Permit 2.-. BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2004 -00212
.ryk DEVELOPMENT SERVICES DATE ISSUED: 5/11/2004
13125 SW Hall Blvd., Tigard. OR 97223 (5031639 -4171 PARCEL: 2S113AD -01800
SITE ADDRESS: 16650 SW 72ND AVE B -12
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 011 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: S2 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 36 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: $ 43,000.00
Remarks: TI: new walls for tenant space.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES C.A. GREEN
15350 SW SEQUOIA PKWY #300 -WMI 15350 SW SEQUOIA PKWY. #300
PORTLAND, OR 97224 PORTALAND, OR 97224
Phone:
Phone: 503 - 624 -7717
Reg #: LIC 156496
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 5/11/2004 $418.30 Electrical Permit Required
TAX 8% State Surchar 5/11/2004 $33.46
Plumbing Permit Required
[TAX] t Framing Insp
[BUPPLN] Pln Rv 5/11/2004 $271.90 Insulation Insp
[FLS] FLS Pln Rv 5/11/2004 $167.32 Gyp Board Insp
Susp Ceiing Insp
Total
$890.98 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 or 1- 800 - 332 -2344.
/� A
Issued By: -- - emu — �--
Perm ittee
Signature: ' ��I�J . t�ApP/Z
CaII 639 -4175 by 7 p.m. for an inspection the n - business day
Bull 1Lri c Fermi 3 li 1ppiv A 6 owning -- • ``••�'" IF IGE ON - _ _
City of Tigard ®!l 40 XDO Re " j
Date /By ii lv 9 Permit No 1 /—Q7>��
r
13115 SW Hall Blvd.. Tigard, OR 972 Plan Reviev �� lJ/ ��✓ ���//// ��•��• i
401 I T ga n I
Phone: 503.6394171 Fax: 50.3. 9o. i 960 „� Date, By: Other Peniit:
Inspection Line: 503.639.4175 ,., _chrt ,� Date Ready /By: Juris: El See Attached Checklist for
Internet: www.ci.tigard.or.us 03 Notified/Method: „,.. , Supplemental Information
Gam3
TYPE OF WORK I 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
1 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 ArConmercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /04, s o Sij/ 704/ New dwelling area: square feet
City/ State/ZIP: 7b/1/v� 40 �,1 9 Garage/carport area: square feet
Suite/bldg. /apt. no. f� -/ Project name: Covered porch area: square feet
Cross street/directions to job site: . Off/ .. ._.. / Deck area: square feet
0 ' = I 4 / L , I/� - _ - Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 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.: equipment, materials, labor, overhead, and the profit for the
•
DESCRIPTION OF WORK work indicated on this application. �
��
Valuation: $
! � ' ' ek7 - 2V /D ep
Existing building area:square feet
� f/ New building area: 40 Sansquare feet
E] PROPERTY OWNER . ❑ TENANT Number of stories:
Name: PacTrus t Type of construction: 14-.4/ 4/4I/ /
Address: 15350 SW Sequoia Pkwy. , Suite 300 Occupancy groups:
City/State/ZIP: Portland, OR 97224 Existing: fA/4.'
Phone: ( 50 )
3 624 - 6300 F (5 03) 624 - 7755 N ew:
• APPLICANT . • ❑ CONTACT PERSON //14.';2—
TICE
Business name: Pa cTrust All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15350 SW Sequoia Pkwy. , Suite 300 jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/ State/ZIP: Portland, OR 97224 apply:
Phone: (503 624 - 6300 Fax:: ( 503) 624 - 7755
E -mail:
CONTRACTOR •
Business name: C.A. Green Company BUILDING PERMIT FEES*
Address: 15350 SW Sequoia Parkway, Suite 300 Please refer to fee schedule.
City/State/ZIP: Portland, OR 97224
Fees due upon application
Phone: ( 503 ) 624 - 7717 Fax: (503) 968 - 1686
Amount received
CCB lic.: 156496
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: ky i' �/ Date: 5 .1 * Fee methodology set by Tri -County Building Industry
111 ��' / Service Board.
i:\Building \Permits \BUP- PermitApp.doc 12/03 440- 4613T(11 /02/COM/WEB)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP A DD ?-0 --
Date Requested 7- 6 AM PM BUP
Location 411--to 7 a 114 Suite MEC
Contact Person Ph ( ) s3 s ( - oZ5.38 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain 7;$ ELR
Crawl Drain
Slab Inspection Notes: � � � SIT
Post & Beam Cis' ��
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm A e`
Susp'd Ceiling
Roof
&lir V Mr
PASS *ART FAIL W
71r"*7IT' G
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 �-� I 1
Service &B ha.®I1
Rough -In I
UG/Slab / \I / I W /' �� W
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: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL