Permit - CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2001 -00002
gif DEVELOPMENT SERVICES DATE ISSUED: 1/3/01
= - �� � I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11569 SW PACIFIC HY PARCEL: 1S136D6 -00201
W
SUBDIVISION: FRED MEYER ZONING: C -G
BLOCK: LOT: 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: UNK : sf N: S: E: W:
OCCUPANCY GRP: M 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: $ 2,000.00
Remarks: Demolition permit for tenant space being demolished for Fred Meyer remodel. Plumbing permit is required to do
fixture count for credit of capped fixtures. All demolition material must be removed and the sewer capped.
Owner: Contractor:
WILMINGTON TRUST CO, TRUSTEE ANDERSEN CONSTRUCTION
BY FRED MEYER, INC 6712 N CUTTER CIRCLE
3800 SE 22ND AVE
7 2 2 PO 6712 R g
P lff a Ngb 6259652 P O Pho e NZ8 6712
Reg #: LIC 63053
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Cap sewer line
PRMT CTR 1/3/01 $62.50 27200100000 Final Inspection
5PCT CTR 1/3/01 $5.00 27200100000
EROS CTR 1/3/01 $26.00 27200100000
ERPC CTR 1/3/01 $8.45 27200100000
(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 -0010 through OAR 952 - 001 -1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246 -1987.
•
Pe mi itee /
Signature: OA/ - J ' z../ e e 7d
•�I
Issued By: �F
Call 639 -4175 by 7 p.m. for an inspection the next business day
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-a.
Building Permit Application
� , ^ Datereceived: of -o 3 -a/ Permit no.:4e.,/ - a0lJD:t
�,1y City of Tigard
^_� Project/appl.no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 -4171 Date issued: By:. I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: _�0 Se Alte /,% '/26 sheer Bldg. no.: Suite no.:
Lot: j� Subdivision: Tax map /tax lot/account no.:
Project name: AWE .14 r
Description and loca r on o on preinises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST '•
IEM /i Mi _� / (Floodplain, septic capacity, solar, etc.)
Mailing address: : s_� _ e �� I & 2 family dwelling:
1yi� ,�.ft rj.. ZIP: ,Z Valuation of work $
Phone: Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
• Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E- mail: Commercial/industrial/multi- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
�� New bldg. area (sq. ft.)
Address: �� ♦ ��
Number of stories
I
iJ– ZIP: � Type of construction
Phone: - we„,„ A;_ -to E -mail: Occupancy group(s): Existing: ,e2 immi lmil CCB no.: , 0 ,, , ,
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
EMII.7 i= , �_ `�_ ✓� provisions of ORS 701 and may be required to be licensed in the
Address: gaip i - J jurisdiction where work is being performed. If the applicant is
exempt from licensing, the following reason applies:
? %. � i - '1i ZIP: Y� P g, g PP
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
;, ag — :.,-1111 Contact person: Fees due upon application $ /D , `w
Address: S� 0,;-/ 7. i Date received:
City: State: ZIP: Amount received $
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 ❑ Visa ❑ MasterCard
work will be complied with, whether specified herein or not. Credit card number. / /
Expires
Authorized signature: Date: Name of cardholder as shown on credit card
$
Print name:
Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (rwVWWCOM)
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CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639- 4175t,siness Line: 639 -4171 _ 000 Z
//470-2.--- Date Requested /� �11 AM PM BLD
Location / / S6 C (� L- /' Suite MEC
Contact Person Ph PLM
Contractor _ Ph SWR
�i?fL[SING Tenant/Owner h ELC
Retaining Wall' ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling �
Roof
Misc:
in
ePASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Date 1/476 � ,� Other Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.