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Permit Buildin • Permit A I s_lication. FOR OFFICE USE ONLY - - ?; __. tt e, � , U_ ,i /0 Received 7 2 Q 2 Building 0 � ^` =k .. t : D J Permit No.: D 6 W Cit O Ti and - '.3 Other Y g Date /By: Permit No.: 13125 SW Hall Blvd. ' APR 2 2 NC? I V\ ,� Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 �M X1960 IC k do l l �°i'. '.1 Post - Review Land Use Internet: www.ci.tigard.or.us BUILDING DIV :e`. � Date /By: Case No. Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information WORK - .: - <:; b:•r��' ,E IX REQUIRED DATAK:: !X New construction ❑ Demolition , . .. if & 2'FAMILY DWELLING : T ' ❑ Addition/alteration/replacement ❑ Other: ' ,.. CATEGORYOF= CONSTRUCTION` :'`.: ; Note: Permit fees* are based on the total value of the work performed. Indicate ❑ 1 & 2- Family dwelling 154 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 $ ; • .'• ,.::: - ' :.:-' � '.. : .. gar? J. OB° SITE`WFQRMATIQN. .; ,, ":';;..: " . No of bedrooms: No of baths: Total number of floors Job site address: �I'i S Sia S et`' LA. . New dwelling area (sq. ft.) Suite #: Bldg./Apt. #: Garage /carport area (sq. ft.) Project Name: 2t1,14t 4\--r- - qv._ Covered porch area (sq. ft.) - Cross street/Directions to job site: '3 Deck area (sq. ft.) \ , . @ // = ' ( C � Other structure area (sq. ft.) • ` ✓ all '' Su.) a t'e --e4^ ' ` .` . ; ;i :::,�, ^:-:; • iy ,;z':au� ..;ai. :?°�1•L'„".�.:, t.s�° t c %'..�� . a`= = ` r � , ', +' REQ.UIR DATA' . Y" z .:'w > '- -F t :�,Ifi�� � 'c r �� x y r.. , � , �e .fx fi rh• z w' u�,k�s'. a u.a _ 1 .fi ,$ ' • COMMERCIAL 1USEtCHECIKLIST t ' !f Subdivision: Lot #: ,<':4`- ,,i, .i14 _ _ .� f ,- mar 'k. . - _x n .ate .,--,1.:: . ; 4..._....,. Tax map /parcel #: ./s135 31 CO a ©0 Note: Permit fees* are based on the total value of the work performed. Indicate {_., -._', ig.€rjDESCRIPTIONrOFW,ORK `= M):�` +r•~ the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. .kit` -- r _IAiekv ii.,\ , 13 -01k, Lee_ -l• Valuation $ •/ ,,� � t �/� Existing building area (sq. ft.) `g e; � ° i_ ) ' New building area (sq. ft.) • Number of stories its' K�PR`QPERT'�YiOWNEitNj?'m=� :��„, ,� iTENA1VT:���.i<'x jam'- ��;;gig` Type of construction Name: lbo' „t to . „ ^ Occupancy group(s): Existing: New: Address: 91 2,r, e.,i e, .aek LA.. City /State /Zip: i 1 c, ,ir & I 0 , 1 t a� NOTICE: All contractors and subcontractors are required to be Phone: 5^3 -6`t- t Wi Fax licensed with the Oregon Construction Contractors Board under gi, A`PPI ICANTifi ° itibMi i >1 ® CQNrTACT PERSQN.EI 's provisions of ORS 701 and may be required to be licensed in the Business Name: e e, p k 1 I.tiG , jurisdiction where work is being performed. If the applicant is exempt Contact Name: j '1 N z_ 0.�Jy from licensing, the following reason applies: Address: t`ta2 '5 ?,,-oc ij-.1c�.. City /State /Zip: N,1 Go- :,.. \-e„r ,,vim 1 9666 Phone: 340 -q b Ha9 Fax:-460_906 `iea ,. - ., - N R „,, ,A.K .t;i, } . , '� �: , � c �BU ILDINGIPERMIT .�EEES *ir;�� "" t� € 4< =.; tt l ,,e; : E -mail: k4-z_ o 1 �� ; : _ . "f"� t-i a ` a rlr y _ ig i ; ^ r ; l ia.ig �"%�', r ' i ' ^. ,: _ ,1 . °:. y,�, P schedule. > ��:��`�w. t v..r - yift' : - °t j - '1 {'- s . Y e!�d '.., 4 - � y y .. -Pik "" - .. �z - ,: b'•= _'. ",. ; i �:,� ^. .X.._ ^,"Yny �+'..5.'• .: -:'lrs�'�S' 1'�.. r)� "!s :� .�.".� v r-. '��$' ... r �YYti :'^V�. A €� �� .. s '"`�' "� ,•..'i.. M :r"Fj �?'t *� _ �„��' b.� .. G - a- ,.:..�.: �i'?.{ �'•" �..,. �. k'2.,....: a�.&._ �4X± �as�.. �.;: i:.• a. �` tc��� :_,- i:.�'s�:.t',..',_'a: . : _a��•_`ta„ : �: zr�ir� :�;�:�CONTRAC�TOR�t�._.. ., -,r_ .. . .- ....�. __. Business Name: bV Z (1 p,It5+1' (AC. -ly'\-- Fees due upon application $ Address: -p u) v sn, City /State /Zip: C; ,e o-R , i Li b Amount received $ Phone: SL-i 1 -343-at-t3(, _ tax: SLi 1 - v, S ° (Ay ' Date received: CCB Lic. #: (pq 0 6 Authori ,. )�QG Notice: This permit application expires if a permit is not obtained within Signature -Date: 180 days after it has been accepted as complete. �kN_ ct • Z 1I \& 'C 1 Lt' *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) o257. 9- 7 4' , — 5 7 is \Dsts\Permit Forms\BldgPermitApp.doc 01/03 /58•3c1/4i A 7(D, , Exhibit / Page .Sll) of .,/-D—Pages �� at :, Commercial Application Checklist R EC E Y E D A_1t City of Tigard APR 2 2 2003 City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 Phone: (503) 639 -4171, Fax: (503) 598 -1960 CITY OF TIGARD Internet address: www.ci.tigard.or.us BUILDING DIVISION • ' PROJECT INFORMATION Project name: ( S Date: vi 0 3 Address: 97g5—az,0 J! City: a � State: 0 R ZIP: c o R a 3 Scope of work: F r i - S-kr,ndt 1 �r °•i•'� vrs`e�..i -�CQ S' ti Q k-t N ,w,T- c.rea1 C sec_ -hb I G.7 0.010 C )(i Map and tax -lot no.: Reference no.: p 1S / 3 c a o Contact person name: Joky, Ft,+ZVIAo.afirtc. Company: Vike Phone: (3 ( 0 0 ) c i 06 b`l Fax: (36o) ci66 (D4 - t Cellular phone , 0 1 `I q 3 (� c E -mail: �S l-`kZ a () O[ NOTES AND INSTRUCTIONS • The purpose of this checklist is to help define a complete submittal package for the scope of work. Plan review will not take place until a complete package is submitted. • This checklist can be used for all commercial construction projects, including new construction, additions, alterations and tenant improvements. • For complex projects, applicants should use the "location" space to note the item's location and page number from the plans or the specification book. • It is not necessary to duplicate submittal information, even if it is asked for in multiple sections. • In the checklist, "Required" means that the applicant must provide this information for plan review. • In the checklist, "P" means — • if checked by the applicant — the information is provided for the plan review. • • if checked by the plans reviewer — this information is required for the plan review. • In the checklist, "NA" means that the information does not apply. • Choose only those sections of the checklist that apply to your scope of work. Section 1.0, "General Project Data," must be included with each .ro'ect submitted. PRE- SUBMITTAL PROCESS An applicant may request a pre - submittal