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CITY OF TIGARD ---- BUILDING PERMIT
PERMIT #: BIJP2003-00615
DEVE ®PMENT SERVICES DATE ISSUED: 10/14/03
�— 13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S102DA-00600
SITE ADDRESS: 13360 SW HALL BLVD
SUBDIVISION: ZONING: R-12
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREASEXTERIOR WALL CONSTRUCTION _
CLASS OF WORK: DENT FIRST:�i sf N: S: ^�E: W:
TYPE OF USE: SF SECOND: sf _ PROJECT OPENINGS?
TYPE OF CONST: sf N: S: E: �W:
OCCUPANCY GRP: TOTAL AREA. 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT. sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ.?: REQ_D_S_ETBAC_KS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DE.T:~� 4
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE:
Remarks: Demo 1500 sq.ft. residence. Septic to be puml,ed/filled or ramoved and inspected. All debris to be removed
Owner: Contractor:
CITY OF TIGARD EAGLE ELSNER
PO BOX 23294
TIGARD, OR 97281
Phone:
Phone: 628-1137
Reg #: LIC 27112
FEES REQUIRED INSPECTIONS
Description Date Amount Pump/Fill Septic Tank Insp I
IBUILD] i'crmit Fee 10/14/03 $62.50 Final Inspection
I TAX] 8%State Tax 10/14/03 $5.00
[ERPRIVIT] Erosion 10/14/03 $26.00
(FRPI_NI Fro Pick-USA 10/14/03 $8.45
(additional fees not listed here)
Total $110.40---_---- ---
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other;applicable law. All work will be done in accordance. with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 (lays. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0100. You may obtain a copy of these rules or direct queMians to OUNC by
calling (503) 24� -699 or 1.800-332-2344.
Issued By: 4 ,'lLJL�—
PerTnIttee 9
Signature'
Call 63f)-4175 by 7 tT m. for an inspection the next business day
F USE:
Quildin J Permit Atmfication Received ' ' building '.
Dale/B :'D / Permit No. ,410
It Of TI Rrd Planning ApprrrvaI Other
y iii Date/Ilx: Permit No.:
13125 SW hall Blvd. Plan Review Other
Tigard.Oregon 97223 Date/By Pe-mit No.:
Phone: 503-639-4171 Fax: 503-59$-1960 Post-Review Land Use
Date/By: Case No.
Internet: www.ci.tigard.or,us Contact Juris.: 'gser Page 2 for
24-hoer Inspection Request: 503-639-4175 Name-Method _ Supplement lntonnatinn
TYPE OF WORK REQUIRED DATA:
New construction I X-Dernolition 1 &2 FAMILY DWELLING
f Addition/alteration/replacement Other: —`
` CATEGORY OF CONSTRUCTION Note: Permit fees*are based on the total value of the work performed. Indicate
r Commercial/Industrial the value lrounded to the nearest dollar)of all equipment,materials,labor,
1 &��-Fatrill dwelling
4f overhead and profit for the work indicated on this application
Accessory,Building Multi-Family
Master Builder Other: Valuation......................................................... $
JOB SITE INFORMATION and LOCATION No.of bedreums. — No.of baths:
Job site address: 13360 5W_4dAL- vp, Total number of floors.... ...... .�,...,�...........
A-__-_._.- New dwelling area(sq.ft.)..../...a..4:.. .............
Suite#: Bld ./A t.#: Garage/tarpon area(sq.ft.)............................
Pro ect Name: tei.tR,t c� _ Covered porch area(sq.ft.).............................
Cross street/Directions to Job site: Deck area(sq.ft.). .......................................... -__—
Other structure area(sq.fl.)................
_ REQUIRED DATA:
COMMERCIAL-USE CHECKLIST
Subdivision: _ Lot#:�� - --- —
'Tax map/parcel#: 9 S 1 02. 6X-0-0-600
,_00600 Note Permit fees"are based un the tow;value of the Murk performed. Indicate
DESCRIPTION OF WORK the value(rounded to the nearest dollar)of all equipment,materials,labor,
overhead and profit for the work indicated on this application.
BNdi Valuatuin.. ................................. .................... $
Existing building area(sq.ft.)-......................
New building area(sq.fl.)...............................
Number of stories. . . -
--- - --- .. . .... .. -- -
PROPERTY OWNERi TENANT Type of construction.................... ..................
1 -- Occupancy group(s): Existing:
' `—�-�
�ai11e: C /f O AD -
Address__—__/ /.?S . New:
_
City/State/Zip: 77,c, oR.__�Zr.3. _
Phone: ,? Fax: NOTICE: All contractors and subcontractors are required to be
APPt,ICANT CONTACT"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: — -� — from licensing,the following reason applies:
Address: ---- ---
City/State/Zip: ----------"-
Phone: X. --
-- BUILDING PERMIT FEES'
E-mail: Please refer to fee schedule.
CONTRACTOR
BUSineSS Named Lc 4rGSw '/t�__.___ Fccs due upon application....... ............... .. .. S
- ----
Address: P.a Sox Z 5 s' 9'I _--_
aQlr1 Amount received. ...... . ... .................. ..
Cit /State!Z�-ri ft" O>. a'7
Phone: az r— //.37 Fax: Date received
CCB Lic. #: 21 Ir —I/--
Authorize _ 1---Notice: This pri_m.a_l application expire {f a permit Is not obtained wNhin
Signature: bate' _J_9--1Q7 IRO dais after It has tain accepted■s complete.
Glees ``UMW 4� —
J
'Fee methudoloac set by Tri-Count Building Industr%Servite Board.
(Please print name)
i Msts\Permn Forma\BldgPermitApp.doc 01101
Flan Submittal Requirement Matrix
Commercial & Multi-Family
City of Tigard New, Additions or Alterations
TYPE OF SUBMITTAL # of Plans-
(includes New, Additions or Alterations) I 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
Plumbing Building Fixtures 2
Electrical II 2
Plan review is dependent upon submittal of a completed application and plans.
After plan revic.,v 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 & Rescue).
*For over-the-counter commercial tenant improvements, submit 2 sets of plans.
**"New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
r.\Building\Forms\PlanSubMatdx.doc 04103
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