Permit 4,0 CITY OF TIGARD BUILDING PERMIT
P ERMIT #: BUP2002 -00224
� DEVELOPMENT SERVICES DATE ISSUED: 6/11/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112DD -00200
SITE ADDRESS: 15862 SW 72ND AVE 150
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: 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: 3N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 40 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : Y HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 25,000.00
Remarks: Tenant improvement. Create two restrooms and storage room.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES H L GREEN
15350 SW SEQUOIA PKWY #300 -WMI 15350 SW SEQUOIA BLVD
PORTLAND, OR 97224 STE 300 C�F� g
Phone: T hrone: t 4 u i74
Reg #: LIC 41328
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Framing Insp
PRMT CTR 6/11/02 $283.30 27200200000 Gyp Board Insp
Final Inspection
5PCT CTR 6/11/02 $22.66 27200200000
PLCK CTR 6/11/02 $184.15 27200200000
FIRE CTR 6/11/02 $113.32 27200200000
Total $603.43
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Pe ' tee ,/' / /Mb
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Si nature: (\- LLB /�LAir " A kk il/. _ •
Is ed By: I if J 4L�
Call : 9-4175 by 7 p.m. for an inspection the next business day
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` . . BuildingPermitApplication
City of Tigard - D ateretxived: �O /� 0� Permitno : ,,__
` Pmject/appl.no.: • ire date:
City j and Address: 13125 SW Hall Blvd, 'Tigard; OR
Phone: (503) 639 -4171 Date issued: ' Receipt no.: .
Fax: (503) 598 -1960 JUN 1 1 2002 Case file no.: Payment Y type:
Land use approval: e < v ' •- 1&2 family: Simple Complex:
TYPE OF PERIIIT
0 1 & 2 family dwelling or accessory 0 Commercial/mdustrial 0 Multi - family 0 New construction 0 Demolition
0 Addition/alteration/replacement ►: Tenant improvement 0 Fire sprinkler/alarm 0 Other.
JOB SITE INFORMATION :
Job address: S; (j, , s� p' 72. /1) Bldg. no.: 1 Suite no.: /4--e7
Lot 'Block: 'Subdivision: Tax map/tax lot/account no.:
Project name: A ter, , A 1 •
Descri • tion md ocation of work on pre • ' special conditions: ,. // ■ riV 4
/ I- ./e , 'W -A 9 .
OWNER FOR SPECIAL INFORMATION, USE CIIECKLIST
Name: PacTrust ( Floodplain , septic capacity,solar,etc.)
Mailing address: 15350 SW Sequoia Pkwy., #300 1 & 2. family dwelling:
City: Portland (State: OR (ZIP: 97224 Valuation of work $
;503 I Phone:' T624 46300 ?IFax6.Z'.4 mail: No. of bedrooms/baths .
Owner's representative: De n n i s P a g n i Total number of floors
Phone: Same Fax: S e E -mail: New dwelling area (sq. ft.)
Garage/carport area (sq. ft.)
Name: P a c T r u s t Covered porch area (sq. ft.)
Mailing address:15 3 50 SW Sequoia Pkwy ., 1/300 Deck area ( S• h-)
City: Portland State: 0 R ( ZIP; 97224 Other structure area (sq. ft)
503 Phone:6 24- 6 300 Fax6 24 - 775 ' E-mail: CommerciailmdustriaUmulti- family:
CONTRACTOR Valuation of work $ 2 , 53G 9 7 .)- Z>
Existing bldg. area (sq. ft.)
Business name: H . L . Green
New bldg area (sq ft) / ? /),. 4,/'
Address: 15350 S W Sequoia Pkwy. , #300 Number of stories
City: Portland I state: ORIZIP:97224 � �
503 ) Phone 24 - 7 717 I Fax: 1E-mail:
Type of construction „
CCB no.: 41328 Occupancy group(s): Existing
New: 2
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Boaid under
Name: John R o m i s h provisions of ORS 701 and may be required to be licensed in the
Address 15350 S W Sequoia Pkwy . #300 jurisdiction where work is being performed. If the applicant is
City: Portland State: 0 R r zlP:9 7 2 2 4 exempt from licensing, the following mason applies:
1
Contact person: Plan no.:
.503) Phone: 624-6300 Fax624 -775 E - ohnr@ actrust I . com
Name: Contact person: Fees due upon application $
Address: - . Date received:
City: (State: 1ZIP:. Amount received $
Phone: I Fax: 1E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept audit cards. please call jurisdiaim for more information.
attached checklist All provisions of laws and ordinances gbvem ng this 0 visa 0 MasterCard
work will be complied with, ,, hether - i ,• emin or n.1 / Credit card number /
Expires
Authorized si y : • -, A' I ■∎V j : < � /, -' -- —/� Name of cardholder as shown oa audit card
S
Print name: i. L AO i . ✓ -- Cardholder signature Amami
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4404613 (61wrooM)