Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00279
r4 DEVELOPMENT SERVICES DATE ISSUED: 5/15/03
-- '� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15946 SW 72ND AVE PRV17 PARCEL: 2S112DD -00400
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 017 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: 1 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 : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 4,000.00
Remarks: TI: Add storage and conference room to open office area,a break room counter, ADA upgrades.
Owner: Contractor:
KAUFMAN, LOTTIE L + H L. GREEN, HL CO. INC.
SUBOTNICK, RUTH ET AL 15350 SW SEQUOIA BLVD
BY PACIFIC REALTY ASSOCIATES STE 300
PORTLAND, OR 97224 TIGARD, OR 97224
Phone:
Phone: 624 -7717
Reg #: LIC 41328
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 5/15/03 $81.70 Electrical Permit Required
TAX 8% State Tax 5/15/03 $6.54 Sprinkler Permit Required
[TAX] Plumbing Permit Required
[FLS] FLS Pln Rv 5/15/03 $32.68 Framing Insp
[FLS] FLS Pln Rv 5/15/03 $53.10 Gyp Board Insp
Total $174.02 Susp Ceilng Insp
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 0 1- 800 - 332 -2344.
Issued By: . %y� �
Pe rmittee
Signature: �_ _
/ i i
Call 639 -4175 by 7 p.m. for an inspection the next business day
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A ,------ -wilding Permit Application
Wit. j; City of Tigar � g D Date received: c_ (S _ -2. Permit no. ZGLM0p3 -6.7)D.77 City of Tigard
Address: 13125 SW ar8, 97223 Project/appl. no.: Expire date: 1
Phone: (503) 639 - 71 Date issued: BO Receipt no.:
Fax: (503) 598 -1960 ,AAy 15 2003 Case file no.: Payment type:
Land use approval: GITy OF T IGAR D l &2 family: Simple Complex:
VI510�
TYPE OF PERMIT
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❑ 1 & 2 family dwelling or accessory Commercial /industrial ❑ Multi- family ❑ New construction ❑ Demolition
❑ Addition /alteration/replacement 1„ErTenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: / rya '.f (p S j 7v.inck Aim IA tAx _ Bldg. no.: 17 Suite no.:
Lot: I Block: (Subdivision: I Tax map /tax lot/account no.:
Project name: rj yo w Oro, kep See usA J � i2G•
Description and location of work on premises /special conditions: ,44 ? 5tOv 44 e 1 GD yptic[_e reot-
i■tttttttttttttttttA a ��
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: Pa rri,t.rf- (Floodplain, septic capacity,solar,etc.)
Mailing address: /5 j S "J .-J
O S2$ c el . fie to 3 00 1 & 2 family dwelling:
City: ?o, - Ka I State: I ZIP: 97 •# Valuation of work $
Phone:3b3 42.4 43oo (Fax: 4 24 77,95(E -mail: No. of bedrooms/baths
Owner's representative: Dctn n1.S p,. r, t Total number of floors
Phone: — fw. - Fax: -SR oa.+e- - mail: d1nnss • New st New dwelling area (sq. ft.)
. APPLICANT Garage /carport area (sq. ft.)
Name: Pot.. c. TnC.sj --- Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi-family:
CONTRACTOR Valuation of work $ .190D . 0 0
Business name: L Gr ex Existing bldg. area (sq. ft.) /, /7 /
Address: /5 „sue _rat 1. .t, Pkwy P 300 New bldg. o . area es ft.) 61 �G.
Number of stories S te_.
Ci Pot- ft" • ! ISlate: Z IZI :97
Type of construction
Phone: .513 • 6 2,.'1. 77171 Fax: I E -mail:
CCB no.: cif 32 Occupancy group(s): Existing: 8
New: $
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 4/14'f.∎ -► Ma n (9QGrA1.4.0) provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: , I ZIP: exempt from licensing, the following reason applies:
Contact person: 1 Plan no.:
Phone: Fax: E -mail:
ENGINEER OFFICE USE ONLY
Name: /1 /�• Contact person: Fees due upon application $
Address: / Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this o Visa 0 MasterCard
work will be complied with, whether specified herein or not. Credit card number: / /
Expires
Authorized signature: Date: 5/r„5e3 Name of cardholder as shown on credit card
Print name: Pe.-1 n 0 5 P0.cy „3 t Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6 /00 /COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST G�
Received Date Requested AM PM D 2€3 ` oo Ze
Location i g A° 7a IP. Suite ?y /7 MEC
Contact Person Ph ( ) 3/0 — 8 g3/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 4?-4t) / 47d 1 ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
PASS PART FAIL
PLUMBING
Post & 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA D ( � 1 f 3/ 6 3
Approach/Sidewalk Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
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