Permit • CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2001 -00292
o ' i i i
DEVELOPMENT r S o ER9 ICES 1 639 -4171 DATE ISSUED: 8/15/01
SITE ADDRESS: 17005 SW 92ND AVENUE PARCEL: 2S114A0-01500
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: p4CV 01—P1 FIRST: 496 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: 496.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 4 BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: 14 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:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 60,000.00
Remarks: 469 square foot gazebo
Owner: Contractor:
TIGARD, CITY OF NORTHWEST EARTHMOVERS INC
13125 SW HALL PO BOX 1467
TIGARD, OR 97223 TUALATIN, OR 97062
Phone: Phone:
Reg #: LAC 00062761
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Foot/Found lnsp
Framing Insp
Final Inspection
Total
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 o1'800-332344.
Pe rm ittee
Signature: �( - � �I //
A ,
Issued B i !I, -_1_
Call 639 -4175 b 7 p.m. for an inspection the next business day
Building Permit Application
y _,,11 " City of Tigard D ate received: 2 / 4/ Permit no.: 646,60/-616 . 92, .
•!!+' "_ Project/appl. no.: Expire date:
CirygfTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receiptno.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: --1-4 --1-4 1 Q O9000 -dop(,1 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm • ❑ Other:
JOB SITE INFORMATION
Job address: ' ELY — 70, c i) (M /17 E,, Bldg. no.: Suite no.: '
Lot: Block: Subdivision: Tax map/tax lot/account no.: ,�/
Project name: . r A — �`,;.' ►AIM
= Ii s �6_ !'`'�
Descri ption and loqation c f work on f - mises/spe . conditions: , -.1 , . Oi --i.ITi" e Agog`
..ter' :, •' 4);_‹ �. _ � �DVN� :s f��
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
IEWErilril
w (Floodplain, septic capacity, solar, etc.)
Mailing addres• 3 ot'T � , • j /3 va_ 1 & 2 family dwelling:
I Stater ZIP: g 3 Valuation of work $
Phone:56 . - -q Fax: E -mail: No. of bedrooms/baths
Owner's representative: „MFtgnlliIllMIM Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.)
OF Covered porch area (sq. ft.)
Mailing address: A 6 v — 4.) Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi- family:
Valuation of work $ (' o ChS0 • c.)0
CONTRACTOR 1
• ir■ Existing bldg. area (sq. ft.)
Business name: /v® .,L 1 „ , r
N ew bldg. area (sq. ft.) 7 6 q sq •
Address: ..6 . i7. _, 7 /
Number of stories
City: 7 4- MIIIMMEMITOM ZIP: ° /'7 0 - a__
Type of construction
Phone: &,9_ &3 Fax: E -mail: Occupancy group(s): Existing:
CCB no.: 0 2 7 I 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: Ail ti . _ :i1 provisions of ORS 701 and may be required to be licensed in the
Address: v� jurisdiction where work is being performed. If the applicant is
MIN • ITIMMINNEEETAM ZIP: _ 13
exempt from licensing, the following reason applies:
Contact person: ilineTM Plan no.:
Phone:_05 - .Y721 E -mail:
ENGINEER
.�. .; Contact person: ` , A x • Fees due upon application $
Address: S 3 - .. lagi . 1 °•{ 36-e.) Date received:
® �d YI ZIP: ® Amount received $
Phone: ," LM> 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 pro isitns of laws and ordinances governing this Li Visa ❑ MasterCard
work will be complied wi t y, ' ether cified herein or not. Credit card number: / /
Expires
,ij
Authorized signatu e: ����'L. ,._ Date: 1 ° I Name of cardholder as shown on credit card $
Print name: • MIME O Cardholder signature Amount
1
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)
C h 62-5-,g, mo0.
•
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
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 plan sets for distribution purposes (for Contractor, City of
Tigard, Washington County, and Tualatin Valley Fire & Rescue).
Total # of
t TYPEOF' S U BMITTFAL f Plans° < KEY:
;" ° Subbltted
S = Site Work (must include
S (New, Add or Alt) 4 location of all accessible parking)
B (New, Add or Alt) 1* B' = Building
F (New, Add or Alt) 3 ** F = Fire Protection System
M (New, Add or Alt) 2 M = Mechanical
P (New, Add or Alt) 2 P = Plumbing
E (New, Add, or Alt) 2 E = Electrical
New = New Building
Add = Addition
Alt = Alteration to existing
building
*For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" requires that plans bear the original seal of an Oregon licensed fire
suppression engineer, or NICET level "3" technicians.
•
I: \dsts \forms \matrxcom.doc 10/27/00
CITY OF TIGARD - 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
$up — 0/ 6d.7-gL
Received Date Requested �� , AM PM BUP
Location 0' �a //4 aa v Suite MEC
Contact Person '�^ Ph ( ) g�� PLM
Contractor Ph ( SWR
' G Tenant/Owner ELC
Foo ing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int ear
rmin
nsu ation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm eg S s4414
Susp'd Ceiling
Roof
Other:
- ART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole '
Storm Drain
Shower Pan / • I
Other:
Final
PASS PART FAIL
MECHANICAL 7,
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 Hail, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line ra / �v •
Approach/Sidewalk Date & Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL