTC) PERMIT
COMMERCIAL ( STRUCTURAL) BUILDING PERMIT CHECKLIST
DESCRIPTION OF PROJECT _/_1 ^��n�rrouc r�lEvV�T -- C� Lr� /.Jgw y� _
o.JTZU�.� —
CLASS OF WORK: _ r� r" FLOOR AREAS: — _— i EXTERIOR WALL CONSTRUCTION
TYPE OF USE: laM FIRST _ SQ. FT. i N: S E. W:
TYPE OF I — I
CONSTR. SECOND SQ. FT. i PROTECT OPENINGS?
O(:CUPANCY GRP: i THIRD SQ. FT. i N: S: E: W:
--- I I
i
OCCUPANCY LOAD: TOTAL SQ. FT. ROOF CONSTR: FIRE RET:
I �
STOR: HT: FT. i BSMNT SQ. FT. AREA SEP. RATED _
BSMNT?: NIEZZ?: i GARAGE: —— SG. FT. i OCCU.SEP RATED
I I
FIRE FIRE SMOKE HANDICAP
SPR NKLER: _ ALARM: DETECTOR: ACCESS: _%`�
---- _•�. l u �e� �.uin��v e�1��G �� �>0�n�CGEL �B�+r �s �c�se�.
COMMERCIAL INSPECTION ACTIONS c7FEE MENU
—
Foot/Found _ Post/Beam $ L r7P3- Permit Fee
Masonry Framing $ IQ�JgSPlanReview
r�5
Insulation Shear Wall $ 1 5% State Surcharge
Firewall _ _ Gyp Board $ 13�_ FLS Plan Review
Suspended Ceilitig Sprinkler Rough-in $ Add'I Permit Fee
n Sprinkler Final Fire Alarm $ Add'I FLS Pln
Smoke Detector -- Approach/Sidewalk $ Inspection
r Miscellaneous — Final $ MIS F
Uj FOR OFFICE USE ONLY:
I'YPE OS USE OPTIONS(COM=comrnercial; CMS-commercial manufactured structure)
CLASS OF WORK OPTIONS FOR ALL PERMITS(NEW-new; Add=addition;ALT=alteration: ACS=accessory:FND-foundation:
OTR=other, DEM=demolition: REP=repair, FPS=tire Protection system, NOTE: USE OTR FOR FENCES, RETAINING
WALLS, DETACI IED DECKS, SIGNS, AWNINGS, CANOPIES)
I\ovrcntr2doc (DST) 4197
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