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12435-12437 SW HALL BLVD W Ul N .Q W v En E x r r x r d I i I 12435-12437 9W HALL BLVD, t CITY ®1 i IGNRD --?LUMBINGPERMIT _ DEVELOPMENT SERVICES PERMIT#: PL11/02 .-00117 13125 SW Hall Blvd., Tigard, vR 97223 (503) 839-4171 DATE ISSUED: 4111/02 PARCEL: 2S102AA-"J,3500 SITE ADDRESS: 12437 SVS,' HALL BLVr) 8 SUBDIVISION: ZONING: CBD BLOCK: —_ I.OT: ___— _JURISD+CTiON: TIG CLASS OF WORK: RE`-' GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: MF WASHING MACH: 1 BACKFLOW PREVNTRS: OCCUPANCY GRP: R1 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUBISHOWERS: 1 SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Remove and replace fixtures. _ FEES Owner: - Type By Date Amount ReceiptSICKLES, DANIEL J + FAi'RiCIA C 5PCT CTR 4111/02 $7.97 27200200000 10432 SW 52ND PR�,IT CTR 4/11/02 $29.60 27200200000 PORTLAND, OR 97219 — '__ Total _ $107.57 Phone 1: 'ontractor: MIKE PATTE?SON PLUMBING 15028 S MITI-HELL LANE OREGON UI-1 Y, OR 97045 REQUIRED INSPECTIONS Phone 1: 632.-7374 Top-out Insp Reg #: LIC 81746 Final Inspection PLM 3-359PB This permit is issued subject to the regulations contained in the T;gard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved glans. 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 Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001 0080. You may obtaLn-copies of these rules or direct questions to OUNC by calling (503) 246-1987. 1 ) / Isliund By: ( Lf Q1tLdG % _ Permittee Sir-iature: — Call (503) 639-4175 by 7:00 P.M. for an inspection needed th next business day Wednesday, April 10, 2002 1:25 PM MIKE PATTERSON 503-632-5647 p 02 04)10/2002 12:07 FAX 5635901900 CITY OF TIGARD Q1002 Plumbing Permit Application --- � llaterercived• '�/G O/� Petmitna.:yj/� City of Tigard sewer permit ne.: Bwtdlogprr:nitoo.. Addrrns, 13125 SW I init Blvti,'rigan!,oR 91223 - "— — Cnyof cg4rrJ Projcc Phone' (5031 639-41"11 dappl.ao.:— Eupiredate: Fan: (503)S9K 19N) fluteunwd: Hy pt no.: Land arse approval' - Gscfiteno.. Paynxnttype- i.]I A.7 family dwellink or accessory U Commemia1hridusuird '>Mohi-family 0 Tenant improvement D New consintchon 0 AdditioNatteranonlreplacement O r•.wod service O Other. tut,address: ries IT11 11M _ �1 , Fbe�,) Todd i Bid oo,: Swte n r: -- �eN ll-atra fitmily�wtub"noir: rax map/tax lot/accoutst no,: SFR(1)bath I.ot: 1,lncic Subdivision. - SM(2)bath ----- -- "C"LaNe: s ( atj -- --- City/cotlpy' j �zip: - -_ Each add! ooa be,h/Iratchen [Xi-iipti and lm or wash on pmmlaas: �itecAUilies 04:4 --ttr — Catch twain/area drain Fu dwe nl compleEonlinspectiow ../ / U. —! Dr wall eaeh l riiajt each d, n - twua iii(no .tt) t '1 Maetaanned hwne ut,L ait 5 Busincabnatrrc. 2fA.k1 +Rtr Iy.,.+ n q`nholes �– Addrets: 0: .51 /y,4G 1 n. _v n a con`aecmi �_ Citi �,� _, Sate ZIP p� unitary hL ft.� -_ irhoneSu3 i1 } ax: 01-24,f E-mail: Storm-Sewer(00.lie - -- CGB no: (, Plumb.bus.rot.no. 3^ -Pis �rva're(no lin.fl-) City/metro lic.nam: ,, ca ,�_ //• O FUfture or item., ('nnrractrx's rrrprescotativc sl Absorption tion valve signature; _ ac now venter Print name: backwater—varve - 1 aslnsllavetor ( s Nnmr.: C othu was r - Address: Dicfrwat- rrU Dnrtkin oruttaln(s) City: Sratc 11 Z[i%: – -- --- - -- - -� 1_ __ �. C:jectorshumP Phone: Fax F:maat �(ancioG tusk WRA'Aaturdsewv cap - Floor drain Vfloor n'i ci/hu WI!