Permit ' BUILDING PERMIT
CITY TIGARD PERMIT #: BUP2003 -00346
4., _ DEVELOPMENT SERVICES DATE ISSUED: 6/10/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S135AB 00100
SITE ADDRESS: 10255 SW 90TH AVE
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DEM FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0 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:
Remarks: Demolition of 4800 sq foot school building (4th grade). All demolition debris to be removed from the site. Sewer to
be capped.
Owner: Contractor: .
WASHINGTON CLACKAMAS CO ROBINSON CONSTRUCTION
SCHOOL DIST 23J 21360 NW AMBERWOOD DR
6960 SW SANDBURG STREET HILLSBORO, OR 97124 -9321
TIGARD, OR 97223
Phone:
Phone: 503 - 645 -8531
Reg #: LIC 00063147
FEES REQUIRED INSPECTIONS
Description Date Amount Erosion Control Insp 846 -8.
[BUILD] Permit Fee 6/10/03 $62.50 Misc. Inspection _ ,.ei) Final Inspection Cep
[TAX] 8% State Tax 6/10/03 $5.00
[ERPRMT] Erosion 6/10/03 $26.00
[ERPLN] Ero Plck -USA 6/10/03 $8.45
(additional fees not listed here)
Total $110.40
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 - 001.0- thr 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 3) 246 -6699 or \1 -800- 332 -2344.
Issue B y: ,` • , 1. o alts ,_(►! / �� '
itt
Si
Signn ature: x
Call 639 -4175 by 7 p.m. for an inspection the next business day
.V -A)0 - . //c Lw
Building Permit Application - ` t ,FOR OFFICE USE ONLY {,
F '
, ' Received / . Building Dq -j �l/
R EC E1 I1 Date /By: ( flo 60 Permit No.:41629V - V 3 ,
City Of Tigard �/ Planning Approval Other
y g Date /By: Permit No.:
13125 SW Hall Blvd. a Plan Review Other
II 1 ®Z�o
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 03 598= 96 r /open fillil � \ Post- Review Land Use
• .J� 4G� 6' _ oT 11 Date /By: Case No.
Internet: www.ci.tigard.or.us 1 1y 7 � W Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information
m >E.. ektiZi „ 040. O NOO L::.; .:. .. a . ia Ti RE Q UIRED' D1 4 ,W
❑ New construction Demolition � ` j ,�, & 2 W ELLING `� ' ` z s r .
❑ Addition/alteration/replacement ❑ Other:
z # 4 `, s CATEGORYYOF; M .j Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling - Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi - Family
❑ Master Builder ❑ Other: Valuation $
`, ;2JOB SITETlINFO I OCATIONie No of bedrooms: No of baths:
Job site address: Z r .S(.✓ /0 el- A-v, .
Total number of floors
�� New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: /Zi etzle✓ Ceilleo y S4-40U/ Covered porch area (sq. ft.)
Cross streetJDirectio s to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
SW Lo k S-/: [ rs L
Sfree T ` f a t ¢ � QUIRED EITA` T ; ' l
k ' g . -�° 'WO. ..IMPINW `'USF CHECKLIST 3 , g
Subdivision: Lot #:
Tax map/parcel #: Note: Permit fees* are based on the total value of the work perfo ed. Indicate
0 � : . ';�DESCRI'P�TI®NOF� V,1'�ORK�....":: ",. _ � *����
v
the value (rounded to the nearest dollar) of all equipment, material , labor,
°° " overhead and profit for the work indicated on this application.
1 �
Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
PROPERTY OWNMi lt0 ' ENANT,y„ l Type of construction
Name: S7rp ems+/ BPD R--6-f" Occupancy Occupancy group(s): Existing:
New:
Address: d g 6 0 5i./ 14 d u 6— S r-
City /State /Zip: 71 6- / D a. 1 e/ 7 -2 ' 2 '3
Phone: 6;3 `�3 / — *o0 3 Fax: Sa3 - 4 3/ — f 7 NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
"' l NT WEICA : ',_ MErSCOISITIAVIOERSONIZSA provisions of ORS 701 and may be required to be licensed in the
Business Name: e agnrgh -s7 e✓‘ CoosiSn Al 6 jurisdiction where work is being performed. If the applicant is exempt
Contact Name: ,7gt-t►j /WO, from licensing, the following reason applies:
Address: Sit/0 $IJ M A2A1J 41/ 5 7 2D
City /State /Zip: -P0,4n D v2 ; 5 7 .z 3
Phone: 37i - ZR S - -ot Fax: ro3 - Z9a - / S' 9 6 r : 5' ;tom , „ fir
- BUII.iDING PERMITtFEES '
E -mail: pt, ha e Co ne ,- S1vA e r tg i a owl.. 1 ' ' > ix
O i' §" ,;r a r i 1 ;6 :: Pleas efer t *fee 4. , dule . k 'WA'.-- .. `' . 'l -4'
ear; s clte
Business Name: / 7 etg t , 3 oN Fees due upon application $
Address: y/ 3 (, o NW Anti 602-N V°9 bee,
City /State /Zip: H l i. b « 6 D to 6 ( ///Z-1- Amount received $
Phone: So) 6 r5 / Fax: 5 z 3 - 6`,s -5357 Date received:
CCBLic. #: „ IIt 7
Authorized ( � ^/ C/1)/3 ° Notice: This permit application expires if a permit is not obtained within
Signature: Date:
g 180 days after it has been accepted as complete.
Lib lik) /,Q e1,-- *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forrns\B1dgPermitApp.doc 01/03
Ti Plan Submittal Requirement Matrix
,, . I Commercial & Multi-Family
City of Tigard New, Additions or Alterations
TYRE OF SU 4 of Plans
(Indiud Ne o r A #y�Requ red �t�
(k Submitta
Site Work 4
(must include location of all accessible parking) •
Plumbing - Site Utilities 2
•
Building 1*
Fire Protection System 3 **
Mechanical 2
Plumbing - Building Fixtures 2..
Electrical 2
•
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 sets of plans for distribution purposes, (for Contractor.,. City of,Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
*For over - the - counter commercial tenant improvements', subniit'2 sets of plans.
•
** "New" fire protection systems require that plans bear'the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
is \Building \Forms \PlanSubMatrix.doc 04/03