Permit CITY OF T I GA R D BUILDING PERMIT
PERMIT #: BUP2004 -00035
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A 4 � 1 � A
DEVELOPMENT SERVICES D ATE ISSUED: 2/4/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112DC -00100
SITE ADDRESS: 15675 SW 72ND AVE
SUBDIVISION: OREGON BUS. PARK III ZONING: I -L
BLOCK: LOT: 002 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: 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: 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: $ 6,700.00
Remarks: TI, add wall ti create offices.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES HOWARD S WRIGHT CONSTRUCTION
15350 SW SEQUOIA PKWY #300 -WMI 425 NW 10TH AVENUE #200
PORTLAND, OR 97224 PORTLAND, OR 97209
Phone:
Phone: 220 -0895
Reg #: LIC 0 89 0 222 44 9
FEES MET REQUQRED3IN0�22
SPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 2/4/04 $110.50 Electrical Permit Required
[TAX] 8% State Surcharl 2/4/04 $8.84 Framing Idsp
BUPPLN Pln Rv 2/4/04 $71.83 GYP Board Inspection
[ ] Finallnspection
[FLS] FLS Pln Rv 2/4/04 $44.20
Total $235.37
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 - 001-01 1 • ough OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling .13) 246 -6. ' • or 1 -800- 332 -2344.
,,. / Ott),444.224-
Issue; By: • 9 07
Permittee _
Signature: X 4 ;��
all 639 -4175 by 7 p.m. for an inspection the next business day
t Building Permit Application FOR OFFICE USE ONLY
City of Tigard Recei Date/B : / I1 i • ved ���
Permit No.: ,
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13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � too it: DateB : Other Permi
Inspection Line: 503.639.4175 _!Jj1, r4 1 I Date Ready/By: fug: ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
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❑ 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: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling 1St Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: s'6 7 S au 77.- NW kV E New dwelling area: square feet
City/ State/ZIP: -' , tj 1 oil- 4}72..z' -f Garage/carport area: square feet
j Mice caol. a(sr vnn�
Suite/bldg./apt. no.: Project ect name: Covered porch area: square feet
Cross street/directions to job site: 6,4 LJ, `Z zoo . 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.
Indicate the value (rounded to the nearest dollar) of all
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Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
— A * LtiA- .. -t-z G/Lr M' T Valuation: $ 6 /7 6 D
Existing building area: square feet
Df[ GF5 .
New building area: square )34DROPERTY OWNER ❑ TENANT Number of stories:
Name: P 'ryti(/ Type of construction: V • N
Address: ('5 9 q .711 J ( � ui pill r-y► '- 36 D Occupancy groups: g F- I r 5
City/State/ZIP: fi7 6 jai 1 jf �. ell 2 7,-(' Existing:
Phone: ( 7 J g ` Z Li -77 g 7 Fax: (57; 6 2'f - 77 5 New:
❑ APPLICANT ❑ CONTACT PERSON , NOTICE •
Business name: /'i if...e m e.. . All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:
e t1 G ' 'D R 5eN under ORS 701 and may be required to be licensed in the
Address: ( howeudittv Ore, jurisdiction in which work is being performed. If the
City/ State/ZIP: 0e14'b -f-A f r L� •► oos -g /� applicant is exempt from licensing, the following reasons
l " G 'T apply;
Phone: (23311p 67 ( - z L.... Fax: : ( 51) 5 - ZCl z5
E -mail:
CONTRACTOR
Business name: i.{ QwA.up iu 0i( 6'l - ' Ca71/5'fXi(/(,nyti BUILDING PERMIT FEES*
Address: 1 2 S 5 Lb E f 20D Please refer to fee schedule
City/ State/ZIP: p 5Xi 7 ZQ C
I Fees due upon application
Phone: ( 51 net - Ogg 5 - Fax: (5b5) zze, - r j L Amount received
CCB lic.: 99' ZZ 1 Date received:
Authorized signs i j j This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: , ex/ Date: Z. 11,41 G,/ • Fee methodology set by Tri-County Building Industry
Service Board.
i:\ Buildineermits \BUP- PermitApp.doc 12/03 440- 4613T(II /02/COM /WEB)
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A iT i'\ Building Division
/% �i P lan Submittal Requirement Matrix
��'�' ? - Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
Type of Submittal # 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)
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Site Work 2
(must include location of all accessible,parking)
Plumbing (site utilities) 2
Building 1*
Fire Protection System 3 **
Mechanical 2 .
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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 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