Permit •
~ a CITY OF TIGARD BUILDING PERMIT
r PERMIT #: BUP2008 -00292
COMMUNITY DEVELOPMENT DATE ISSUED: 8/28/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136AD-04000
SITE ADDRESS: 11509 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: PACIFIC TERRACE LOT: 007 JURISDICTION: TIG
PROJECT: VILLELA THERAPUTIC CENTER
Project Description: TI.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 10 BASEMENT: sf AREA SEP. RATED:
STOR: 2 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: N SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : N HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: N PARKING:
VALUE: $ 1,200.00
Owner: Contractor:
SMITH, EDITA M INLAND PACIFIC RENOVATION LLC
833 NW 170TH DR PO BOX 25035
BEAVERTON, OR 97006 PORTLAND, OR 97298
Phone: Contact #: PRI 503- 268 -7848
Reg #: LIC 182234
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 8/28/2008 $62.50
[TAX] 12% State Surch 8/28/2008 $7.50
[BUPPLN] Pln Rv 8/28/2008 $40.63
[FLS] FLS Pln Rv 8/28/2008 $25.00
Total $135.63
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 days. 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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
i
Issued =.•� -', i Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
• Building Permit Application
1Co>oumercial ro orl-icl- t �l c, �1.1
City of Tigard �B b C1 Permit No.: —c�yl 6 lli 13125 SW Hall Blvd., Tigard, OR • _`:, G SNSD P� • /
Other Permit: p Phone: 503.639.4171 Fax 503.59 • . ^Q
• 4 * ! 1 / ut / 2 for 4, �
r I G A R D Inspection Line: 503.639 1 • Date Ready /By: Page
Internet: www.tigard - or.gov P, O Notifed/Method: 0 Supplemental Information
1 + � V 0 FI r6` p1SV0 -
TYPE OF WOI e ` � G O�` t REQUIRED DATA: I- AND 2- FAMILY DWELLING
❑ New construction 0 on Permit fees* are based on the value of the work performed. ,
Indicate the value (rounded to the nearest dollar) of all
[] Addition/alteration/replacement ❑ Other equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 1- and 2- family dwelling ❑ Commercial mdustrial Valuation: $
0 Accessory building 0 Multi- family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ii 6 9 S i ?A G G 1 v 3 `1 New dwelling area: square feet
City/State/ZIP: ,---p Pa. , O cis 1 1-23 I Garage/carport area: square feet
Suite/bldgJapt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: 'V. C__kLc t L Tlc .,, Deck area square feet
Other structure area: square feet .
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees' are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
' DESCRIPTION OF WORK work indicated on this application.
Valuation: $ V_p 0
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I Ea TENANT Number of stories:
' Name: L S LA C J t L AI 1, � Type of construction: 5Q •
Address: 115- p 1 Qt,. C
) - ) p,-C 1 FtC \Fy Occupancy groups: j v
City/ State/ZIP: -- "T k (el P-2n O Q, ' ( '7 2 23 Existing:
Phone: ( 0 ) (pi .- O 0 3 3 I Fax: ( ) New
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: S p O� J licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/ State/ZIP:
applicant is exempt from licensing, the following reasons
�y
Phone: ( ) I Fax: : ( ) '
E -mail: '
CONTRACTOR
Business name: , N u N i• O Yp C k' iC \t chl pa t 01J BUILDING PERMIT FEES*
Address: g (9 0 n 5 cJ S e i-0 Li S � Q * 5 (Please refer to fee schedule)
� 0 O n a t / a O O � Structural plan review fee (or deposit):
City/State/ZIP: C _
Phone: ( 565 2 ( - y x 9 Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: I 11_3 o Total fees due upon application: /35
�
Amount received: / 35": `O3
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: •SESUS 'Si_ p 0 N I Date: f) 2 $ J 0 • Fee methodology set by Tri -County Building Industry
Service Board.
IABuilding\Permits\BUP -COM PermitApp.doc 2/23/07 440- 4613T(I1 /02JCOM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 03UP2008-00292
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/28/2008
Phone: (503) 639 -4171 QYI11
Inspection Requests (24 Hrs.): (503) 639 -4175 �d �__..
INSPECTION WORKSHEET FOR DATE: 9/8/2006 TIME: 7 :00AM PAGE: 10
SITE ADDRESS: 11509 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: PACIFIC TERRACE LOT #: 007 TYPE OF USE:
PROJECT NAME: VIL.LE-:LA THERAPUTIC CENTER
DESCRIPTION: TI.
OWNER: SMITH, E1)ITA M, PHONE #:
CONTRACTOR: INI..AND PACIFIC RENOVATION LLC PHONE #: 503 - 268.7848
Inspection Request Scheduled For: Date: 9/8/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 '7 Framing 075212 -01 760- 672 -0033 N
Corrections /Comments/ Instructions:
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:2 Date: & So c Phone #: (503) 718- v? /Z 3
CITY Of TIGARD
BUILDING DIVISION PERMIT #: RUP2008- 00292
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/26J200Fs
Phone: (503) 639 -4171 q
Inspection Requests (24 Hrs.): (503) 639 -4175 1I
INSPECTION WORKSHEET FOR DATE: 9/5/2008 TIME: 7:OOAM PAGE: 24
SITE ADDRESS: 11 509 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: PACIFIC TERRACE LOT #: 007 TYPE OF USE:
PROJECT NAME: VILLELA l HER APUtI C CENTER
DESCRIPTION: TI.
OWNER: SMITH, EDITA M PHONE #:
CONTRACTOR: INLAND PACIFIC RENOVATION LLC PHONE #: 503-266 -7848
Inspection Request Scheduled For: Date: 9/5/200B Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 07511301 7G0- 672 -0033 N
Corrections /Comments/ Instructions:
J ,b0T
❑ PAS ❑ PARTIAL APPROVAL ❑ CANCEL I1 NO ACCESS
AIL ❑ CALL FOR INSPECTION (l ADDITIONAL FEES ASSESSED
I L O
Inspector: r/ { Date: J Phone #: (503) 718 -2'J