Permit .,..
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CITY OF' TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00206
4 DEVELOPMENT SERVICES DATE ISSUED: 5/18/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S101AD -02800
SITE ADDRESS: 12665 SW 69TH AVE 100 ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 031 JURISDICTION: TIG
Project Description: TI: Walls and ceiling.
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: 27 BASEMENT: sf AREA SEP. RATED:
STOR: 1 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: $ 30,000.00
Owner: Contractor:
CEDAR ENTERPRISES INNOVATION CONSTRUCTION INC
12665 SW 69 AVENUE 17020 SW BOONES FERRY #303
TIGARD, OR 97223 TIGARD, OR 97224
Phone: 503 - 636 -6657 Phone: 503 - 620 -5413
FEES Reg #: LIC 96581
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 5/18/2005 $320.80
[BUPPLN] Pln Rv 5/18/2005 $208.52
[TAX] 8% State Surcharl 5/18/2005 $25.66
[FLS] FLS Pln Rv 5/18/2005 $128.32
Total $683.30
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: :, j,,, , Permittee Signature ..�YYI�,, �."4
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
IF mit .
Building Permit ApailewEIVED FOR OFFICE USE ONLY
City of Tigard Received d
1A Date/By: 518 t5 80 Permit No.:
,A k�Vt�avn— aVav(o
13125 SW Hall Blvd., Tigard, OR 97223 MAY 18 2005 Plan Review
Phone: 503.639.4171 Fax: 503.598.16 8 / / � i aa- Ak i,... Other Permit:
� P,_ � ii 0 Date/By:
Inspection Line: 503.639.4175 OF TIGAR. ilL Date Ready/By: Juris: El See Attached Checklist for
Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: 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 performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition / alteration /replacement Other:' rv,/— %IA fapojam tv equipment, materials, labor, overhead, and the profit for the
• . CATEGORY OF work indicated on this application.
Valuation: $
• ❑ 1- and 2- family dwelling tCommercial/i nstriel --
El Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
'" t JOB` SITE INFORMATION • AND LOCATION Total number of floors: A .
Job site address: �W 6411 1 71 Avkle VET ' 1- e., W 100 New dwelling area: square feet
(
City/State/ZIP: ` Io r ep. ° i p - � • Garage /carport area: square feet
Suite/bldg. /apt. no.: t 00 Project name: C. ?(re76) 69 PfAkja Covered porch area: square feet
Cross street/directions to job site: „l -vv. 0 Deck 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.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
-DESCRIPTION OF WORK work indicated on this application.
T N/ C i M PPt tYVA0vi r ' ;- Z jC� C Valuation: $ ?)Q� ��,�}
(I) 0 m aw , ,�1eka5) Existing building area: square feet
J New building area: square feet
PROPERTY, OWNER. ' ❑` TENANT - Number of stories:
Name: e„,ej _ t.y.Jtv.R..pp-tyE . Type of construction:
Address: &L) , 60 etyr k, - Occupancy groups:
City/State/ZIP: `11 C,Ler4170 I U2 — Existing:
Phone: ( 9P3) 603 (0 — 6' Fax: ( )
New:
0 APPLICANT ,CONTACT PERSON NOTICE
Business name: '7f VAPt .ci Ap.eAm, yCk ye 1 e All contractors and subcontractors are required to be
Contact name: ��� Iq/i /�qj pt-pp licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: I OW)O *kA) 1 N DP' _. jurisdiction in which work is being performed. If the
City/ State/ZIP: p7 ,b/L(�3� i C.9 el 1 C� applicant is exempt from licensing, the following reasons
apply:
Phone: (i3p 16 _ 2 4_ 2A Fax: : ( )
E -mail:
'CONTRACTOR
Business name: i (J w+-im CNv 6.0W `j 1p-J (-) tat1j • . *; : • .
,:,,•;,,-:. ; BUILDING PERMIT FEES
Address: 1 7 be, 6 LP-- r 't .1.YX 1 TO Please refer to fee schedule. •
City/State/ZIP: fr? ∎, o0) CAR 4 1 . ?Glj
Fees due upon application
Phone: ( V 3j) (p7.Q - 54 13 Fax: ( )
Ito G ( Amount received
CCB lic.: l
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name : y . 1 IA , Z +� 4 ✓J Date: ✓_mil -- QS. * Fee methodology set by Tri- County Building Industry
Service Board.
is Building \ Permits \BUP- PemtitApp.doc 12/03 440- 4613T(11/02/COM/WEB)
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-
Building Division
/'Hph'.���w`�I�;�\ Plan Submittal Requirement Matrix
' Commercial & Multi - Family - New, Additions or Alterations
City of Tigard
Type of Subintttal- .: - # 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
CITY -OF TIGARD
BUILDING DIVISION - PERMIT #: BUP200S.00206
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 5/19/2005
Phone: (503) 639 -4171 ° 0 , h�i, 11"
Inspection Requests (24 Hrs.): (503) 639 -4175 '__..
INSPECTION WORKSHEET FOR DATE: 7/293/2005 TIME: 7 :07AM PAGE: 112
SITE ADDRESS: 12665 SW 69TH AVE 100 CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 031 TYPE OF USE:
PROJECT NAME: CARLSON GROUP
DESCRIPTION: TI: Walls and ceiling.
OWNER: CEDAR ENTERPRISES, PHONE #: 503- 636.6657
CONTRACTOR: INNOVATION CONSTRUCTION INC PHONE #: 503-620-5413
Inspection Request Scheduled For: Date: 7/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 012381 -01 503 -201 -5037 N
Corrections /Comments /Instructions:
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....,_
E PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR IN PECTION ❑ ADDITI AL F S ASSESSED
Inspector: 17140 Date: `' 1, hone #: (503) 718 -
Inspec ( )