Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #:
AI DEVELOPMENT SERVICES DATE ISSUED: 2 20/04 BUP2004-00063
•-° 13125 SW Hall Blvd., Tidard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16655 SW 72ND AVE 500 PARCEL: 2S113AC 00101
SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I -P
BLOCK: LOT: 029 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: 99 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: $ 33,000.00
Remarks: TI, create retail sales 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
[TAX] 8% State Surcharl 2/20/04 $27.46 Electrical Permit Required
[BUILD] Permit Fee 2/20/04 $343.30 Sprinkler Permit Required
Plumbing Permit Required
[BUPPLN] Pln Rv 2/20/04 $223.15 Framing lnsp
[FLS] FLS Pln Rv 2/20/04 $137.32 Gyp Board lnsp
Total Final Inspection
$731.23
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 (50 - . •9 or 1- 800 - 332 -2344.
•
Issu By: , ; • at
Pe nn ittee /
Signature: , f /lr : ,,,w e_
Call 639 -4175 by 7 p.m. for an inspection the next business day
• -20 ..0 1
. 'Bl�dh kgPiermit Appiication
J ! . .1 I City of Tigard / /! PCmntno -• b -ig/ r ..00 /
City
Address: 13125 SW Hall Bli� 4 Project/appl.n..: Expire date:. .
Phone: (503) 639 -4171 Date issued: By:. I Receipt no.: •
Fax: (503) 5984960 FEB 2 0 2004 Case file no.: Payment type:
Land use approval: CITY OF TIGARD 1&2 family: Simple Complex:
.. tr ∎ DIVISION - -
TYPE .OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/mdusttial 0 Multi - family 0 New construction 0 Demolition
0. Addition/alteration/replacement ,Tenant improvement 0 Fire sprinkler/alarm 0 Other. -
JOB SITE INFORMATION
Job address: &ea, 4 ail/ 7 4 0 r • 4(b Bldg. no.: ISuite no.: >�
Lot Block: Subdivision: Tax map/tax lot/account no.:
Project name: 6 /A /A .
Description and location of work on Fuemisedspecial conditions: / /Gff7 /Cr' Y /,- /!J/VJ 7,
,4, l/YA Z J .0 / f'1 - w !
OWNER FOR SPECIAL INFORMATION. USE CHECKLIST
Name: PacTrust • ( Floodplain , septic capacit) . solar, etc.)
Mailing address: 15350 SW Sequoia Pkwy., #300 1 & z family dwewng: _
City: Portland . state: OR IZIP:: 97224 Valuation of work ... $
503 I Phone :62456300 1Fax6a' 4'7 - /.'T. . E -mail: No. of bedrooms/baths .
Owner's representative: D e n n i s P ag n i Total number of floors
• Phone: Same . ax: S e . E-mail: New dwelling area (sq. ft.)
Garage/carport area (sq. ft.)
Name: P a C T r U S t Covered porch area (sq. ft.)
Mailing address:15 3 5 0 SW Sequoia Pkwy ., #300 Deck area (sq. ft.)
City: Portland State: 0 R I ZIP: 97224 Other structure area (sq. ft.) .
503 Phone:6 2 4 - 6300 Fax6 2 4- 7 7 5' E -mail: Commerdal indnstrial/multi- family: ,� C � ?'
CONTRACTOR Valuation of work $ ./'7J2
C � I' Existing bldg. area (sq. ft.) .. 3 2.0 , / , — ,�
Business name: �I' r N New bldg. area (sq. ft.) /
Address:1535 SW Sequo a Pkwy., #300 --
City: Portland. Istate:ORIzIP:97224 -
Number of stories
503 Phone6 2 4— 7717 I Fax: I E-mail: Type of construction
CCB no: 41328 Occupancy group(s): Existing: _
New: " S
City/memo lic. no.: Not ice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: J o h n R O m l s h provisions of ORS 701 and may be required to be licensed in the
Address: 15 3 5 0 SW Sequoia Pkwy . t #300 jurisdiction where work is being performed. If the applicant is
City: Portland I State: OR I �:9 7 2 2 4 exempt from licensing, the following reason applies:
Contact person: Plan no.:
503) Phone:624 -6300 Fax624 -775 E-mail: 'ohnr@ actrust 1 . com
Name: Contact person: Fees due upon application $ . '
Address: - Date received:
City: State: ZIP:. Amount received $
Phone: (Fax: 1E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not as jutisdcdoas accept aedit cards. please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this °visa O MasterCard -
work will be complied with, whethe s. ifred herein o • not. Gediz card maib« /
Authorized si /L ` + // cr d
%' e: vn°"� j� Name cerdholaa as shown as «edit card
Print name: . . it �. , ' csawdime $
‘ ‘ pmoaat
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440.4613 (6.VD/COM)
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