Permit CITY OF T I G A R D BUILDING PERMIT
PERMIT #: BUP2002 -00058
it, DEVELOPMENT SERVICES DATE ISSUED: 3/4/02
AA '-" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15900 SW 116TH AVE PARCEL: 2S110CD -00105
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: NONE : sf N: S: E: W:
OCCUPANCY GRP: NONE 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: $ 20,000.00
Remarks: New sidewalk and handicap ramp to east side of building.
Owner: Contractor:
UNITED STATES NATIONAL BANK QUADRUS INC
REAL ESTATE MGMT DIV -T3 4647 SW HUBER ST
PO BOX 8837 PORTLAND, OR 97
P 9h RRone ND, OR 97208 Phone: 293 -8931
Reg #: LIC 88404
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Foot/Found Insp
PLCK CTR 2/20/02 $152.95 27200200000 Misc. Inspection
Final Inspection
PRMT CTR 3/4/02 $244.90 27200200000
5PCT CTR 3/4/02 $19.59 27200200000
Total $417.44
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 R 952 - 001 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or - 800 -332 -2344.
Pe rm ittee • ( \
Signature: q
Issued By: .L,,L,t,� . S 1 .(:64_,
Call 639 -4175 by 7 p.m. for an inspection the next business day
/ / /ri . / 2i " 0 Z/
TRI COUNTY •
SERVICE CENTER B uil d ing Pe r>r At pt OFFICE USE ONLY
\ Date received: ,002_ a . Permit no .APo?000? _ 000
(1=j: z City of King City
` , 13125 SW Hall Blvd. FEB ? 0 2002 Project/appl. no.: Expire da :
Tigard, OR 97223
Clackamas Date issued: By: 7\,�Receipt no.:
Multnomah Phone: (503) 639-4171, FAX: U I LD I N N GDNTS I ON Case file no.: Payment type: V
Washington (J
C O U N T I E S Land use approval: 1&2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 'Cornmercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: ^
JOB SITE INFORMATION
Job address: !Seipp 6i I La tlkv PUeiek_L Bldg. no.: Suite no.:
Lot: Block: � S � u � bdivision: ,,•, 1 Tax map /tax lot/account no.:-L5/ /j�ca / y /( 7S
Project name: u. dJ ( '�Z) r �.f�- - t y Q f�.V�h- f
Description and location of work on pr- mises/ ctarconditions: _....0 ' I � ::..1-_■ ta _■.
1 Ili
a
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
L Name: k 011.61L!.-) (Floodplain, septic capacity, solar, etc.)
Mailing address: 1 1 0.,0 S-\+- Ave, 1 & 2 family dwelling:
City: CO>s State: o e- ZIP: a l 1204 Valuation of work $
Phone: IFax: E -mail: No. of bedrooms/baths
Owners representative: 11, l GLWv, e5 Total number of floors
Phone: 21 b - 5d $ci Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: n( 1 \ 1_, , Covered porch area (sq. ft.)
Mailing address: 4-14 t R uJoec Deck area (sq. ft)
City: ) - .\ -A,, z State: 04_, ZIP:1-7 ii e Other structure area (sq. ft.)
Phone: 'al 3 1,,1 3 I Fax: Sp a -� 31 r•:, , Commercial/mdustrial/multi- family:
CONTRACTOR Valuation of work $ 20, 000
Business name: Q LJL/.l�S l �� ,
Existing bldg. area (sq. ft.)
Address: + New bldg. area (sq. ft.)
Lou 7 � I - Number of stories
City: ,�-t-t e I State: 04.1 ZIP: Gi - 1 Z t G Type of construction
Phone: Zii 3 ....e 1 Fax: 11 3131 341 E -mail: Occupancy group(s): Existing:
CCB no.: Sa 4 0th New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: Pykk_ra_ I.A, r,i S ew provisions of ORS 701 and may be required to be licensed in the
Address: 6-1 2_ _ , D D jurisdiction where work is being performed. If the applicant is
City: ({� 6,..p State: ZIP:t 2--11 exempt from licensing, the following reason applies:
Contact person: tCi_.0 0 j Plan no.:
Phone: Z4- - 1 1 D O Fax: Z45 -7
ENGINEER OFFICE USE ONLY
Name: Contact person: Fees due upon application $
Address: Date received:
City: 'State: ZIP: Amount received $ /5 ' , 7S
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 o Visa ❑ MasterCard
work will be complied ith, whether spe iffed herein or not. Credit card number: I /
Expires
Authorized Si nature: ate: 2 " 2 0 - 0 2- Name of cardholder as shown on credit card
Print name: C..pk I X616 Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted gs complete. 440 -461 (6/0O /CO I
,Q- [. P/ ° L Al /5,2 . ' 5 ' 1 d . .LS ,< . ez-' L . �1
t
lilt KING CITY NO Q DNua�n8
15300 S.W. 116th Avenue, King City, Oregon 972
r Z00Z n -)
Phone: (503) 639 -4082 • FAX (503) 639 -3771 83j
Q2AI232.