•g addra:es: --- --- City: Sate: ZIP. -- - . � ►ce malrtr _ _ Phone. FAX! E.-maul: ntersapton�easc trap_` �� owner inuillafon/residential maintenance only. 11r wuai insiallatron s) 'will be made by nic ca the maitnenanot and repait made by my regular Rout drain(commerc al) cmptoyrr on the pmprtny I own ass per ORS Chapter 447. Si f'S-T5attn(s, avi(s) ,70 Owners si nature: Date: bump 110"1A s/ owerlahowet pan _ Name nal--� Water closet Address: ate( eater - Gty. Sale: 7.1P: Phone: Tax B(nail: o ('– NaYll�rddltearscyectiedlaero(.ple�raUl�e'tedmrat•.+.+Mwwrlen MINf]fUtnllti ................3 —' O Notice ibit permit application u Vlra UMarartrarec>,pires If a prnnlr is sot obteirxd Plan review(at –%) S cern me scwbcr.__ – wlttw,'80 days after n:.o beets State Sutdlarge(596)....S --N" ise►a�it r iii N s c `– ecteptw as Complete. rOTAI........................f I WWWA -- arM"' wwua 4606COM) CITY OF T I GA R D _ ELECTRICAL PERMIT PERMIT#: ELC2002-00178 DEVELOPMENT SERVICES DATE ISSUED: 4/19/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 09-4171 PARCEL: 2S102AA-03500 SITE ADDRESS: 12437 SW HALL 3LVl7 8 SUBDIVISION: ZONING: CBD BLOCK: LOT : JURISDICTION: TIG Proiect Description: Istall 200arnp/less panel and 15 branch circuits. RESIDENTIAL UNIT _ _ TEMP SRVCIFEEDERS MISCELLANEOUS _ 1000 SF OR LESS: J 0 - 200 amp PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER v BRANCH CIRCUITS ADD'L INSPECTIONS _ 0 - 200 amp: 1 W/SERVICE OR i:EEDER: 15 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FUR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amn/volt: >=4 RES UNITS: �N > 600 VOLT NOMINAL: — Reconnect only: _ SVC/FDR >= 225 AMPS: _ _ CLASS AREA/SPEC OCG: _ Owner: Contractor: SICKLES, DANIEL J + PATRICIA C HUGHES ELECTRICAL_CONTRACTORS 10432 SW 52ND 10490 NW JACKSON QUARRY PORTLAND, OR 97219 HILLSBORO, OR 97124 Phone: Phone: 647-2204 Reg #: LIC 49850 SUP 2347S ELE 34-281C Required Inspections Type By U!"fa /amount Re.eipt Rough-in PRMT CTR —4,19/02 $180.05 2720020000( Wall Cover Elect'I Service 5PCT CTR 4/19/02 $14.40 2720020000( Elect'I Final Total $194.45 This Permit is issued subject to the regulations contained in the Tigard Muniapal 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� ork is not started wrthm 1A0 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 Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952.001-0080 You rn9y obtain copies of these rules or direct questions to OUNC at(503) 246-6699 or 1-800-332-2344 Permit Signature: Issued By: r OWNER :NSTALLATION ONLY The installation is being made on property I own which is not intenc.ed for sale, lease, or ent. OWNER'S SIGNATURE: _ __ DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: _ __—___,__ DATE:______ _ LICENSE NO: Call 639-4175 by 7:00pm for an inspection the next business day 04/18/02 THU 11:60 FAX 503 647 2205 HUGHES ELECTRICAL [J001 04/17/2002 18:43 FAX 5035981960 CITY OF TIGARD c ooz ElectricalPermitA Hcatiun -- ^ uric la lo-a— Pervtit no.: � iYJa on City of 'jygard Project/appl.no,: Expirodate: City of7isard Addfass: 13125 SW Hall 131vd,Tigard,OR 972211 pole issued: By:._ t; Receipt no.: - Phone: (503) 639-4171 Case fi Fax: (503) 598-1960 le no.: Payment type: -- Land use approval: ° (] I Xr 2 family dwelling;or accessory J Commrttial/indusatal Mul1l-iA'i-;;Y U Tenant improvement p New coneuuction Addition/alteration/repl:u:emcnt U Other: __ ❑Partial t1 1 ' t luh address: ? r-' — Bldg_no,: Suite ne.: Tex map/tax lot/aceount no.: I r _ Bltxk. Subdivision. Descri tion and location of work on premises: / (� Pru3ect name y� D _ — P:stitnawd date of cornpletion/inspcc 'oil: P 11 s 1 1 Maut Fee Max .Yob no; — [eruption Qty. ss) ToWI na.1114P Business name: bl t I to tetltkntial• gk ormd6•(amlly pre Address:—� 2 D 2 dtroll:ngtmit[nclud,y srtadrd l star• Ci r^I] _ State. ZIP: Scuticemrtud.d Phone Fax: . &mall: 1000 ch sq.n.ar Irs 4 — Each additional 500 sq.ft,or pardon thereof _ —� CCS no Elec.bus.lie.no: .ImilrA energy,residential 2 City netro 1Ir„no.: 1031,�_-- Umiled energy,non-ttsidendal _ _ 2 - L� n Each manufactured home or modular dwalling 9Tgpaturo of sv s vlattriclan(nnu�cd) Date Sctv Ie0 and/or feeder = Lirxnse na Retvic�or�ee gra- na-� argon. Sup.aloin nan+a(pdnt: j -1 alteration at reloattinui s ' s : CITY OF TIGARD 24-Hour BUILDING Inspection Line: (b03) 639-4175 INSPECTION DIVISION Business Line: f(503)639-4171 MST BUP — Received ____ ____—Date Requested APM— BUP _ Location_ F 1' MEC Contact Person — — . �� Ph( Ca-e C ) J Rte' PLM Contractor � — Ph( ) SWR - Q BUILDING _ V Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELF — Crawl Drain Slab Inspection Notes: SIT Post& Beam —__ ___--_— _ Shear Anchors - Ext Sheath/Shear _ Int Sheath/Shear — Framing — ---- -- Insulation Drywall Nal".ig ---- — Firewall C Fire Sprinkler -- --- �� ' -- — Fire Alarm Susp'd Ceiling — Root 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: Final —_._ PASS_PARTFAIL ------------ — -- -- — -�— MECHANICAL ..-- — -- -- ----- --- ------ ---- -- --- Post& Beam Rough-In Gas Line Smoke Dampers — --------__— _..__ __---_-- _--- -- Final PASS PART FAIL ---� -- - ------- —-- ELECTRICAL Service Rough-In — — UG/Slab Low Voltage —__— Fire Alarm Reinspection fee of$---_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART _FAIL SI Please call for reinspection RE: -- _ Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date�Lzo_a�� r�,2 Inspector __/01 C Ext Other: _ - Final DO NOT REMOVE this inspection record from the fob site. PASS PART FAIL CITY OF TICARD 24-Hour BUILDING Inspection Line: (503) 639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP Received _—__ Date Requested—_ �' — AM —PM BUP Location _� y,.�77 iV,&d/ Suite -- MEC Contact Person __ Ph( _) PL.M l f Contractor�_ _ Ph(_ ) (--.3 2, —.73 V sWR — BUILDING Tenant/Owner __- ELC Footing 1 ELC Foundation -- Access: Ftg Drain ELF! Crawl Drain _ ? Slab Inspection Notes: SIT — Post&Seam Shear Aorhors Ext Sheath/Shear Int Sheath/Shear -- - - --- - - - _- Framing ---- Insulation Drywall Nailing - - - - Firewall Fire Sprinkler - --- -- - Fire Alarm Susp'd Ceiling - - -t - Roof Other: ---- -- - - --- Final PASS PART _FAIL PLUMBING Post& Beam - ---- - Under Slab Rough-In Water Service -- --- Sanitary Sewer Rain Drains -- -- -- -- - Catch Basin I Manhole Storm Drain -- Shower Pan Other: - PART FAIL :_HAN_ICAL Pos;&Beam— _ Rough-In _.. Gas Line Smoke Dampers — Final PASS PART FAIL -- ELECTRICAL Service _- --- --- ----- -------- — - -- Rough-In _. _T�_----- ------- - UG/Slab Low Voltage -- Fire Alarm Final Reinspection fee of g^__-- required before next Inspection, Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE U Please call for reinspection RE: _ ❑ Unable to Inspect-no access Fire Supply Line ADA Approach/Sidewalk Date / - 2 Irspoi-firs �`— Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Flout nspection Line: 639-4176 Business Line: 639-4171 BLIP �q99-�v3(P/ _ --Date Requested � AM �k PMv BLD Location 2-- Ll 2)-2 _ �/ - StHte MEC Contact Person 0ZW I e Q Ph 2 PLM -� Contractor— U Cf4� Ph 2 V Ll-090. SWR UILDIN . Tenant/Owner � �Gl'r �•� �" — ELC Retaining Wall a ELR Footing Access: t Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: --- ------- Slab -- --------.___�-._—. _-_-- — _--- SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing —_ ------- ---Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling - - -- _._-.... --- Roof Mis ---------- PASPART FAIL --... ___-----------_ ---- ------.___ .____ — - -------- ---�__ _ -___.___-.- _.-- MBING Post& Beam ------- -------- ----__..-- ----------------- ---- Under Slab Top Out - Water Service Sanitary Sewer Rain Drains Final ----- ----_-._ _--_--------- - ----- PASS PART FAIL MECHANICAL Post& Beam - --- - - — --- Rough In Gas Line -_-.-------- Smoke Dampers Final — PASS PART FAIL EiLECTRICAL - --- -f f Rough In ` UG/Slab Low Voltage --------------------- ------- --- __ -- Fire Alarm - Final PASS PART FAIL_ SITE Backfill/Grading ---' `�— — -- Sanitary Sewer Storm Drain [ ]Reinspection fee of$ —_required before next inspection. Pay at City Hall, 13125 SW Fall Blvd Catch Basin Fire Supply Line [ j Please call for reinspection RE. — -_— [ j Unable to inspect no a tress ADA Approach/Sidewalk. Date Inspector_ — Ext ther _ �` F-vZ7 - 7 Final 4 „- PASS PART FAIL DO NOT REMOVE this Inspection record from the job site. CITY �� BUILDING PERMIT _ / \ PERMIT M BUP1999-00361 ^ DEVELOPMENT SERVICES DATE ISSUED: 8/27/99 13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 2 S 102_AA-03500 SITE. ADDS?ESS: 12437 SW HALL BLVD SUBDIVISION: ZONING: CBD BLOCK: LOT: JURISDICTION: TIG REISSUE: _ _ FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: OTR FIRST: 240 sf N: S: E:� W: TYPE OF USE: M1= SECOND: sf PROJECT OPENINGS? TYPE OF CONST: 5N sf N: S: E: W: OCCUPANCY GRP: U1 TOTAL.AREA: sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 1 BASEMENT: sf AREA SEP. RATED: STOR' 1 HT: 12 ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: _ REQD_SETBA_CKS_ _ REQUIRED FLOOR LOAD: 40 psf LEFTS ft RGHT: 5 ft FIR SPKL: N SMOK DET:Y DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : N HNDICP ACC:N BEDRMS: BATHS: IMP SURFACE: PRO CORR: N PARKING: VALUE: $ 5,600.00 Remarks: This is a 10'X 24 accessory building, unheated. Requires a rninimurn 50" setback from prope-ty line, Owner: Contractor: DANIEL J. SICKLES OWNER 10432 SW 52ND SIGNED RESPONSIBILITY FORM PORTLAND, OR 97219 IN FILE Phone: 503-579-4144 Phone: Reg M FEES REQUIVED INSPECTIONS Type By — Date Amount Receipt Footing Insp PLCK BON 8/12/99 $55.10 99-.,17593 I Foundation Insp Framing Insp PRM-1 DST 8/27/99 $97.00 99-317994 Gyp Board Insp FPCT DST 8/27/99 $6.09 99-31799' Final Inspection PLC2 DST 8/27/99 $1.45 99-317994 Total $149.64 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of 0I3. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if%,•.oik is riot started within 180 days of issuance, or if work is suspended for more than 180 nays. