12090 SW HALL BLVD-1 ,r
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12090 SW HALL BLVD ...,.,
CITY OF TIGARD
BUILDING PERMIT'DEVELOPMENT SERVICES PERMIT #. . . . . . . : BU
F98-Q(451
1317.5 SW Hall Blvd., Tigard,OR 9722:(503)639.4171 DATE ISSUED: 11 '1 /93
PARCEL: 2S 101 PIA-00801
SITE nDDRE'39. . . : 1."2090 SW HAI....L PL_VD
SUBDIVISION. . . . : TIGARD ROAD GARDENS ZONING:C-G
BL.C,CK. . . . . . . . . . : LOT. . . . . ... . . . . .. . . . . . . .
006 ,JURISDICT!3N:T'IG
REI 591-JE: FLOOR AREAS - ---- -` - EXTERIOR WALL_ CONSTRijC'CION
CLASS OF WORK. :OTR FIRST. . . . . 443 sf N: c: [= : W:
TYRE OF USE. . . :C,,)M SECOND. . . : 0 Sf PROTFCT _-
TYPE OF CONST. -5N . . . : 0 Sf N: ,: E: W:
0(-CUPANC)' GRP. : R 1 TO.1'AL-•-------•: 443 s f ROOF CONST: FIRE RE:T ? :
OCCUPANCY LOAD: 0 HASEMENT. : 0 sf AREA SEP. RATED:
"3TOR. : 0 HT: 0 i-t GARAGE'. . . : 0 Sf OCCU SE"-°. RATF_Dr.
T3SIr1T?: MEZ7_" : REDD SETBACKS------ REQUI RED--------
1='1_0OR LOAD. . 0 ps f LEFT: N ft RGHT. it f+., F I R SPKL: SMOK DET. .
DWELLING L1NI'rS: 0 FRNT: 0 ft REAR: 0 ft FTR AL..RM: HNDICP ACCs
13EDRMS: 0 l H I I IS• 10 IMP SURFACE: 0 F'RO CORR: PARK I NO: 0
VAI.._I.1F. $ : 8000
Remar-t(s : Remove Il rebuild deck for comsercia? ten,nt. There is no increaee in
occupant load -- No C of 0 required - This is an oioer build)ng no record of
construction classification wilo use 5n for the purpose of this permit - Heavy
Timber used as shown on plan because of closeness to property line.
Owner . FEES -_-_--_.-----_-
FRANC.IS M DELANEY tYPe amol_int IDy date r-ecpt
18F,8 GL.ENmnRRTE DR PLCK $ 44. 53 JSD 10/1F,/98 98-31005_,7
I.-.AKE OS!'EGO OR 97034 PRM T $ 68. 50 JSD 1. 1 /12/98
98-.3107LO
5F'CT $ 3. 43 ,JSD 11 /12/98 98- :a 10760
Phone #: FIRE L 27„ 40 JSD 11/12/98 98--3107FAI
Cant i^actcr.
DAN CURTIS I
..'fi d.35 NE 62ND
PORTLAND OR 97213
r'h ntl e -4: 287--3564 $ 143. 86 TOTAL
Reg #. . : 54267
----REQUIRED ACTIONS o r INSPECTIONS
This permit is issued subject to the regula ions contained in the Framing Insp
Tigan; "micipal Code, State of Ore. Specialtiy Codes and a'.1 other
appl .cablr lags. All Nero will bo done in accordance with
approved plars. 10is permit will expire if work is not started _
within :8P days of issuance, or if work is suspended for more ---•---•--
than 180 days. ATTENTION: Or-gun law requires you to follow the _ ----
rules adopted by the Oreton Utility Notification Center. Those -
rules are set forth in DAR 952-001-9010 through DAR 952-00101981.You many obtain a copy of these rules or direr: questions to OIArC _ - _._•�_— ----
by cellino (503)246-1987.
i
Per^mittee Signatl.tr-e : � h `� Issl.red By . — --
+ +++4....4,+.++++++++4-++4-+4-++-++++4-4........4-,+++4-+4....4-++++4......4-++4........4-44+
+-r ++++++a•+++++++++i•+++++++++++4-+•++++++++•++++•++++.++++++++++++++-++++++++++.++++ �
, 11tont brT5T1fe55
•+++++4++#-++++ +++++++i-+- +i +++++4 h++-1 •+4-+++4++++1 4+t+++++ ++++++++++•.++++4+++ +.4 4-4 4.
�e�sass�s:
/ 0_Cj
"TY OF TIGARD Commercial Building heimit Application Rec'dBy w
�
13 2u tiff's HALL BLVD. New Construction and Additions Date Recd 6' /Date to P.E 101701
TIGARD, OR C7223 .L �, Date to DST /0 7�.
