Permit K __ J ,,_�
CITY TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00210
4 DEVELOPMENT SERVICES DATE ISSUED: 4/29/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S113AC -00101
SITE ADDRESS: 16655 SW 72ND AVE 800
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: 150 BASEMENT: sf AREA SEP. RATED:
STOR: 1 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: $ 130,000.00
Remarks: Tenant improvement of 14,473 square feet.
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:
Phone: 624 -7717
Reg #: LIC 41328
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 4/29/03 $861.30 Electrical Permit Required
TAX 8% State Tax 4/29/03 $68.90
Plumbing Permit Required
[TAX] Framing Insp
[BUPPLN] Pln Rv 4/29/03 $559.85 Gyp Board Insp
[FLS] FLS Pln Rv 4/29/03 $344.52 Susp Ceilng Insp
Total Final Inspection
$1,834.57
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 ough OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 246 -669' or 1- 800 - 332 -2344.
I `
Issue By: , 1 ; 1 - ii .dr .4' 4
Pe rm ittee
Signature: ,..i./.,
Call 639 -4175 by 7 p.m. for an- inspection the next business day
•
A L Building Permit Application
Datereceived:
City of Tigard 1 AP 03 Pemano.: /, -Ana/.
`(j' �' '� Pmject/appl,no.: `. date:
Ciry ogard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued 1111 Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1&2 family Simple Complex:
TYPE OF PERMIT ;
0 1 & 2 family dwelling or accessory 0 Commercial/mdustrial 0 Multi- family 0 New construction 0 Demolition
❑:Addition/alteration/replacement ,Tenant improvement 0 Fire sprinkledalarm 0 Other:
JOB SITE INFORMATION •
Job address: / itiv _ %M , � r Bldg. no.: Suite no.: �.i� .
Lot Block: Subdivision: Tax map/tax lot/account no.:
Project name: 2, % ./f/rA •
Desch'tion and location f work on premises/special conditions: � V.S _ w . _' 0 -
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST -
Name: PacTrust • ( Floodplain , septic capacity. solar, ctc.)
Mailing address: 15350 SW Sequoia Pkwy., #300 I & 2.family dwelling: ,
city: Portland . State: ORIzIP:: 97224 Valuationofwork $ _. 'h.: - � ` "
503 Phone :5624 S63O0 OfFax62i4 --775 mail: • No. of bedrooms/baths ._ .
Owner's representative: D e n n i s P aq n i Total number of floors
• Phone: S ame . • Fax: S e E -mail: New dwelling area (sq. ft.)
Gamge/carport area (sq. ft.) -
Name: pa c T r U s t -. , Covered porch area (sq. ft,)
Mailing address:15 3 5 0 SW .Sequoia Pkwy ., #300 Deck area ( s• ft,)
City: Portland I state: O R J ZIP: 97224
Other stnrctu a area (sq. ft.) ............... ......_
503 Phone:624- 6300 Fax6 24 - 7 7 5 ' E -mail: Commercial/Industrial/maid �p/� �.
CONTRACTOR Valuation of work $ .�.�'.i } G� �
Existing bldg. area (sq. ft.)
Business name: H. L. Green
Address: T5 3 50 SW Sequoia Pkwy., #300 New bldg. area (sq, ft
City: Portland . . ( state: O R ZIP: 9 7 2 2 4 Number of stories .. ,
503 1 Phones 2 4 — 7 717 I Fax: I jrMail: Type of construction
CCB no.: 41328 Occupancy group(s): Existing: 47 5' -
New: ii� -
City/metro lic. no.: Notice: All contractors and subcontractors are req 1 . to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Boaidunder
Name: John R O m l sh provisions of ORS 701 and may be required to be licensed in the
Address: 1 5 3 5 0 SW Sequoia Pkwy . # 3 0 0 jurisdiction where work is being performed. If the applicant is
City: Portland ! State: 0 R I ZIP:9 7 2 2 4 exempt from licensing, the following reason applies:
Contact person: • Plan no.:
503) Phone:624 -6300 Fax - 775 E •ohnr@ actrust I . com
Name: Contact person: Fees due upon application $
Address: - Date received:
City: State: VIP:. Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule. -
1 • I hereby certify I have read and examined this application and the Not as jurisdictions immix credit ands, please call jurisdiction for mine r minimum ,
• attached checklist. All provisions of laws and ordinances governing this ❑visa 0 MasterCard
work will be complied 'di, whether s i r:• . • mi., o n , Credit card n"
Authorized signatu r i,/ / ..1 ; ,-..' Name of cardholder as shows on credit card Evian
$
Print name: ..,� � _P5 1 i = Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4404613 (6i00IC0M)
•