12185 SW MAIN STREET-1 IS NIHW MS 991U
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12185 SW MAIN ST
CITY OF T1C�p►RD BUILDING PERMIT
PERMIT#: BUP2003-00533
DEVELOPMENT SERVICES DATE ISSUED: 9/15/03
13125 SW Hall Blvd..Tigard. OR 97223 (503) 639-4171 PARCEL: 2S102AA-05300
SITE ADDRESS: 12185 SW MAIN ST
SUBDIVISION: KINGSTON ZONING: CBD
BLOCK: LOT: 020 JURISDICTION: TIG
REISSUE: _ FLOOR AREAS _ EXTERIOR WALL CONSTRICTION
CLASS OF WORK: DEM FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf _ PROJECT OPENINGS? _
TYPE OF CONST: UNK sf N_ S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 0 of ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: hT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: _ READ SETBACKS RcQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft _ FIR SPKL:- SMO% DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE:
Remarks: Demo existing 400sf structure. Septic tank to be removed, or pumped, filled and inspected or may be on sewer.
(sewer to capped and inspected.)
Owner: Contractor:
ELSER, HARVEY D + IRENE O MICHAEL HANSEN
23900 SW MT CREEK RD 8915 SW COMMERCI AL
SHERWOOD, OR 97140 i'IGARD, OR 97223
Phone:
Phone: 503-830-3997
Reg#: LIC 156524
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
IBUILD] Permit Fee 9/15/03 $62.50
TAX] 84.,State"I'ax 9/15103 $5.00
Total $67.50
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Cooes
and all other applicable law. All work will b- done in accordance with approved dans. 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 OAR
j 952-001-0010 through OAR 952.-001-0100. You may obtain a copy of these rules or direct questions to OUNC by
j calling (503)246-6699 or 1-800-332-2344.
Issued By: ,�✓L C L 6 L Gc t_.. Lz_
Permittee
Signature:
7
Call 6394175 by 7 p.m. for an inspection the next business day
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Building Permit Application Received Building
HLGEIVED Dat&B . . e-- Permit No. CD3 dD S
Cit 0�Tigard Planning ppr al Other
Y g Date/By: Permit No.:
13125 SW Hall Blvd. 'J } � n Plan Reviers Other
Tigard,Oregon 97223 Date/By: _ Permit No.:
Phone: 503-639-41715813 98 L960 Post-Review Land Use
t%� OF Tj(ANA Date/By _ Case No. _
Internet: www.ci.tigao t4LJ�J Contact Juris.^ See Page 2 for
24-hoar inspection Request39 Name/Method: Supplemental information
New construction ='Demolition
Addition/alteration/re lacement :
Note Permit fees*are based on the total value of the work performed. indicate
1 &2-Family dwelling_ Commercial/Industrial value(rounded to the nearest dollar'of all equipment,materials,b,bor,
Accessory Building Multi-Family overhead and profit for the work indicated on this application.
Master Builder Other: Valuation......................................................... S
No.of bedrooms: No.of baths:
Job site address: Al Total number of floors....................................
New dwelling area(sq.ft.).............................
Suite#: Bld ./A to Garage/carport area ft. ............
Project Name. Covered porch area(sq.ft.).............................
Cross street/Directions to job site: Deck area(sq.ft.)............................................ _
Other structure area(sq.Ill.)............................
Subdivision:
Tax map/parcel '43 3c c) Note: Pemrit fees*are based on the total value of the work performed. Indicate
the value(rounded to the nearest dollar)of all equipment,materials,labor,
overhead and profit for the work indicated on this applies ion.
Valuation......................................................... S
_--
Existing building area(sq.ft.
New building area(sq.ft.)...............................
Numberof stories............................................
Type of construction.......................................
Name: Occupancy group(s): Existing:
Address: - -G� Nom'
S w T '��
Cit /State/Zi : __1 f Q � />✓U
Phony: - C Fax: NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdictior.where work is being performed. !rthe applicant is exempt
Contact Name: from licensing,the following reason applies:
Address: --- —
a _Cit /State/Zi : - — -
oc Phone: Fax:
rn E-mail:
,_J Business Name: ��
Fees due upon application.............................. $
ED Address:
(9 w Cit /State/ZI � , 2 Amount received.....................�
S I
Phone:sv J, Fax: _
Late received:
CCB Lic. #
Authorized Notice: This permit application expires If a permit Is not obtained within
Signature: `— Date: 180 days after It has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
(please print name)
i:iDsta\Pcrmit Forms\BldgPermitApp doe 01/03
----; 7.t5U
' 1
Plan Submittal Requirement Matrix
Commercial & Multi-Family
City of Tigard New, Additions or Alterations
1J y
t_il\
Site Work 4
(must include location of all accessible parking)
Plumbing - Site Utilities 2
Building I*
Fire Protection System 3**
Mechanical 2
Plumbing - Building Fixtures 2
Electrical 2
i
a
Plan revie.�, ?w riependent upon submittal of a completed application and plans.
N After plan review 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).
m
J *For over-the-counter commercial tenant improvements, sut mit 2 sets of plans.
""New" fire protection systems require that plans bear the origh ial seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
is\Building\Forms\PlanSubMatrix.doc 04!03
CITY OF TIGARD 24-Hour
. BUILDING . Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 �- MST
� / � /� �euP
Received Date Rgquested_ Z_M_�L_�AM _PM__� HUP
Location -._ Z21.9 �_� M Suite--_ MEC _--
Contact Person _ Ph( —) PLM —_—
Contractor__—. _.. Ph( ) SWR
BUILDIN_O Tenant/Owner _____—_ -- _ ELC —_
Footing ELC
Foundation ACCASS --
Ftg Drain /G /'T,�jt� / ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam _
Shear Anchors -- ---
Ext Sheath/Shear J
Int Sheath/Shear /yE�t�
Framing — O� ! T.-7
Insulation
Drywall Nailing — r --��'�N #41(=cf JF�rc)re-Firewall
Fire Sprinkler
Fire Alarm ^T�
Susp'd Ceili --
Roof
Other: ----
F'
PASS RT FAIL - --
Post&Beam
Under Slab --
Rough-In
Water Service --- ------ — —. —
Sanitary Sewer
Rain Drains --- - C A
Catch Basin/Manhole
Storm Drain -- - —
Shower Pan
Other: - — - --
Final
PASS PART FAIL — � -
MECHANICAL
Post&Beam ---V-----_—^_ — -
Rough-In _
Gas Line
CL Smoke Dampers -- -
Final
PASS PART FAIL
U)
ELECTRICAL
Service
=0 Rough-In
m UG/Slab —
Low Voltap-
-t Fire Alarn,
Final n Reinspection fee of$ required befor9 next inspection. Pair at City Hal;, 13125 SW Nall Blvd.
PASS PART FAIL
SITE _ Please call for reinspection RE:-- _ Unable to inspect-no access
Fire Supply Line /�)
ADA /O�/ 3 / G!-7
Approach/Sidewalk Date-/
Inspoetor �t
Other: _
Final u DO NOT REMOVE this Inspoctlon record from the job site.
PASS PART FAIL