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd. Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: 1XS b"�.Y� °�- • [ YVtAP
located at: 1 59 11 l akJe-
King City Representative
I DSTS FCINST DOC
CITY OF TIGARD 24 -Hour
BUB.DING Inspection Line: (503) 639 -4175 MST t,
INSPECTION DIVISION Business Line: (503) 639 -4171
BU ' t �c � - Se
Received Date Requested `"/6 AM PM BUP
Location / S c i 6 0 / hi A& 44)-e— Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
UILDI Tenant/Owner i/S 8f-rlI ELC
Footing
Foundation ELC
Ftg Drain
Access: _ _ ELR
Crawl Drain • S
Slab Insp- tion otes: SIT
Post & Beam i/ -A = IV L= 1 ', t_
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
in
• PART FAIL
- ING
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
Service
Rough -In
UG /Slab
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 4/ ADA �' / 1 47 0 - L.---
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour -.1P114 lot
BUIt.DING Inspection Line: (503) 639 -4175 MST , ~ma y
INSPECTION DIVISION Business Line: (503) 639 -4171 BUP c 2-06 Ga 6005g
Received Date Requested _ oZ AM PM BUP
Location / /1 Suite MEC
Contact Person Ph ( ) PLM
Contr. - Ph ( ) 3_93 8 SWR
U PING Tenant/Owner C./ 5 ELC
ELC
• • • ation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam / J
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
0 . Other: �i,
PART FAIL
• I BING
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
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspe ion RE: Unable to inspect — no access
Fire Supply Line
ADA 3 / Z
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
• (7 ' II.
BUP - Building Permit ELC - Electrical Permit
J Inspection Description Date Passed By Inspection Description Date Passed Ity
Footing /Setback 3 ( 240 2 _ Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab _ Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Ener Permit
Roof nailing 4 Inspection Description Date Passed By
Firewall _ Low voltage _
Tilt -up panel Electrical final
Masonry/Reinforcement
Framing -
MFG-Structure set -up MEC - Mechanical Permit
Insulation J Inspection Description Date Passed By
Drywall nailing Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper _
Concrete Lab Final - Duct work
Bolting Lab Final Smoke detector
Structural observation
- Mechanical fmal
Fireproofing Lab Final
Final inspection L f i e" 2-- as 1---
C PLM - Plumbing Permit
.4 Inspection Description Date Passed By
BUP — Fire Protection System Permit - Plumbing underslab
4 Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
1
Sprinkler final _ RP/backflow preventer
Fire alarm final Rain drain
_ Storm drain _
Water service _
SIT - Site Permit Sanitary sewer _ _
J Inspection Description Date Passed By — Culvert/catch basin _
Footings Pump /fill septic tank
Foundation walls Plumbing fmal
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils 4 Inspection Description .. Date Passed By
Engineering acceptance _ - Sanitary sewer
Final inspection - Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
is fists\ forms \InspRecordBUP.doc 04 /17/01
J
A
CITY OF TIGARD BUILDING PERMI
PERMIT #: BUP2002 -00058
fll�l� DEVELO PMENT r O
SERVICES 639 -4171 DATE ISSUED: 3/4/02
SW Hall
SITE ADDRESS: 15900 SW 116TH AVE PARCEL: 2S110CD 00105
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ACS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: NONE : sf N: S: E: W:
OCCUPANCY GRP: NONE 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: $ 20,000.00
Remarks: New sidewalk and handicap ramp to east side of building.
Owner: Contractor:
UNITED STATES NATIONAL BANK QUADRUS INC
REAL ESTATE MGMT DIV -T3 4647 SW HUBER ST
PO BOX 8837 PORTLAND, OR 97
PORT OR 97208 Phone: 293 -8931
o:
Reg #:
LIC 88404
• FEES REQUIRED INSPECTIONS we
V
Type By Date Amount Receipt Foot/Found Insp
PLCK CTR 2/20/02 $152.95 27200200000 Misc. Inspection
Final Inspection
PRMT CTR 3/4/02 $244.90 27200200000
5PCT CTR 3/4/02 $19.59 27200200000 lib
Total $417.44
lb
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 4
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 • a R 952 - 001 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or - 800 -332- 344. 0
Signature:
S ^(`
Sigure: , C •(
UP )
Issued By: ,O .c , SL / ..f/l_
CD
Call 639 -4175 by 7 p.m. for an inspection the next business day