Permit f.
•
CITY OF TIGARD BUILDING PERMIT
P ERMIT #: BUP2004 -00218
` DEVELOPMENT Tigard. OR 9 SERVICES
1639 -4171 CES DATE ISSUED: 5/13/2004
- 13125 SW Hall Blvd..
SITE ADDRESS: 11745 SW PACIFIC HWY PARCEL: 1S136CD -01000
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: - S: E: W:
OCCUPANCY GRP: M 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: $ 1,500.00
Remarks: Free standing sign.
Owner: Contractor:
MONAGHAN FARMS, INC CROWN CARPET
14120 EAST EVANS AVE 21655 SE STARK
AURORA, CO 80014 TIGARD, OR 97030
Phone:
Phone: 503 - 244 -8813
Reg #: LIC 2690
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 5/13/2004 $62.50
[TAX] 8% State Surcharl 5/13/2004 $5.00
Total $67.50
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 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -23-
Issued By:
Permittee
Signature: • ' y ��� ` ,��j`
II 639 -4175 by 7 p.m. for an inspection the next business day
A.
Building Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Dat : ; U / p I � Permit No. ���
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 61 Dat e/ Other Permit:
'jrll�
Inspection Line: 503.639.4175 IL Date Ready/By: kris: ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
' TYPE OF WORK ' . , . REQUIRED DATA:1- AND 2- FAMI DWELLING.
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
$' Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION , work indicated on this application.
❑ 1- and 2- family dwelling RCommercial/industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
. JOB SITE INF.ORMATION AND LOCATION Total number of floors:
Job site address; - I (14'S sw e—Pit.�.G TT`40y New dwelling area: square feet
City/State/ZIP: —r, -p_b, e2 1112-3 11 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: n- �
l..i'A�� �� � - 1 , Covered porch area: square feet
Cross street/directions to job site: 1
I Deck area: square feet
th - rt.4Th eAci4 "I It ttd 1 . Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST '
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
C, �C ae.p. S �aIPP ("14 -Cvee- Vtai►, Valuation: $ �� 00
(C1 x� S Existing building area: square feet
'YY New building area: square feet
❑ PROPERTY OWNER - KTENANT Number of stories:
Name: C p,G - Type of construction:
Address: ( 2 7,-50 r jtk) Nla,t.� C �'r eef- Occupancy groups:
City /State/ZIP: T A l 8 Q . q 1 2 Z 3 Existing:
Phone: ( S�3 ) (rg (`i8g Fax: (5b3)2.-8B—C,41150 New:
❑ APPLICANT ❑ CONTACT PERSON
Business name: All contractors and subcontractors are required to be
Contact name �i,,. C 5 LeD licensed with the Oregon Construction Contractors Board
/ 1 under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/ State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: (-Sn) 2 - 1.41 tb3 I Fax:: ((9.2)) 2 6 s.4, 06
E -mail: cicleFi G OrekAryt .0...Te+s ,c. rr.
CONTRACTOR - .
Business name: f s i- s . c Caw tj C lei :, BUILDING .PERMIT FEES* ,
Address: Z 4) SC i l CJ�• I (755 t.5 `5 rptiek<'
Please refer to fee schedule.
City/State/ZIP: 1� -
ty / State/ZIP: T� I �� �� �� 3 �" LK2+ i M I D 9 ,V Fees due upon application
Phone: (3 )24`4 1 3 Fax: (Sp3 )2 S 3
CCB lic.: ' I 1 - 1 04 Amount received
Date received:
Authorized s 4 ��+ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: , . e . • U " • Date:- 13 -0 * Fee methodology set by Tri- County Building Industry
_ Service Board.
i:\ Building \Permits \BuP- PermitApp.doc 12/03 440- 4613T(I 1 /02/COM/WES) v.,
I A
Building Division
41 A l l , j Plan Submittal Requirement Matrix
=--• • Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
Type of Submittal - # of PIans '
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(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, submit 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.
i:\Building \Forms \COM- PlanSubReq.doc 12/24/03