Permit BUILDING PERMIT
61TY OF TIGARD PERMIT #: BUP2000 -00472
DEVELOPMENT SERVICES DATE ISSUED: 12/11/00
s 1 , ''I�I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11308 SW 68TH PKWY PARCEL: 1S136DA -00100
SUBDIVISION: ZONING: MUE
BLOCK: LOT: 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: 3N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0.00 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 38,000.00
Remarks: Tenant Improvement 882 s.f.
Owner: Contractor:
•
PROVIDENCE HEALTH SYSTEM IN LINE COMMERCIAL CONSTRUCTIO
4706 NE GLISAN PO BOX 5837
PORTLAND, OR 97213 ALOHA, OR 97006
Phone: 503 - 531 -0505 Phone: 642 -5117
Reg #: LIC 51880
FEES REQUIRED INSPECTIONS •
Type By Date Amount Receipt Electrical Permit Required
PLCK CTR 11/21/00 $247.52 27200000000 Sprinkler Permit Required
Framing Insp
PRMT CTR 12/11/00 $380.80 27200000000 Gyp Board Insp
FIRE CTR 12/11/00 $152.32 27200000000 Susp Ceiing Insp
5PCT CTR 12/11/00 $30.46 27200000000 Final Inspection
Total $811.10
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable law. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246 -1987.
Pe mi itee
Signature: . ' a (9„ \
___,_.
Issued By: j --e/i/Y1
Call 639 -4175 by 7 p.m. for an inspection the next business day
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/,2- -oo „'. , / /�� v / r,ia.4_s / __.,,,,
A .., Building Permit Application
Datereceived: 7 r a+ Permitno e4, l„ .. yi ,
.. ^ :"iyti' City of Tigard
- :_. Project/appl.no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: = Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition
❑ Addition /alteration/replacement (Tenant improvement ❑ Fire sprinkler /alarm ❑ Other.
JOB SITE INFORMATION
Job address: /13 p$ 5W , )j p,(r(c Bldg. no.: Suite no.:
Lot: I Block: (Subdivision: I Tax map /tax lot/account no.:
Project name: Pro i. al Pn C-C. 3 5 C orr+wip rp1 C er�t ✓ (Zc. Auvi C
Description and location of work on premises/special conditions: (Ze 0 noO1G I Ei 5 Goo, pvi Coiiirrtai.4
Ce rJl"&i.--
OWNER FOR SPECIAL INFORMATION, USE CIIECKLIST
Name: Prvvi Ott s∎(. 11(.4. I 4 Si 5•11M (Floodplain, septic capacity, solar, etc.)
Mailing address: 4 7g 14 &I irti r, 1 & 2 family dwelling:
City: pot,. - 4 . IState:0(Z 'zip: 4 724 3 Valuation of work 4 , C 4
Phone: 215 - 61 34 IFax:Zl 5 - 67102_1E -mail: No. of bedrooms/baths
Owner's representative: Wq rrGv ) S (rr% r S 47'■ Total number of floors
• Phone: rn nn c. Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
•
I G 1
Name: h c D4hru ws. ki Covered porch area (sq. ft.)
Deck area (sq. ft.)
Mailing address: I tos se ML l_ iv •„ 1 i 24th Other structure t) (sq. ft.)
r (Av� I State: o? I ZIP: g 721 41-
Phone: 2.. • - 7 7 Fax: Z 3Fi -73 -mail: Commercial/industrial/multi- family:
Valuation of work $ 3 $ 0o0
CONTRACTOR /
Business name: 1,.� L. L1 h t Loh S iv in e-fi eel Existing bldg. area (sq...) � .. �7- 8 N A S
P New bldg. area (sq. ft.) . '� S _
Address: O gc� S$� 7 Number of stories ... ` It / 2
City: AI o 1^ A I State: t; I ZIP: g ? o0 6
Type of construction 3 N
Phone:4 y 511 1 I Fax: 6? 1- 33 j E -mail:
Occupancy group(s): R . Existing:
CCB no.: 51 88 o New:
City /metro lic. no.: p O 0 a 3 g 5 0 Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: s G( YYt e A 5 G pPitcarJr provisions of ORS 701 and may be required to be licensed in the
Address: t a -s on Dab ►v ws lei /�krZ'.h ��'e� f's jurisdiction where work is being performed. If the applicant is
City: I State: I ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $ ,? 'J9. •5 ,
Address: Date received:
City: (State: IZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All p; vis' ens of laws and ordinances governing this ❑ visa ❑ MasterCard
work will be complied he . r s . : ified herein or not. Credit card number: e: ire
P
Authorized signature: ■1 J b ate: 1 1121 1 0 O Name of cardholder as shown on credit card $
Print name: EA-A 1 (c P • t:7 wS kl Cardholder signature _ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4.0.4613 (6O0R OM)
9,9: , ti4/ ore Co4) q
CITY OF TI
4F SPECTION DIVISION
24 -Hour Inspection �..: Busi Line: 639 -4171 -coy?
•
— 0
Date Requested
11111)1 PM LD Z 0'Z - GO Z
Location // 3 0 8 68 Suite MEC a'Z? ^ U
Contact Person Ph PLM
Contractor Ph Sw
UILDI Tenant/Owner ELC
Re aining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing , /'"( Ar•a,a //e &/6'
Fire . • • Ceiling A-10 '4( S /
Roof
1:r_3. -• PART FAIL
PLI BING
Post & Beam
Under Slab C S ( :q L.
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final •
P• .• FAIL
Post . :ea
Rough In
Gas. Line
Smoke Dampers
PART FAIL
CTRICAL
Service
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 Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ Unable to inspect - no access
ADA ✓ Z 7i ,/ f
Approach /Sidewalk
Other Date I _ v Inspector • Ext
Final
PASS PART FAIL _ DO NOT REMOVE this inspection record from the job site.