Permit I
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CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2001 -00296
v� DEVELOPMENT SERVICES DA ISSUED: 8/31/01
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13125 SW Hall Blvd., (503) 639 -4171
SITE ADDRESS: 16112 SW 72ND AV- 18 PARCEL: 2S113AA -00500
SUBDIVISION: OREGON BUSINESS K 1 ZONING: I -L
BLOCK: LOT: OOA 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: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 54 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:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 50,000.00
Remarks: TI
Owner: Contractor:
PACIFIC REALTY ASSOCIATES H L GREEN
15350 SW SEQUOIA PKWY #300 -WMI 15350 SW SEQUOIA BLVD
PORTLAND, OR 97224 STE 300 BB g�2
Phone: 503 - 348 -5602 TI RO; s '3 Z4 f 4
Reg #: LIC 41328
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Mechanical Permit Require
PRMT CTR 8/15/01 $470.80 27200100000 Electrical Permit Required
Sprinkler Permit Required
5PCT CTR 8/15/01 $37.66 27200100000 Framing Insp
PLCK CTR 8/15/01 $306.02 27200100000 Gyp Board Insp
FIRE CTR 8/15/01 $188.32 27200100000 Susp Ceilng Insp
Final Inspection
Total $1,002.80
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 rm ittee
Signet Alb. rA6 /1 7 . i."4r11 '
Iss d B '► AMPIWITZ • . i..: ! I
Call 639 -4175 by 7 p.m. for an inspection the next business day
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Building PermitApplication
. A .
:14r City of Tigard Datereceivedf /< 0 7 Pe mitan -: r�� ,0/ _ t 24.4i ,' "
Address: 13125 SW Hall Blvd, Tigard, OR 97223 PrvjecNappl -no.: Expiredate:
Cuya Bard! Phone: (503) 639-4171 Date issued: By:. I Receiptno.: .-
Fax: (503) 598 -1960 Case file no.: Payment type: \
Land use approval: 1412 family Simple Complex:
TYPE OF PERIIIT :c�
0 1 & 2 family dwelling or accessory Commercialfndustrial Cl Multi - family 0 New construction 0 De molition ` \,
0 Addition/alteration/replacement
AT improvement 0 Fue sprinkledalarm Cl Other: •
JOB SITE INFORMATION
Job address: /b 1, g- 4;/( 7 a.VO 1 i/. Bldg. no.: / 1 Suite no.:
Lot I Block Subdivision: l Tax map/tax lot/account no.:
Project name: A/i/liDfi.E3
Descriptio4 'qa f work on . . • special conditions: 7(G j/'S /�.r/s / 7 4 0". / i rL
OWNER FOR SPECIAL INFORMATION. USE CIIECIKLIST :
Name: PacTrust ( Floodplain , septic capacity�,solar, ctc.) t U
Mailin address: 15350 SW Sequoia Pkwy. , #300 t & Z bunny dwelling: (�
City: Portland estate: OR ZIP: 97224 Valuation of work---------- --- ---- ---- ---- --- _---- --.-.- $
( 5031 Phone: = 62446300 CIFaxfZ4:--1 / E -mail: No. of bedrooms/baths . ......................... .... ._
a
Owner's representative~ D en n i s P a g n i Total number of floors . ........ ... ...... ......
• Phone: Same Fax: E -mail: New dwelling area (sq. ft.) - ...... -- k
Garage%azport arts (sq. ft.) .........................
Name: P a c T r u s t Coveted porch area (sq. it) •- •-- •....•- ( f
Mailing address:153 5 0 SW Sequoia Pkwy . , #300 Deck area (s• ft -•-• --••••
City: Portland State: OR I ZIP: 97224 Other structure area (sq. ft.) - •- •-- -•-- -• (\
(503 Phone{ 2 4 - 6 3 0 0 Fax 2 4 - 7 7 5 E-mail: Commercial/indust>tiaUmultf- family:
d? �
CONTRACTOR
Valuation of work......... ......•......... $ � ��
Existing bldg area (sq. ft.)
Business name: H . L. Green New bldg. area (sq. ft.)
Address: 15 35 0 SW Sequoia Pkwy. , #300 Number of stories ... fOa�%
City: Portland I State: 0 R I ZIP: 97224
Type of construction -
( 503) Phone624- 7717 I Fax: I E -mail: "•
CCB no.: 41328
Occupancy group(s): E S - 4
New: .:i;/
City/metro lic. no.: Notfce: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: John R om i s h provisions of ORS 701 and may be required to be licensed in the
Address: 15 3 5 0 SW Sequoia Pkwy - # 300 0 0 jurisdiction where work is being performed. If the applicant is
exempt from licensing, the following reason
City: Portl and [stare: 081w:97224 p g g applies:
Contact person: f Plan no.:
( 50 3) Phone: 6 2 4 - 6300 Fax4 24 - 7 7 5 tE-mail: •ohnr@ , actrust i ' . com
E1NGINEER
Name: Contact person: Fees due upon application ........... ...... ....._... $
Address: Date receive&
City: 'State: ZIP:. Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
. I hereby certify I have read and examined this application and the Not all jurisdictions accept =lit colds. please as jurist m for more information:
attached checklist. All provisions of laws and ordinances governing this 0 visa 0 MascezCard
work will be complied with, hether . 'ft,. • rein or s o wit cant amber: ___L--/--
Expires
Authorized sly • . ' �� / /.re .6_,,,! ' !: J A" �� credit . , Name of cardholder as shown oa edit card
S
.4 . �� , v WA
Print name: 4 / ca<dholaa awe Imo int ,
Notice: This permit application expires if a permit is not obtained within 180 d after it has been accepted as complete. 440-4613 (6)0X OM)