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. These rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a cop's of these rules or direct questions to OUNC by calling (503) 246-1987. Permitee Signature: Issued By:.- ail 639-4115 by 7 p.m. for an inspection the next business day Permit#: =, Address: F ' i Issued by. _ Date: Statement: Information Notice to P.oiperty Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration wider ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Dill in the appropriate blanks and initial boxes I and Z, and either box 3A or 313: ® 1. 1 own, reside in,or will reside in the completed structure. 2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. D3A, My general contractor is�,eg"t. d - �+� c�(Name) Co ractor rcgis. # 1 will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 1B. I will be my own general contractor. If 1 hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property nets about Constrgetion Responsibilities on the reverse side of this,form. /(Date/Com_'_ er_ (Sign re of per t applicant) (White copy to issuing agency permit file. pink copy to applicant) ffiform ation Notke to Property Owners About Construction Responsibilities ;,;; It Notice to hope? Ux'►tr,rii al►ptll Construction Responsibilities i I iiv"'r1ie t"'rinii1ra•tion Corltrarwrt3neirfhirt ucce�rrlwte•er with ORS 701 05,5(5)' new home or make a a,Nhstantial improvement to art existing NUL101II't_, i:.11:;- .1"A '� ., i,.: I'All'1win": and. r;o of i +11t'm). EMPLOYEP VIESPONSIBILITIFS: ii . 'I -,`UI''.-' Is'r'I:. 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I I' it Ili al<!tlalS jmr1)le.w,: 1,11 1110 t;'tfrllllilLl:lrP, 'aiiltlL".�jtE°lT1;nI'I!'Ir!,IIy'll' III .o1',WII ,!' lilt lll Human Reiliourcos �'�wJl'i♦1'C,� + `+'t}wi111Ue1 llr�it117irlll': :°1V ;I I' 4"141(1!tl,,.1, 1„II �trt `11:lIr� ( lit ti � � nl 4 I,' . ;11�� Ill At 01'�I..IIr1 1y(11'�, e'1,1111171'li 'i l( 1,7 lri.itlrlll'.t'. i'til! j�lli; l Illt'1f11C'1::, Si y-o"A Lill It �1f1,111,•. 111111, i I'1i: •,11,�2'(ft 11C1�11111�tIl��i ',' Nilly",'11.11'le. �l1Y,1{Il'lilllllCi ,,l Il1. 14, ISI1„l tit�11, I Gtl! III ;h' l.I;,r! :Iw t{,t' i h"e,r111pl °11t ,•I �.�ulttilllltc`1 rlllfl lili i,ll' S,'!'• ✓.. �...;!i. l(ttr• , 'i ti. 01111'.,�Mi.'t" Iw'. . .1 l:� .. „� .L. ,. .I, .I H'1�'t;lY e.., l•t'"t,•.,Iwl�i,i, y', Nflfit,.„ ��„tl 'gill iq hililiC tit,l'�' �'' p iVltrit, it t`, ?I ,I �til.u!,iii ( _.Ill,+[ � � lit I� I:, 1 111 Lt t,r,' It flit: hl!� i" .1t I Sixl OTHER RESPONSIBILITIES AND AREAS OF CONCERN: ��twQll Clh'+ o'.++.y': '�'. tlll`l)C:dll'^;1411,I,11'1 (i+l ili-,I,I�'.I' I. •. •tl:l"'!-l"',l'-�l,ll�,11i.' (, il:'•�� II':;!11�. 11lILII('Itt llll''ltC'I1(�l,"ft"('hllCt 11 lly;T1t�. t11It III,Iv II' blow') 1 r,+ your alJ-'flti(IrI II11.1ifI:II IJ1`,p111,111`• G y l.,Idl►11111 11,11 I!1+,'j!, w 34 donvil'o 1114i.rR11(t, l 111 111%!Il Jr 1'111 to ser.'t 'll-ki 11.`f! 1161t:quatc lamiralict'C(I','t'1'i11Te' i11:'t ijci ,, , ,it] 1;II' 1. 1,, 'U. „+I,.,�,, l. : �..l,;wl 4}V'it\', t�,ll;'t 01.111111 ,,: 1111111 pipe 1)1m0I4lC',, lift•. 01 \Wick 111,11 1111.114 N" re t1onc, Time ;u s;upervi.se empltrv1't-, %I urr you ha\'r uit'iCielli link to supt'I"IsV '1111,1, it o E, .v;d t(,notily hl►ilrhnw 1'I ficins !t the ,11,l-1rnl,•riMr,titnre .1)ifiev ::w Ivrl'ntlt,thr re,1mi-r1 ittslwdiollsl. 5t11ita'l8 16211,). helil3r� d 111111"'t,ltt,.i',11r7litiltiumn1CI'St.11NE1�1Suitel tNi, In Scar c 1 d WOW.-, 14 14(X Sal;ln, ()12 Y7 100 " ). rxkrn. i ty+! CITY OF TIGARD Commercial Building Permit Application Rev'd By 13125 SW HALL BLVD. Tenant Improvementr Dale Recd TIGARD, OR 97223 Iz-/ Date to P.E.(503) 639-4171 q/35/ Date to DST Permit#j�pf '7(� Print or Type Related SWR Incomplete or illegible applications will not be accepted Called Name of Development/Project —�— Existing Bllllding New Building 0Job �h�- � (,c-�Ci c:C.(I �� ------ Address Street Address suite Building I )-.-I 3 I f-el� Data _ Bldg I - City/State Zip Existing Use of Building or Property: Name Property Propor�Use of�Building or Properly: �j('.;,Jt'�-( 'T' S, C !{� �eS "m 2wa'`r •, Owner Mailing Address Suite T !4 U 3 Z w S 2 No. Of Stories: -� city/bi..: Zipn Phone _ Pootif 04- �,+�''172f� 1 iS25 Z Sq. Ft. Of ?ro' ct. -- /� Occupant ame _ o_-s / 17AL.jgf".lOccupancy ;.I.�ss(es)co � Name S COnttc�rior f ,j I Type(s) of Construction Prior to permit Mailing Address Suns _ _ _ n} _A C dam_S-f RVC lC Y issuance,a copy w� Will this project have a Fire Suppression System? of all licenses l I \ _)2. S t! 5 Yrs 0 NO tom' are required if 2�fpe ty/State Zip --- `�---- --- expired In C.O.T. I 'q171Q �10767 Americans with Disabilitie Act(ADA) database /L (A a - 2. S '�r2S� Valuation ',' 25% = $tel/ Particip tion Oregon Const.Co .Boerd L .# Exp.Date Complete Accessibility Worm A- 0q -4� Project $ Name -" — _Valuation `J Architect •C— � Plans Required: See Mafrix for number of sets to submit Mailing Address - uitS e on back City/Slate .;/ zip Phone I herei y acknowledge that I have read this application,that tha Information given is correct,that I am the owner or authorized agent of the owner,and En lneer Name that plans submiltel are in compliance with Oregon State Law- �- Signnk -Owner Date Mailing Address / Suitev e / i � oP on Poie City/Slate Zip Phone Indicate type of work: New Arm Addition FOR OR'FICE USE ONLY ' 1" Demolition O MaprTL# Land Use: Accessory Structure O Foundation Only O Alteretion O Repair O Other O Notes Description of work: -.. IF Nolen Site Work^er^^rt Application must precede or accompany Building Pennit Application ,1 I _ 11COMNEWII DOC (DST) 5/QR f COMMERCIAL PLAN SUBMITTAL REQUIREMENT MATRIX Plan Review is dependent upon suF }iittal of BOTH plans AND a COMPLETED application. Foran electrical subr the application must contair, the signature of the supervising electrician oefore plan review will be cor ducted. After plan review approval, Plans Examiner will contact the applicant to req+lest 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) 1 B = Building F (New or Add or Alt) 3 F = Fire Protection System M (New or Add or Alt) s i M = Mechanical B & M (New or Add) 1 P = Plumbing P (New, Add, or Alt) 2 E = Electrica B & M & P (New or Ad(') 2 New = New Building _C(New, Add, or Alt) 2 Add = Addition B & F & M & P & E 3 Alt = Alternation to r'xisting (New , Add) _ Building *B or B & M (Alt) 1 (Alt) 3 *B & M & P & E(Alt) 3 *B & M & P & E &�F(Alt) 3 —� NOTES: *Shaded areas des!gnate ALT submittals only. I Wsts\fcrmslmatrxcom doc 10/30/98 l-- rl A 416 lM ts, �1 ,0 Oo LAlz CL\ 1--- - - - _- - - - -- --- - --- -- M . o o �z CA � m Q-� 4Z `� �