Permit a ,
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00587
� ��;� DEVELOPMENT SERVICES DATE ISSUED: 12/21/2004
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S112DC -00500
SITE ADDRESS:.-1.58 72ND AVE BLDG -B . #R )
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: /5 ?cis LOT: 040 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: 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: $ 56,000.00
Remarks: TI: Walls and ceiling.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES JOSEPH HUGHES CONSTRUCTION, INC
15350 SW SEQUOIA PKWY #300 -WMI 7035 SW HAMPTON ST
PORTLAND, OR 97224 TIGARD, OR 97223
Phone:
Phone: 503 - 624 -7100
Reg #: LIC 45645
FEES REQUIRED INSPECTIONS
Description Date Amount Electrical Permit Required
[BUILD] Permit Fee 12/17/2004 $503.62 Sprinkler Permit Required
TAX 8% State Surchar 12/17/2004 $40.29
Plumbing Permit Required
[TAX] � Framing Insp
[BUPPLN] Pln Rv 12/17/2004 $327.35 Susp Ceilng lnsp
[FLS] FLS Pln Rv 12/17/2004 $201.45 Final Inspection
Total $1,072.71
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: / .4
Permittee --r,WI,"
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
. • Build .
ing Permit ' II EC I V ED FOR OFFICE USE ONLY
City of Tigard t, i �Tf o Date/By: /�— fj D j Permit No.: ) p j � - 1
13125 SW Hall Blvd., Tigard, OR 9723DEC 1 '7 2004 Plan Review ii�� ""
Phone: 503.639.4171 Fax: 503.598.1960 . �ii.�, Date/By: Q� 1` n10a, Other Permit:
Inspection Line: 503.639.4175 T .y» O .._: Date Ready /By: / tuti ® See Attached Checklist for
Internet: www.ci.tigard.or.us CITY OF 1 1 Notified/Method: l C Supplemental Information
BUILDING DIVISION Y l
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: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1 -and 2- family dwelling ® 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: Oregon Busn Park 111: J58SW 72nd Avenue, Suite 250 New dwelling area: square feet
City/State/ZIP: Portland, OR 97224 / 75 Garage /carport area: square feet
Suite/bldg. /apt. no.: Bldg B I Project name: Dr. David Kao Covered porch area: square feet
Cross street/directions to job site: Intersection of 72nd and Carman Drive 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.
Tenant improvement within existing building suite. Minor demolition and interior Valuation: $$56,000.00
partition walls. Convert offices to exam rooms and conference room to waiting /reception Existing building area: 2240 square feet
& open up supply room for staff station. 6 new sinks, minimal HVAC & sprinkler work New building area: 2240 square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 2
Name: Dr David Kao Type of construction: V -N
Address: 15875 SW 72nd Avenue, Suite 250 Occupancy groups:
3ity /State/ZIP: Portland, OR 97224 Existing: B
Ione:(503)481 -1060 Fax:( ) New: B
® APPLICANT
0 CONTACT PERSON NOTICE
Business name: Miler Design Management All contractors and subcontractors are required to be
Contact name: Scott Miler licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: PO Box 20025 jurisdiction in which work is being performed. If the
City / State/ZIP: Portland, OR 97294 -0025 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 255 -1308 I Fax: : (503) 253 -0950
E -mail: s.miler @comcast.net
CONTRACTOR
Business name: �cp / �j /4 t C - ^ �yv� BUILDING PERMIT FEES*
Address: /// /� ��`" �� 1� / c r' J L/e, .
Y/� _ ! G� Please refer to fee schedule.
City /State /ZIP: /� / vim . R �A�f /
/ Fees due upon application
{ Phone: (5Z) & a y —'7z./ Lb Fax: egg — Cfv?9Gj Amount received
/ 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: Scott Miler I Date: 12 -17-04 * Fee methodology set by Tri-County Building Industry
Service Board.
CITY, OFTIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP d6n - 6f4C7
Received Date Requested / 0 (F AM PM BUP
Location ! .S 74), /nGC uitS eat MEC
Contact Person s--evi Ph ( ) a0 ! 3 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: L C 40o 5 -cSb 033 SIT
Post & Beam
Shear Anchors /Zap s- 4(0/3 eL013 g
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation •
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
PAS ' PART FAIL
•LUG. =ING
& Beam
Under Slab
Rough -In / -
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL _• ,
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ r: • .fired s :fore next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please , for rei spection RE: : : Unable to inspect -. no access
Fire Supply Line
ADA /Pi F ,.,,
'
Approach/Sidewalk Date Inspe Ext
Other:
Final DO NOT REMOVE this Inspe Ion record from the Job site.
PASS PART FAIL