(503) 639-4171 /` \' �l �� Permk*
l Print or Type Related SWR*
Incomplete or illegible applications Will not be accepted caned -AN MOIL 101-Z3�qC'
�o
--T Namc.of Development/Project
Job / _�f- -- -- Existing Building New Building 0
Address SreetAddress Suite �-
%T� yQ Building
I91dg# Cil tate Zip ( Data
> ' Existing Use of Building or Property:
---��-� Name
Propeity
— --
Owner Mailing Address suite Proposed Use of Bui,ding or Property:
City/stele zip Phone No. Of Stories:
FOccupant ,Name ' Sq. Ft. Of Project:
Name Occupancy Oass(es)
Contractor A
Prior to permit Melling Address Suite Type(s)of Construction
Issuance,rCQapY
of all licensim 33 5 /
are required if cityistale zii Phone Will this project have a Fire Suppression System?
expired In C* Yes.Y y—. YeS NO y
database Americans with Disabilities Act(ADA)
Oregon Const.Ofint.Board Lic.* Exp.Dae o
Valuation X 25% = 9. Participation
Complete Accessibili Form
Name Pro'ect $
Architect ,f, �liQ��q C5 ` F 'V X Veluat;or� �
Mailing Address Suite ,
7ti � jQ- Plans ,Required: See Matrix for number of sets to submit
Ity/ tate zip Phone on back
Engineer Name I hereby acknowledge that I have read this application,that the information
given is correct,the!I am the owner or authorized agant of the owner,and
Mailing Address Suite that plans submitted are In compliance with Oregon State Laws.
Signature of Owner/Agent Date
City/State Zip Phone r � ��i� �! �`�
Contact Person Name Phone
Indicate type of work: New O Addition O Demolition C) ' � i
Accessory Structure O Foundation Only O Alteration i
_fair o Other o _ _ FoR OFFICE USE ONLY _
GescHpf.lon of work: INap/TL# and Use:
Perks: Estimated•of Employees TIF:
If the shove figure is not supplied at the time of appiicatlon,tits city will
calculate the fee based upon the number of parking spacos.,^_ --
Note: Sits Wirk Ps,.nit Application must precede or accompany Building
Permit Application
I:\COMNEW.DOC (DST) 5/98 ���
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependent upon submittal of BOTH plans AND a COMPLETED
application. For an electrical subm'ttal. the application must contain the
signature of the supervising electrician before platy review will be conducted.
After pian review approval, Pians Examiner will contact the applicant to request
additional plan sets for distribution purposes. (Copy for Contractor, City,
Washington County, Tualatin Valley Fire & Rescue)
Total # of
TYPE OF SUBMITTAL � ' Plans � KEY:
_ Submitted _—-
S (Private) _ 1� _ S = Site Work
B (New or Add) I B Building
FLL (New or Add or Alt) 3 F = Fire Protection System
M (New or Add or Alt) _ 1 M = Mechanical
B & M thew or Add) —� 1 P = Plumbing
P (New, Add, or Alt)v 2 E = Electrical
B & M & P (New of Add)` 2 New = New Building
E (New, Add, or Alt) 2 Add = Addition
B & F & M & P & E 3 Alt = Alternation to Existing
(New , Add) _� Building
*B or B & M (Ait) 1
P (Altj.�����. ��3
*B & M & P $ E & F(Alt) �W 3
NOTES:
*Shaded areas designate ALT submittals omy.
I.WstsUnaxtrrrt doc07/0G,98
CITY OF TIGARD BUILDING INSPECTION DIVISION i( MST
24 Hour Inspection Line: 639-4175 Business Line: 639-4171
,�� � /r- E3UP
Date Requested AM / 13PM Bt r
Location_ I_ ��' L ite MEG
Contact Person ( _ jN_ r)h �� PLM
Contr Ph SWR
XUILJXNG _ Tenant/OwnerELC
wining Wall �— - ELR _
Footing Access: �—
Foundation FPS
Fig rarain SGN
Crawl Drain Inspection Notes: -----
SlabSIT
_- -----_---
Post& Beam -
Ext Sheath/Shear I _
Int Sheath/Shear •,
Framing
Insulation ---
Drywall Nailingl�/\ --
Firewall
Fire Spnnkier �_ ti• "� �-'yr`-G`-"`-'
Fire Alarm --- --- - - - -----�
Susp'd Ceiling --_--__--- - -----_ __
Roof
ink
SPARI FAIL __-----__-__ __ _--- _�_-.-�.---.--- ---.------_ -
GING
Post& Hearn -.---
Under Slab
Top Out -_ ---- . ------------_-____��
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART PART FAIL
MECHANICAL
Ilost& Beam -. - ---- - - -- - --- ---.