meeting with representatives of the jurisdiction in which the project will be built. The meeting may take place during the conceptual, schematic, or in- progress phase, or when the applicant has completed plans. INDEX OF CHECKLIST SECTIONS 1.0 General project data Page 2 7.0 Mechanical data (Types I and II 2.0 Civil data Page 2 kitchen -hood permits) Page 6 3.0 Architectural data Page 3 8.0 Plumbing data Page 7 4.0 Structural data Page 4 9.0 Electrical data Page 8 5.0 Mechanical data (new construction, tenant 10.0 Fire - suppression data Page 9 improvement, gas - piping permits) Page 5 11.0 Fire - detection and fire -alarm data Page 9 6.0 Mechanical data (additional or replacement 12.0 Re -roof installation data Page 10 rooftop- equipment installation permits) Page 6 13.0 Jurisdictional requirements Page 10 This checklist is for building department jurisdictions in Clackamas, Multnomah, and Washington counties. 440 -2734 (8/01 /WEB /COM) i:\ Dsts\Forms \COM- AppChecklist.doc 05/29/02 Exhibit /H Pap S/ of /lf�- Pao^s r SECTION 1.0 — GENERAL PROJECT DATA - Construction documents Location (sheet number or spec section) 1.1 ® Required No. of sets of plans: New: 1 TI: 2 1.2 Z Required Cover sheet title block 1.3 ® Required Cover sheet vicinity map 1.4 ® Required Cover sheet plan index 1.5 ❑ P ❑ NA Code summary 1.6 ❑ P ❑ NA Deferred submittal summary 1.7 ❑ P ❑ NA Professional stamp and signature 1.8 ❑ P ❑ NA Fire and life - safety plan 1.9 ❑ P ❑ NA Landscape plan 1.10 ❑ P ❑ NA Landscape specifications Supporting documents Notes 1.20 ❑ P ❑ NA Land -use or planning actions 1.21 ❑ P • ❑ NA Required fire -flow calculations 1.22 ❑ P ❑ NA Fire- hydrant flow -test report 1.23 ❑ P ❑ NA Fire department or fire district building survey report 1.24 ❑ P ❑ NA Material safety data sheets (MSDS) • SECTION 2.0 CIVIL DATA • Construction documents Location (sheet number or spec section) 2.1 ® Required Site plan 2.2 ® Required Site utility plan 2.3 ® Required Grading plan 2.4 ® Required Erosion - control plan 2.5 ❑ P ❑ NA Utility -vault location and details Supporting documents Notes 2.20 ❑ P ❑ NA Geotechnical/soil engineer report 2.21 ❑ P ❑ NA Storm -water calculations 2.22 ❑ P ❑ NA Site retaining -wall structural calculations 2.23 ❑ P ❑ NA "Assurance of Compliance" with environmental rules .... 440 -2734 (8 /01/WEB /COM) Tri- County Commercial Application Checklist 2 For use in building department jurisdictions in Clackamas, Multnomah, and Washington Counties i:\ Dsts\Forms \COM- AppChecklist.doc Exhibit 1N Page 57.. of /8 Pages . SECTION 3.0 ARCHITECTURAL DATA Construction documents Location (sheet number or spec section) 3.1 ® Required . Floor plan(s) 3.2 ® Required Transverse and longitudinal cross sections 3.3 ® Required OSSC Chapter 11 accessibility requirements 3.4 ❑ P ❑ NA Interior elevations 3.5 ❑ P ❑ NA Exterior elevations • 3.6 ❑ P ❑ NA Roof plans 3.7 ❑ P ❑ NA Exterior wall sections and details 3.8 ❑ P ❑ NA Reflected ceiling plan(s) 3.9 ❑ P ❑ NA Fire -rated construction details 3.10 ❑ P ❑ NA Energy code compliant construction