Permit f
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00126
fi j i �; � DEVELOPMENT SERVICES DATE ISSUED: 3/18/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12395 SW 68TH AVE PARCEL: 2S101AA-04500
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 022 JURISDICTION: TIG
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: 9 BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 5,000.00
Remarks: TI, create new exam rooms.
Owner: Contractor:
LOUIE, RICHARD C TENANT PER APPROVAL FROM OWNER
12395 SW 68TH
TIGARD, OR 97223
Phone:
Phone:
Reg #: LIC 00013125
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 3/18/04 $91.30 Electrical Permit Required
Plumbing Permit Required
[TAX] 8% State Surchart 3/18/04 $7.30 Framing Insp
[BUPPLN] Pln Rv 3/18/04 $59.35 Gyp Board Insp
[FLS] FLS Pln Rv 3/18/04 $36.52 Final Inspection
Total $194.47
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 (50 • •-669• • 1- 800 - 32344.
Issued :y: 1 digh 4 ' • t......14/ t - --
Pe mi ittee / c-D Signature: )( fWt( 1! I
Call 639 -4175 by p.m. for an inspection the next business day
1p. .
RECEIVED
Building Permit Application FOR OFFICE USE ONLY
City of Tigard MAR 1 8 2004 R ► /
J Permit No.: i u -"
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
r ITY OF TIGARD /� „t 114 I i Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960' " �� � �' ( ``� DateB : : "'O t3 Sa
Inspection Line: 503.639.4175 BUILDING DIVIS . JI. `:1' I 1 Date Ready/By: . ._.,,s0;--1 ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: f (Co. . Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work perfo • ed.
Indicate the value (rounded to the nearest dollar) o : I
❑ Addition/alteration/replacement ❑ Other: . equipment, materials, labor, overhead, and the • ofit for the
CATEGORY OF CONSTRUCTION work indi • • red on this application.
Valuation: $
❑ 1- and 2- family dwelling ❑ Commercial/industrial
❑ Accessory building ❑ Multi - family Number of be. emits:
•
1:1 Master builder ❑ Other: Number of bathroo .
JOB SITE INFORMATION AND LOCATION Total number of fl.: :
Job site address: I z 3 5g -- 5 &, J , 8 th 4-(/- New dwellin• • rea: quare feet
City/State/ZIP: 1-/ 0 X4 D / Q 72 9.7-Z2,3 Garage/•:rport area: squa - feet
Suite/bldg. /apt. no.: Project name: f x C L / N / - Co - red porch area: square fee
Cross street/directions to job site: D eck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ 6 . CID
1 r3 `+•. 71 /n, p ry ( 1f0 r►i e bn 1
Existing building area: � square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: /2 /G-/,( mt. D Type of construction: 3►J
Address: /23 of J b) 1p y A /¢'✓ Occupancy groups: 13
City/ State/ZIP: 1/r9 / IA- 0 / DyL g99-22.3 Existing:
Phone: (.93) 75 - ii 3 Fax: (93) `! (O Y - 77-71 New: .
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: 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
applicant is exempt from licensing, the following reasons
City/State/ZIP: apply:
Phone: ( ) Fax: : ( )
E -mail:
CONTRACTOR
Business name: 7 J 4 BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lic.:
Date received:
Authorized signature: ( 1 J '1 This permit application expires if a permit is not obtained
met t J within 180 days after it has been accepted as complete.
Print name: b °A t j Date: 3 / /(,, / O / * Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building \Pennits\BUP- PcrmitApp.doc 12103 440- 4613T(11/02/COM/WEB)
Building Division
nil I ,�� Plan Submittal Requirement Matrix
Commercial & Multi - Family - New, Additions or Alterations
City of Tigard
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
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)
* 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.
i:\ Building \Forms \COM- PlanSubReq.doc 12/24/03
r TY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPEQTIOf DIVISION Business Line: (503) 639 -4171 MST d6 /61-
Received _ Date Request d 5 /3 @ PM BUP
Location /� 3 lad ' r Suite MEC
Contact Person /)P ".. Ph ( ) PLM
Contractor Ph ( ) SWR
ir DING Tenant/Owner ELC
•
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation /'i,�,�. n �,.• /1 Og 7 D � n7
Drywall Nailing �`���Y'�iL �1� /'
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
l PART FAIL
f c .. /
PLUMBING
I 6
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: i 0 Unable . inspect — no access
Fire Supply Line
ADA 3 6
Approach/Sidewalk Date Inspector ✓ _ ii . Ext
Other:
Final DO NOT REMOVE this Inspection record from he Job site.
PASS PART FAIL