Rough In
GasLine - -------.._---_.._._------.-__----
Smoke Dampers
Final
PASS PART FAIL.
ELECTRICAL
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL.
SITE
Backfill/Grading — -
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line l J Please call for reinspection RE:_ _ ( J Unable to Inspect-no access
ADA
Approach/Sidewalk-- Date �� Inspector
Other Ext
Final
PASS PART FAIL UO NOT REMGVE this inspection record from the job site.
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00341
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/14/03
SITE ADDRESS: 12090 SW HALL BLVD
PARCEL: 2S 101 BB-00801
SUBDIVISION: TIGARD ROAD GARDENS ZONING: C-G
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKr LOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES_ _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 50ft. of water service replacement.
Owner: --- FEES
—' - Description Date Amount
CARLSON, CLAY -- - —
4000 KRUSE WAY I I'LUMB] Permit I'er 7/14/03 $72.50
b!_DG. 3 STE #12 l l'AX] 8%State Tw, 7/14/03 $5.80
TIGARD, OR 97035 Total $78.30
Phone : 503-515-4335
Contractor:
ROTO ROOTER- WEST OFFICE
25599 SW 95TH B
WILSONVILL.E, OR 97223
REQUIRED INSPECTIONS
Phone : 50-217-31311 Water Line Insp — —
Final Inspection
Reg #: I Il 13989
I'LM 37-761113
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: —4 Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next businiss day
Building Fixture 1,011 O'VFICE'tISF ON.IN
Plumbing Permit Al _ Received 1�.0„i,ing.
Planning Approval I Sewer
City of Tigard Datc/By: Permit No.:
13125 SW Hall Blvd. JUL 14 0 Plan Review other
Tigard,Oregon 97223 S
Datc/13 : Permit No.:
(( OF Post-Review Land Use
Phope: 503-639-4171 Fax: 503-5 ' NG Date/By: Case No.:
Internet: www.ci.tigard.or.us +r Contact is, See Page 2 fur
24-hour Inspection Request: 503-6394175 1 Name/Method: -1 t� Su cmcntal Inforuaation.
TYPE OF WORK FEE*SCHEDULE(for sep.cial Information use checklist
❑New construction Demolition Descr) tion Qty. Fcc(ca.) Total
Addition/altcration/re !agement ❑Other: Nev ' &or each a dwellings
�- Includes tu. ..for each uUlit connection
CATEGORY OF CONSTRUCTION SFR I bath 249.20
1 &2-Famil dwellin Commercial/Industrial SFR 2 bath _ 350.00 v_
❑Accesso Buildin Multi-FamilySFR 3 bath 399.00
❑❑ Master Builder Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler-sd R.: Page 2
Job site address: I I-S-1. ^ . _ Site Utilities _.
Suite#: Bid .1,A:AA Catch basin/area drain 16.60
Dr ell/leach line/trench drain 16.60 _V
Project Name: Footing drain no.linear ft. Pate 2
Cross street/Directions to job site: 0 c4 1) 4• Wy k4anufactuted home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer no,linear ft. Pae 2
Subdivision: _ Lot#: Storm sewer no.linear ft.) Pa e 2 _
Water service no. linear(t.i 2.�F Pa c 2
E'ax map/parcel #: _ _ Fixturc or Item
DESCRIPTION OF WORK Absorption valy, 16.60
�fym _Backflow preventer Pae 2
I )V\e4 _ Backwater valvc 16.60
Clothes washer 16.60
- - Dishwasher 16.60
Drinking fountain 16.60
ROPERTY OWNERTENANT Ejectors/sum 16.60
- Expansion tank 16.60
Name �,lc SI D t^, -
Fixturcisewer ca 16.60
Address: r)Oi�tt�;� UJ�r�I �` � 3 la- Floor drain/floor sink/hub 16.60
City/State/Zip:i-•-,t; _. �� �_�' ' - Garbage disposal 16.60
Phone: y �� Fax: Hose bib 16.60
APPLICANT CONTACT PERSON Ice maker 16.60
Name: 4 h > Interco tor/grease tra 16.60
Medical gas-value: $ Pa e 2
Address. 7 `- Ci 0 Primer 16.60
Cll j/Jtate/Zl _i�� R < 7O Roof drain commercial kI .60
Phonf; r,(;�, �' S Fax: 3 '27�L Sink/basin/lavatory 60
� -E -mail: Tub/shower/shnwor an .60
CONTRAC' Olt Urinal _ .60
Water closet .60
Business Name: k Gnr�� ,,., '�Vatcr heater .60
Address: IJ, <t;" Otber
Cit /State/Zig �
(')A, C -1070 Other: _
Phone: �'� �S- rt 7 If L1 FaX' 503 (`$� tl q Plumbing Pcrmlt --
Subtotal
$
CCB Lic. : I- Plumb. LICA J�7?8 14 Minimum Permit Fee$72.50 S
Authorized / . J�� )` Residentia 13ackflow Minimum Fee$36.25
Signature: ; .-_ Date:7 -fj`-3 rtan Review(25%of Permit Fee $
4l�7 �� ��(S _ State Surcharge J8516 of Permit Fee $
-- �--} ___
(Please print nsnx l TOTAL PERMIT --
Notice: This perndt application expires If a permit Is not obtained within All nor commercial buildings require 2 sets of plans with Isometric or
1110 days after It has been accepted as complete. riser dh grim for plan review.