details and specifications 3.11 ❑ P ❑ NA Door schedule 3.12 ❑ P ❑ NA Glazing schedule 3.13 ❑ P ❑ NA Furniture plan Supporting documents Notes 3.20 ❑ P ❑ NA Energy code compliance forms /calculations 3.21 ❑ P ❑ NA Material safety data sheets (MSDS) 3.22 ❑ P ❑ NA Hazardous materials inventory statement (HMIS) 3.23 ❑ P ❑ NA Hazardous materials management plan (HMMP) 3.24 ❑ P ❑ NA Written fire and life- safety evacuation plan for area of rescue assistance 3.25 ❑ P ❑ NA Active and passive smoke - control information 440 -2734 (8 /01/WEB /COM) Tri- County Commercial Application Checklist 3 For use in building department jurisdictions in Clackamas, Multnomah, and Washington Counties i:\Dsts\Forms\COM-AppChecklist.doc Exhibit /`/ Page S of )8-? —Pages . r , SECTION 4.0 STRUCTURAL DATA Construction documents Location (sheet number or spec section) 4.1 ® Required Structural cover sheet 42 ❑ P ❑ NA Foundation plan 4.3 ❑ P ❑ NA Under -slab mechanical plan 4.4 ❑ P ❑ NA Under -slab electrical plan 4.5 ❑ P ❑ NA Under -slab plumbing plan 4.6 ❑ P ❑ NA Floor framing plan 4.7 ❑ P ❑ NA Roof framing plan 4.8 ❑ P ❑ NA Structural elevations 4.9 ❑ P ❑ NA Structural details and cross sections 4.10 ❑ P ❑ NA Standpipe information 4.11 ❑ P ❑ NA Special inspector /structural observation matrix Supporting documents Notes 4.20 ❑ P ❑ NA Geotechnical /soil engineer report 4.21 ❑ P ❑ NA Site - specific seismic hazard report 4.22 ❑ P ❑ NA Design narrative 4.23 ❑ P ❑ NA Structural calculations • • 440 -2734 (8 /01/WEB /COM) Tri- County Commercial Application Checklist 4 For use in building department jurisdictions in Clackamas, Multnomah, and Washington Counties i:\ Dsts\Forms \COM- AppChecklist.doc Exhibit 1W Page 54_ of /8 Pages 1 APR 22 20C3 CITY OF TIG, DIVis ;CN City of Tigard Planning and Building Department Tigard, Oregon RE: Authorization To Apply For Permits Letter To Whom It May Concern/City of Tigard: This letter authorizes Media Art, Inc. to apply for the issuance of all necessary permits to construct an Off Premise Advertising Sign (Billboard) located on my property at: 9785 S.W. SHADY LANE TIGARD, OREGON 97223 Land Owner Name: Print DONALD L. HUGGINS uthorized Land • . er/R presentative Signed I i / � Authorized L. d r ! ner ref esentative Date: Exhibit ' ` /C i Page Hof /- Pages co 0 . r - ,� ti _; O t` G d Q 44 r, 7,;,. F OUTDOOR ADVERTISING BUSINESS LICENSE Department of Transportation 355 Capitol St NE Rm 408 Salem OR 97301 -3871 Media Art Inc License No: M921 1923 Broadway Vancouver OR 98663 Issue Date: April 1, 2003 This is to certify the above name is licensed to engage in the business of outdoor advertising in the State of Oregon - p F_ o State of Oregon by and through its Department of Transportation Z By (. 3/4 Outy 4o Advertising Program Technician Expires June 30, 2003 t;i CD -- - ---------------- m U, 0). Site Plan Scale- 1"=35' APR 22 2003 • HIGHWAY 217 CITY OF TIGARD BUILDING DIVISION klievn 91 S _ 15 ` Sul Sk0i y Lek. s R. 0 ry CO z o s uJ � --i U W 'n om V — • • / -._... 1 SW SHADY LANE • • Exhibit /(o • Page f 1 ?a-- -Pages