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Permit Build Perm A lication FOR OFFICE USE ONLY Received y Building / uilding City of Tigard I t' : 03 Permit N. rs*_ - 00 g A pproval Other 13125 SW Hall Blvd. '• Perm No.: Tigard, Oregon 97223 ,, Plan Review Other it Phone: 503- 639 -4171 Fax: 503 - 591.,_6,0 �� Land No.: 8, Use Internet: www.ci.ti dor ' I " � � r , - c � - �jj a�,;3 'ost- Review Land Use gar ;' LL ++��G DIVi.�'� ell„ :t " � ' ' Case No. : 50 -6 39.4175 Contact Juris.: e See Page 2 for 24 -hour Inspection Request Nave/Method: Su . lemental Information TYPE OF WORK New construction REQUIRED DATA: D emolition 1 & 2:FAMILY DWELLING ❑ Addition/alteration/r .lacement D Other: CATEGORY OF CONSTRUCTION • . No te: Permit fees* are based on the total value of the work al & 2 -Famil dwellin : � performed. Indicate it coinmercialfindustrial the value (rounded to the nearest dollar) of all equipment, materials, labor, 111 Access() Buildin: Mamjl overhead and profit for the work indicated on this application. ❑ Master Builder • Other: — Valuation - • JOB SITE INF ORMATTON , OCATION - No. of bedrooms: No. of baths: $ a d I: Job site address: / *��jl Total number of floors. . ��ri it Suite #: Bld_./ .t. #: New dwelling area (sq. 11.) Pro'ect Name: « _ i / ` i� Garage/carport area (sq. R) Cross street/Directions to job site: Covered porch area (sq. ft.) Deck area (sq. ft) Other structure area (sq. It) 5Z<) 707 4 -I Aver r SI✓ de 1 /1- Red r u . REQUmED DATA Subdivision: Lot th ear-0 C�OMIVVIERC W, =USE CHECKLIST Tax ma. /. arcel #: .2S / /.Z 44- Note: Pemit fees* are based on the total value of the work performed. Indicate : .:- %DESCRIPTION OF WORK - the value (rou to the nearest dollar) — ) of all equipment, materials, labor, T A/d/ �, �' �4/l�l. ■�„ overhead and profit for the work indicated on this application. 4 "` __- /rte- ' _ /e. • ., . Valuation ,(� D.:_,,- i "' - cP• ..C9 • D 4 • e ■ Existing building area (sq. ft) $ / CC _ New building area (sq. ft.) f �s , lE'ROPERTY.O . a Number of stories. Name: • E . - Type of constr-,: on , Name: 7, - , { - , = , . - SP' Occupancy group(s): Existing: . (0,, � ': S E _ 3 •' � d New: . /State/Zi e : A , 44v40 it_ " 7 Phone- ,, _ - - luat . F Fax : .i3 :29 -/ / ` - NOTICE: All contractors and subcontractors are required censed with the r teed to under �� - �NTA��I:RSON � =''� >-' li Ore Construction Contractors Board under Business Name: 7t22,,-.9- At/. SAC provis of ORS 701 and may be required to be licensed in the Contact Name: n �, jurisdiction where work is being performed. If the applicant is exempt -, from licensing, the following reason applies: Address: _ ,g owe sr" T" Ci /Sta te/Zi .: d--# e ' t c . Phone :J(_ �� .D Fax: -p G6 - E mail � �; f ••acr ^F- � . x y * L S y ��+ 1c. _ de. / e_ or C eYl� 7 44 �" VI"I/ RO i`i .. 4 - , t , r = K'.-7 x:k iaCON 'RAC OIC ri''Y i : - .1.,•:.R- 7 ::-. 1 : - ' .:,.� 4, . �C$Se Cfel' C��CI _ _ ...le 4 s �� „ B usiness Name: o ice C.e - 0 .'��.. •, ..�.� ... s_ _ -_ . � ..�::.� _ _._ Address: i es due G t -' . / 3 ,. upon application _ ... $ Ci /State//Zi e : e -4.16- „,/e_ ` Amount received... Phone; j 93 , 6 CCB Lie. #: e9 Date received: Authorized Notice: This Signature. ��� . w Date: permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. (Please print name) *Fee methodology set by Tt i- County Building Industry Service Board. i :\Dsts\Permit Forms \BldgPermitApp doc 01103 Exhibit 7 Pere `� i of / 2L 15ages • Commercial Application ChecklistRECE '` U= 1.11. City of Tigard APR 22 2003 City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIG�= Phone: (503) 639 -4171, Fax: (503) 598 -1960 BUILDING DIVA,.. Internet address: www.ci.tigard.or.us PROJECT INFORMATION Project name: maw S Date: y/J /0 Address: 674 t.3 /�N /7 - F Rd - City:f j . °tie, State: 0 ZIP: 97,9 a 3 t 1 r nl C ale s-e_ fiv v� Scope of work: Free- - S l ��� �"'� new= -u,��� o r��v.Q S �� ��r �a �c g (3;7 8©` 010 CE > 0-) e Map and tax -lot no.: ' 1 Reference no.: p 15135 - T3 -- 00a 00 Contact person name: J � ,}.z k m A tdur Company: ol Phone: (36 X 06- di Fax: (36o) qo6- oyLt a Cellular phone o- ' m_ 3 (( E -mail: ST` - 2 300[ ( , •L, (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 R Page 1L of / /r2- Pages . • N 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 ® 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/O1/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 7 Page of / cr - L a s • 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 a' Page lap of /2- Pages SECTION 4.0 — STRUCTURAL DATA Construction documents Location (sheet number or spec section) 4.1 ® Required Structural cover sheet 4.2 ❑ 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 /O1/WEB /COM) Tri- County Commercial Application Checklist 4 For use in building department jurisdictions in Clackamas, Multnomah, and Washington Counties i:\ Dsts\Fotms\COM- AppCheck1ist.doc Exhibit e17 Pa )) of /L e Pages —APR. 21. 2003— 7:57AM— »_RREEF NO 655 P. 2 • R ECE , . �_ APR 22 2003 . • • CITY OF TIGARD AC BUILDIN:; DIV -- -^ 1 MS Interstate 5 A a aal On m ==1:1 m CD CM m m Q , } _ _ ' 1 ',I rlh1Hlllf ti l l ' r4 ' 1Ylll/! 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