Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00300
AVvwx�lI DD EVE I L i OP B MENT r S o ER9 I CES DATE ISSUED: 5/28/03
(503) 639 -4171
SITE ADDRESS: 11950 SW 69TH AVE PARCEL: 1 S136DD -06300
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 012 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DEM FIRST: sf N: S: E: W:
TYPE OF USE: SF 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: $ 4,000.00
Remarks: Septic system must be pump, filled and inspection. All debris to be removed.
Owner: Contractor:
ROOT, GORDON C + DOW BROS, INC
ROOT, WILMA L + 1045 N 4TH AVE.
ROOT, JACK B CORNELIUS, OR 97113
WEST LINN, OR 97068
Phone:
Phone: 503 - 357 -5804
Reg #: LIC 41902
FEES REQUIRED INSPECTIONS
Description Date Amount Misc. Inspection T PT /c-
[BUILD] Permit Fee 5/28/03 $62.50 Final Inspection
[TAX] 8% State Tax 5/28/03 $5.00
[ERPRMT] Erosion 5/28/03 $26.00
[ERPLN] Ero Plck -USA 5/28/03 $8.45
(additional fees not listed here)
Total $110.40
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: ( •! . /,
Permittee /
Signature: �l
Cali 639 -4175 by 7 p.m. for an inspection the next business day
i Building Permit Application FOR OFFICE USE ONLY
Received , Building
Date/By: b'AS -03 : D D O O 3 - 0 o&9!)
City g of Tigard . - Planning Approval Other
DateBy: Permit No.:
13125 SW Hall Blvd. Plan Review Other -
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 //a n , �, i' i'' Post - Review Land Use
ei '
l Date/By: Case No.
Internet: www.ci.tigard.or.us Contact Ju ; ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/Method: 7 / C/ _ Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction E Demolition 1 & 2 FAMILY DWELLING
❑ Addition/alteration/replacement Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi - Family � �
❑ Master Builder ❑ Other: Valuation $ ` . aa ,4O
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: I q S't) S(ti (j' i U ' usb Total number of floors
/ New dwelling area (sq. ft.)
Suite #: 1 Bldg. /Apt. #: 97 3 Garage/carport area (sq. ft.)
Project Name: Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
i— b —tt4 _ ltis 1 W i (
CO #4 et._ t-i( Other structure area (sq. ft.)
564./ 69- -si Av■i -o DA °u REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: 1 Lot #:
Tax map /parcel #: Note: Permit fees' are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
0 s`r
Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.) •
Number of stories
PROPERTY OWNER ❑ TENANT Type of construction
ame: 6oe-P »'J r r)1 f-. i / /wtt..4.# gaur Occupancy group(s): Existing:
New:
Address: / 5w SLIFf-
City /State /Zip: We L►.rN, OR_ 61'7O 6 a ` •
Phone:5 -6-16'-o S' 1 Fax :St3 ^63$- 04r9 NOTICE: All contractors and subcontractors are required to be
El APPLICANT. CONTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: i .ocsr (t.1blA /Cj /...1_C._. jurisdiction where work is being performed. If the applicant is exempt
Contact Name: 0 2 b 14-00 from licensing, the following reason applies:
Address: No6 5 W S
City /State /Zip: o-r Li »JsJ c 4 41 ' 68
Phone:sb3 :71-c o'I I 1 Fax : - 03 .3e- b 9
BUILDING PERMIT FEES*
E -mail: 4 cl
c e1 roc* Q- � d
(• c "''
'" Please refer to fee schedule.
�J CONTRACTOR
Business Name: Wit,,) /10T ' F ees due upon application $
Address: I O4( 14 v mt 4L1 !it::-
City /State /Zip: 4jr/t^/ 67-1 tA , O✓L g711 3 Amount received $
Phone:503 -33`7 ^S".5a``' Fax:S03 -YI L - 22y‘.- Date received:
CCB Lic. #: 4-/-/Q 2— - -0_3
Authorized Notice: This permit application expires if a permit is not obtained within
N ate: S 3 180 days after it has been accepted as complete.
67/ &a -160*NA 72 - 0 07 — *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\B1dgPermitApp.doc 01/03
,������ I , Plan Submittal Requirement Matrix -
,4J - ��� Commercial & Multi- Family
City of Tigard New, Additions or Alterations
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 4
(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 \PlanSubMatrix.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDU G Inspection Line: (503) ,, 175 MST •
INSPECTION DIVISION Business Line: (503) • :z' , ..7!1
-402-7 BUP 3 _ D d 3
Received Date Requested AM PM BUP
Location 1 I q-5 6 9 Suite MEC
Contact Person Ph ( ) - 7f 3 - 3677 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: d , SIT
Post & Beam !. `� ��('•A -�
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear i , " ,,,, A
Framing
Insulation
Drywall Nailing ,
Firewall ��_ _ yy� `b V 'k U Y�.�.�5 "C
Fire Sprinkler
Fire Alarm - Air ---b • �---- ` �
Susp'd Ceiling
-
Roof 1
Other:
Fin IL
PART FAIL
BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer % ,
.) A
Rain Drains ll
Catch Basin / Manhole .,1
Storm Drain �' - , r
Shower Pan "
Other: / 0'
Final
PASS PART FAIL : /
MECHANICAL z ''
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Ei 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: 0 U able to inspect - no access
Fire Supply Line
ADA - �j
Approach/Sidewalk D ate �� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
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