*Fee me,hodology set by Tri-(bunt) Building,Industry Service Board.
i,\DstsTermit Forms0mPermitApp.doc 01/03
Plumbi_ne Permit Application - City (tIr Tigard
Page 2 - Supplemental Information e
Fee Schedule: Residential Fire Su pcession Systems:
Site Utilities Qty. Fec(ca) Total Square Footage: Permit Fee: _
Fooling drain- I" 100' 55.00 0 to 2,000 $115.00
Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00
3 601 to 7,200 $220.00
Sewer-1st 100' 55.00 7,201 and greater $309,00
Sewer-each additional 100' 46.40
Water Scrvice-Ist 100' 55.00 _ Medical Gas S stems:
Water Service-each additional 100 46.40 Valuation: Permit Fee:
Storm&Rain Drain-Ist 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
Fixture or Item Qty. Fee(ea) notal additional$100.00 or fraction thereof,to and
including$10,000.00.
Commercial Back Flow Prevewton Ikvtce 4e.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
minimum permit fee$36.25 27.55 and including$25,000.00.
Rain Drum,single family dwelling 65.25 $250)1.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or and including$50,000.00.
specially requested inspections-per hour 72.50 550,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures." If
"Yes",please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
Quantity b Fixture Work.Performed I Comments regarding fixture work:
Fixture Type: Replace
New Moved Uiting Cal ed
Ira lP istr�/Putt! -
Bath -Tub/Shower
_ Jacuzzi/whirlpool
Car Wash -Loch Stall -
-Drive Thru _
Cus idor/Water Aspirator
Dishwasher -Commercial
-Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink -2"
3"
4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Carnage -Domestic increase of sewer EDUs,a sewer permit will he Issued and
Disposal -Commercial
-industrial ferns assessed for the sewer increase must he paid before the
Ice Mach,'Refri .Drains plumbing permit can be issued.
Cil Se orator OAS Station
Rec.Vehicle Dum Station _
Shower -Gang _
-Stall _
Sink -Bad Lavatory
-Bradley
-Commercial
-Service
Swimming Pool lifter
Washer-Clothes_
Water Extractor
water Closet-ioiict
Urinal
Other Fixtures.
ODsts\Permil FormsOmPenmitAppPg2.doc 01/03
CITY OF TIGA RD 24-HOUr
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503) u39-4171
�q,r RUP - _--
Received �� ,�--_ Date RequestedAM--____ PM BLIP
Location Suite_ — MCC
Contact Person Ph( ) 1 L( PLM _ v�
Contractor _ __ __ Ph SWR _
BUILDING Tenant/Ovine ___— ELC
Footing ELC
Foundation Access:
Ftg Drain ELR _- _ -------
C:awl Drain
Slab Inspection Notes: SIT
Post&Beam s—
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing - -- --- --------
Firewall ,
Fire Sprinkler - ---- ---- --
Fire Alarm
Susp'd Ceiling —
Roof ! L.
Other:
Final _
PASS _PART FAIL
_PLUM8_ING
Post& Beam .*-
Under Slab -
Rough-In
ervic —
Sam ary Sewer
Rain Drains ---- -- — --
Catch Basin/Manhole
Storm Drain --- — -
Shower Pan
Othur.
R9,W PART FAIL — -- — -----
MEtH-ANICAL — —� _ -- ---.-
Post& Beam --
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough-In
UG/Slab 1
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of$ required before next inspection. Pay at City I+all, 13125 SW Hall Blvd.
_PASS PART FAIL
SITE _ [� Please call for reinspection RE: ___ __ _ F� Unable to Inspect-no access
Fire Supply Line
ADA /,
Approach/Sidewalk Date �!,' _ Inspector Ext _
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL