Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00609
,A„,,,, DEVELOPMENT SERVICES DATE ISSUED: 6/6/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112DD -00300
SITE ADDRESS: 15900 SW 72ND AVE ZONING: I -L
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Rebuild gas station islands and canopy. •
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: 2,436 sf N: NR S: NR E: NR W: NR
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2 -1HR . sf N: N S: N E: N W: N
OCCUPANCY GRP: M TOTAL AREA: 2,436 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: 18 ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: 0 ft RGHT: ft FIR SPKL: N SMOK DET:N
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : N HNDICP ACC:N
BEDRMS: BATHS: IMP SURFACE: PRO CORR: N PARKING: 18
VALUE: $ 64,960.00
Owner: Contractor:
TIME OIL CO MENG - HANNAN
P 0 BOX 24447 5906 SE 122ND AVE
SEATTLE, WA 98124 PORTLAND, OR 97236 -4607
Phone: 206 - 285 -2400 Phone: 503 - 761 -5290
FEES Reg #: LIC 47283
Description Date Amount REQUIRED ITEMS AND REPORTS
[FLS] FLS Pln Rv 12/30/2004 $221.14
[BUPPLN] Pln Rv 12/30/2004 $352.85
[BUILD] Permit Fee 6/6/2005 $552.85
[TAX] 8% State Surchari 6/6/2005 $43.79
Total $1,170.63
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 5' - • . ,699 • r 1-800- 332 -2344.
Issued : y: i , ♦L, Ll _. L. Permittee Signature: U
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.
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3u ildi n Pe rmi t A licat0ECEIV.. ' �� FOR OFFICE USE ONLY
as yo City of Tigard �/) Date /By: ' r /1a Permit No.:e, o A O � f ^ 007 0 4 '
13125 SW Hall Blvd., Tigard, OR 97223 c! Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 I/ /yi�
h•; : i4! t ,1, r� Date/By: r / 1 f other Permit:
,_� • l . � �1IN � � 'i Date Ready/13y: )ue'./ y
Inspection Line: 503.639.4175 • y► F•! ® See Attached Checklist for
Internet: www.ci.tigard.or.us CITY OF " "` � - - • Notified/Method: ( Supplemental information
BUILDING DIVISION p
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. S<
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.
Valuation: $ 4711[ 61 b ()
❑ 1- and 2- family dwelling ogt Commercial /industrial
❑ Accessory building ❑ Multi- family
Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: Z
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: is 0 0 5u) ,,4 vj ' __ _ New dwelling area: square feet
City/State/ZIP: T ( Z•p eeft.. "1, 1 2 23 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: 514 ELL ST�I UN Covered porch area: square feet
Cross street/directions to job site: S C ca R Niel( 7 M .t Deck area: square feet
A'Nb (At 'e T&. 50 0 N ES 1— e (ty R•p Other structure area: square feet
;.
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 00300 Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: `_ 5 i 1 2 0 b equipment, materials, labor, overhead, and the profit for the �'
g; DESCRIPTION OF WORK work indicated on this application.
RE t i t,* C-Y} 5 S 1 rid N (5 LA14 S Valuation: $ 1{ t b 0
A lit) C n 1 �I (V 0 p • , Existing building area: , 2_ct ( square feet
New building area: z 1t 3 • square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: I
Name: TIME 01 L GO Type of construction: if A
Address: P 0, 1 2'-1 ii Occupancy groups: M
City/ State/ZIP: c iI :11T•T"L% u/is_ q, 8 1 2,1-1 - Q g y 7 Existing:
Phone: (2:* zgg - zq t o X 326 Fax: (2d(v) 2 $b - it 4 i b New:
IX APPLICANT ❑ CONTACT PERSON NOTICE
Business name: hit (Ai 1 ' c - r l, ( (E ' Wei Sr p [� . All contractors and subcontractors are required to be
Contact name: Vefat. 1,41146 ER-r'Z licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 11 al 3 0 SC '2 ION HILL Ibk jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: CrQ S him 042 4`10 2tO apply:
Phone: 1503) 55 p c gL 2_4f Fax: : (s)3) 5-13.— 42 12
E -mail:
CONTRACTOR \\
Business name: 7 t; �p
1) Mt- `V'rl0 13 ( BUILDING PERMIT FEES*
Address: 596 � /24 L.....0 4-J f. Please refer to fee schedule.
City/ State/ZIP: Pr op 02.. 7 -7 9:56 - 407
Fees due upon application
Phone: ( t'j,, 71, 1 5;440 Fax: ( )
Amount received
CCB lic.:
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: pen_ tint E p" Date: i Z ,ZZ -01 * Fee methodology set by Tri-County Building Industry
Service Board.
i:\Building \Permits \BUP- PermitApp.doc 12/03 440-4613T(1 1/02/C0 M/WEB)
•
A \ Building Division
i ll . Plan Submittal Requirement Matrix
C ommercial & 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)
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- PlanSubRegMatrix.doc 12/29/03
CITP.OF TIGARD
BUILDING DIVISION PERMIT #: BUP2004 -00609
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2005
Phone: (503) 639 -4171 � n�� „,, ,,,
Inspection Requests (24 Hrs.): (503) 639 -4175 ,„4-
INSPECTION WORKSHEET FOR DATE: 6/23/2005 TIME: 7:10AM PAGE: 68
SITE ADDRESS: 15900 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: JACKPOT FOOD MART
DESCRIPTION: Rebuild gas station islands and canopy.
OWNER: TIME OIL CO, PHONE #: 206-285 -2400
CONTRACTOR: MENG - HANNAN PHONE #: 503. 761 -5290
Inspection Request Scheduled For: Date: 6/23/2005 Pour Time: 1:00�,,�-
Code # Inspection Description Confirm # Contact # Message U" ' 6
S e -- `emu
205 Footing 009975 -01 503 - 519 -8788 Y /
Corrections/Comments/Instruction • , �` SA se
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l ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: '23/' Phone #: (503) 718-
CITY'OF TIGARD
BUILDING DIVISION PERMIT BUP2004 -00609
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSU tr 1 ,
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 639 -4175 „„ +�-
INSPECTION WORKSHEET FOR DATE: 8/11/2006 TIME: 7:09AM PAGE: B4
SITE ADDRESS: 16900 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: JACKPOT FOOD MART
DESCRIPTION: Rebuild gas station islands and canopy.
OWNER: TIME OIL CO, PHONE #: 206-286-2400
CONTRACTOR: MENG - HANNAN PHONE #: 503- 761 -5290
Inspection Request Scheduled For: Date: 8/11 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 013282 -01 503 - 619-8788 N
Corrections/Comments/Instructions:
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1 U7 - 00607
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(3UP 2c o5 - 632-576
❑ PASS - ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /MK Date: ( C( ( G ' ph one #: (503) 718-
CITY - OF TIGARD
BUILDING DIVISION PERMIT #: 13 'fLi(4_(�Q6Oc�
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: E /6 /2Q l5
Phone: (503) 639- 4171 F +
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/31/2006 TIME: 7:01AM PAGE: E;(;
SITE ADDRESS: 16900 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: JACKPOT FOOD MART
DESCRIPTION: Rebuild gas station islands and canopy.
OWNER: TIME OIL CO, PHONE #: 206- 285 -2400
CONTRACTOR: MENG- HANNAN PHONE #: 503 761 -6290
Inspection Request Scheduled For: Date: 1/31/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 02599f3 -02 111 - 111 -1111 N
Corrections /Comments / Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ C;LL Fs - INSPECTION ❑ ADDIT ONAL FEES ASSESSED
s�
Inspector:
dr Date: ( \ ®� Phone #: (503) 718 - 47.