Permit A. OF TIGARD BUILDING PERMIT
CITY PERMIT #: BUP2004 -00384
,��1;� DEVELOPMENT SERVICES DATE ISSUED: 8/6/2004
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL PARCEL: 1 S136DA -00100
SUBDIVISION: ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: F PS FIRST: sf N: S: E: W:
TYPE OF USE: d_ O m 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 ?: 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: $ 2,500.00
Remarks: Relocate (5) SSP & add (5) ssp in data room.
Owner: Contractor:
BENENSON 68TH PARKWAY MCKINSTRY COMPANY
KEY LLC, THE 5400 NE COLUMBIA BLVD
BY FIRST AMERICAN TAX VALUATIO PORTLAND, OR 97218
WORCESTER, MA 01615
one:
Phone: 331 -0234
Reg #: MET 40g0�00011 00001179
FEES LIC REQU INSPECTIONS
Description Date Amount
[BUILD] Permit Fee 8/6/2004 $72.10
[TAX] 8% State Surcharl 8/6/2004 $5.77
Total $77.87
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.
Issued By: _�fl.
Permittee .
Signatur
Call 639 -4175 by 7 p.m. for an inspection the next business day
AUG -06 -2004 10 30 MCKINSTRY CO 503 331 6906 P.01
',uild'l]�L Permit kpDlicati()Il $nn�Y + [E ONIN •
_
( iry of Tigard lnw.w,� - ic_ ., t'crtur. Wc,
I 3,,, NV ,•bill Blvu.. TtuOrd C,,.. 1,-__ ` r I'I;u, l.c•,•IC,
'tu . ..... 4; 14(111 j�`i � ! - lN1C! !'unNt
None SUi.Li. -117! 1'u.. l _ _ ;.N i r riucc� _ .
luspcctiDn Line. 30,1.:4L .11 . Dal: 1,L.10. Jun' E Scr hip = 1 b
!Vtrui 1 ) \( I`upplunrtuut lniurnrrliur
TYPE OK WORK 1 ItEQU11tE1) BATA: ]- AND 2- FAMILY DWE LINC
w I fool! lees' ar_ bused on the value of the wail: perform:
❑ New construction ❑ Demolition 1 Indtr.iLL. thr value (rouudod i0 the nearest dollar) of all
' Addition/al i trait unvreplaccment i ❑ Ot equipment, materials, labor, overhead, and the profit f 1
". CATEGORY C)F; CONSTRIJCT]ON wort: utcIir. iicd nn flu::Lppllcmlo1I.
\'uluauon 5.
❑ ) -and 2- family dwelling ET Contntercialiindustrtal
Number o f hc d rooms'
D Accessory building ■ -
❑ Master builder ■ Number of bathrooms;
' ' ' '' JUF],SITE TNPORMATION'.ANVk):LOCATION 70 number of floors:
Job site address: 3t t F- — New dwelling area: square feet
Ctn.'StateiLIP: Garage /carport area: square feet - -T
SuiteT1dg.ape• nu.: Project name: ?WI PFD G g` Covered porch • 5. square feel
Cross strect/directions to job site: Deck area; square feet
Other s ctUTC area square feet
REDgi.iIFTL) :Y 'AtA _.:06 ISIEliC1A:LillS i; CEECKJ -IS
subdivision: Lot no.: Permit fees' are based on the value of the wort: perfornei
Indicate the value (rounded to the nearest dollar) of all
Tait map/parcel no.; equipment, materials, labor overhead. and the profit for tl
•• • , OI2I:' +', ;I work indicated on this application.
,�' " DES CII .Vii '.a;• , , .
C \l aluali on: S Z
,- � ` ���� +n`Cfr Extsung building area:��. square feet
I `-� ` New building area: r/t1 square fee{
''! ”' 1. '(;.1 . - <RO O :i!r��l "•i� i '%�i.,' ':ti!^ „C4, :1 r r i , r4 'C'aal ,,• '.��•�: Number of stories; J % f `•�
:TE>rR1fl�irf+�B, ,,i ?,�s<,. ,,, �],; i,
”' +,, + r� I"r
Narne; ¶4 v' i DC L.c _ T of constntction:
Address: Occupancy groups: j.164 r ^ �$..v6
Ci e : Existing: R
,
Phalle: ( Fax: ( ) New: g ) 1
L " i • �<," sr.: i}z,n .,,y,., Jti �'�' ,��r ,1— �iC1�' 1 `.'.�,nur:xyi •• �' -' w � -J
4',L :, --," t ® ' m,�� i lt , ;:ik fr M nf. A d t i I •. } • ti 7, ' ':., ilia' , . • , ::4:: .
r �,.7..p. ,,... ' F 1".w� „1.0� 6.,,'1'•. t...•�.w4::,,g. • �i ,. ly y . ,�. y,,l'gi yC. �:r ,. {in 7 w n}nTf�'/ ` : h . , . t . . ..' •
,+ -; . , A ...p' -c�ld • 1;,,"`w s c :�, , '1' ~•11,t+w d .. 1' '. � X41' 1 . . ,''�I•,'� ,.. ,. '
Business name: L)Ly i Cr . All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: L% /11t 74C L, under ORS 70] and may be required to be licensed in the
Address: 5 LI C'L? _r e `,0l { '/1'1 ;/r, L. D . jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: ----' 01Lrt A ci ` + Z l E apply:
Phone: ( r xrl "S 1 . 01.31 Fax :: (QS) j7 1 - 6.flC• (,.›
mail : J t j I C. 4:t1JS1 le 0 ("rip '
E - Si w ��, � s Jil „71,1 • , . f M. ' " J '' ) ,�� ' 1 4 6. ! 1 741{ i LTn' � ti
'.y _^' k "..e, .' air )w l r` ell yaii 7 a 27744,1.'71. - .1 ag i fir 1 1 ! .. 1 : fj,; ;' ( 1 ,4 1 F I aNy F1 X14 '&
Business name; . 3 .
Address: � � /(� �V ; � f_�r� r �[ Please refer ro fee schedule.
City/State/ZIP: J .; A % , ,. • Cf Z E> pees due upon application)
Phone: ( ';3) -$; 1 , C' 7 Fax: ) j3 / , [�r•ci C7 L„ p mount received
r
CCB tic.: 0/ i i
y 1 ."�-� Date received:
Authorized signature: •r _ • 7 This permit application expires if a permit is not obtained
within a90 days alter it has been accepted as complete.
print name: .• g,,:?:''' � _. L:ti IC_ Date: eq., 0 ,E7 j - * Fee methodology set by 7ri•Covnty Building industry
Service Board.
i•Tuiipl„ BtPnrmiulFP5-Pe mitApp.doc 11103 400 461]T(I IJ071CCM/WBD)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
z .
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP - 60 381
Received Date Requested AM PM BUP
/l p
Location `r 3 n 6914"- P/(-dr Suite MEC
— .Contact -P-e sen- C ?* Ph ( ) S7a -7q6 7 PLM
Contractor ,, ,� Phi ) SWR
BUILDING Tenant/Owner /✓'_ ' ELC
Footing
ELC
Foundation
Ftg Drain _- / t -
Crawl Drain
Slab Inspection N e t -f g - AE
g SIT
Post & Beam
Shear Anchors ,f757
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Alarm
/ 67
Susp'd Ceiling ' ,
Roof
Other: _Ik &
PASS PART FAIL gropp
�;��
NG
Post & Beam lop
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 El Please call for reinspection RE: ID Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL