Permit A :i.,
' CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00105
M � i � DEVELOPMENT SERVICES DATE ISSUED: 3/6/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S136DA -00100
SITE ADDRESS: 11308 SW 68TH PKWY
SUBDIVISION: ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM 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: $ 1,000.00
Remarks: Relocate (2) sprinkler heads.
Owner: Contractor:
BENENSON 68TH PARKWAY BASIC FIRE PROTECTION INC
KEY LLC, THE ' 8135 NE MARTIN LUTHER KING BLV
BY FIRST AMERICAN TAX VALUATIO PORTLAND, OR 97211
WORCESTER, MA 01615
Phone:
Phone: 503 - 285 -1855
Reg #: LIC 4 0EDOIN
8 0 64 4Q3 11 441�
FEES MET REQS IRSPECTIONS
Description Date Amount Sprinkler inspection
[BUILD] Permit Fee 3/6/03 $62.50 Final Inspection
[TAX] 8% State Tax 3/6/03 $5.00
Total $67.50
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
1 4, r / Issued By: 5517/A) �� �
Pe mi ittee
Signature: / 44,,449
Call 639 -4175 by 7 p.m. for an inspection the next business day
g. , pPoe-4-556-4/
Building Permit Application OFFICE US ONLY
�J City of Tigard Date received: Permit n "Tr)J ?0003 — pplo
,r
�! ^_ Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial 0 Multi- family 0 New construction ❑ Demolition
0 Addition /alteration/replacement 1t4 Tenant improvement It Fire sprinkler /alarm 0 Other:
.IOIt SITE INFORMATION
Job address: //30$ 5 , 8 P Bldg. no.: Suite no.: 125
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: — • , )_ 5 Ye • -, ' r
Description and location of work on premises /special conditions: ' • rt) • P
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
EMSIREMAI i n F J47, ',A al ( Flundplain , septic capacitv,solar,ctc.)
t_ _rlm[.rc:T.x_arj' � j w 1 & 2 family dwelling:
nalgrrrAMIMIll State:O ZIP: 47ZZ3 Valuation of work $
Phone: Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.)
Name: .r- Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi- family:
CONTRACTOR RACTOR Valuation of work $ /MO. DO
Existing bldg. area (sq. ft.)
a. �- New bldg. area (sq. ft.)
Address: E/
State: 0 ` ZIP: 9 z )
Number of stories
' = Type of construction
Phone:+$03._; ./; INIFMTEI E -mail:
Occupancy group(s): Existing:
CCB no.: . ; S • New:
City/metro lic. no.: 3, . Notice: All contractors and subcontractors are required to be
ARCIII l I C'I' /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP:
exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER OFFICE USE ONLY
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions acccpt credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this 0 Visa O MasterCard
work will be complied with, whether specified herein or not. Credit card number: / /
I' Expires
Authorized signature: Date: 3J3.k3 Namc of cardholder as shown on credit card
Print name: UY✓e._ PAY Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/00 /COM)