Permit - CITY OF T BUILDING PERMIT
PERMIT #: BUP2002 -00473
r � ,� I � DEVELOPMENT SERVICES
DATE ISSUED: 10/25/02
13125 SW Hall Blvd.. Tigar OR 97223 (503) 639 -4171 PARCEL: 2S113AD -01900
SITE ADDRESS: 16640 SW 72ND AVE B -10
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 009 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DEM FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0.00 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:
Remarks: Demolition to prepare space for tenant improvement.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES H L GREEN
15350 SW SEQUOIA PKWY #300 -WMI 15350 SW SEQUOIA BLVD
PORTLAND, OR 97224 STE 300
TIGARD, OR 97224
Phone: 624 -7717
Phone: 624 -7717
Reg #: LIC 41328
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 10/25/02 $62.50
[TAX] 8% State Tax 10/25/02 $5.00
Total $67.50
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 -00 -0'10 through c :R 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
cal . g (503) 246 -6699 or 1 - :-00- 332 -2344.
,41 1
ssued By: ` ■ 41111M1 Al / j , /
- - rrn ittee
Sign- - - PS ' , -
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application
� Date received: e 0 -C p� Permit no.: (0 }�- ,
� City of Tigard
- Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family ❑ New construction ; - 0 Demolition j
0 Addition/alteration/replacement ❑ Tenant improvement 0 Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job = address: ? , , ' / 5(t) i Il Bldg. no.: MitSiiite no.: ? '
Lot: : lock: Subdivision: , Tax map/tax lot/acco nt no.:
- Project name: ' ; T es-,,,, t f- , s -
tDescription and1ocation of stork pmises/special conditions: S
re e- L r'. t t ./-e � -e i k o / < r. o , ) S
/i . , .i /t i_ /
OWNER FOR SI'I:CIAL INFORMATION, USE CHECKLIST
<Name :- - (Flootlplain, septic capacity, solar, etc.)
Mailing -ad' Tess: Cp 51 5a . t a 7' 6 ,, '3e,' 1 & 2 family dwelling:
City: ' °p4 r 300 J5 ZIP. - /EMI' Valuation of work $
cPhone so •%2y•,,7;' j E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
CBusiness name: t L G/'oQ New bldg. area (sq. ft.)
Address: S SD 5 Ste- • , .0
Number of stories
FL ZIP: , Type of construction
Phone:; SaJbZ f 717 Fax: E -mail: Occupancy group(s): Existing:
CCB no:: ; / New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECI' /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 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: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: 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 Cl Visa ❑ MasterCard
work will be complied wi , w Cher specified herein or not. credit card number: E><pi / es
Authorized signature: i Date: a 2s o Name of cardholder as shown on credit card
Print name: / U k✓Ti.- - 4t os--0.Z 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)
•
A i" Commercial Plan Submittal
Iii Requirement Matrix
City of Tigard
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 4
(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.
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