Permit w
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00358
c . � t DEVELOPMENT SERVICES DATE ISSUED: 7/23/2004
A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135DD -00800
SITE ADDRESS: 11847 SW PACIFIC HWY
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK: LOT: 022 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: M TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 165 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: TI and change of use
Owner: Contractor:
SANOKEE TENANT PER APPROVAL FROM OWNER
45 FRONT STREET -SOUTH
SUITE B
ISAQUA H, WA 98027
one.
Phone:
Reg #: LIC 00013125
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUPPLN] Pln Rv 7/22/2004 $40.63
[FLS] FLS Pln Rv 7/22/2004 $25.00
[BUILD] Permit Fee 7/23/2004 $62.50
[TAX] 8% State Surchari 7/23/2004 $5.00
Total $133.13
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 -2344.
Issued By: t
Permittee
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application FOR OFFICE USE ONLY
� ' 1 �7 ! '' Received
City of Tigard I � Date/3 : I Permit No.: 0 ,,� ,e),33- ,
13125 SW Hall Blvd., Tigard, OR 97223 "� � �
g Pl an R eview
�'"' ��x,,,
Phone: 503.639.4171 Fax: 503.598.1960 . +1� 6\ Date/B �'Z U (� AM Other Permit:
� ✓X 'y � /
Inspection Line: 503.639.4175 , , - e_ l I Date Ready/By: El See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: Era Supplemental Information
' int . °� Ti
TYRE• ,R `; r - .'• • r - REQUIRED DATA:'i -2- FAMILY 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, niatt;rials; labor, overhead, and the profit for the
•. CATEGORY OF CONSTRUCTION '. • '.i . work indi✓ral;illba t4 application.
❑ 1- and 2- family dwelling ❑ Comm 1tial /industrial Valuation: $ ,
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: .it• Number of bathrooms:
JOB SITE INFORMATION AND, LOCATION il - - Tbtal•humber of floors:
Job site address: /' 7 7 Tew dwelling area: square feet
City/State/ZIP: l ' 4 4L Garage/carport area: square feet
./a t. no.: Project ti ` `�
Suite/bld ect name: )
Suite/bldg./apt. p I f 'I tQ5 �' 1� �i5/ D� F A ) 41,, , Covered porch area: square feet
Cross street/directions to job site: v6A-. 5J( L� _ lle�e /••iDlMe / L I , Deck area: square feet
1 i ; :ti t' := - Other structure area: square feet
,! REQUIRED DATA COMMERCIAL -USE, CHECKLIST:
Subdivision: I 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.
l ,
1 ' 1 _R J $ Valuatio$ �
C 7 I7 �' f c � r R- fi &A)._ i 3OR 1 Existing building area: square feet
_ -
New building area: square feet
. PROPERTY OWNER' . r . • ; , ❑ TENANT , Number of stories:
Name: ke0 it) 0' y -e Type of construction: 5 /0.
Address: 3 � AJo 9 `y4 0 - I � 20/ Occupancy groups:
City/State/ZIP: q s .4 1 vi Va. , Existing:
Phone: ( ) 3 / I gI✓ b A Fax: ( �,�g J� ! Q 334
New:
❑ APPLICANT . 7 ON ACT PERS NOTICE
Business name: � R�� � L . : LA ,,s ( rat. a-r All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board .
under ORS 701 and may be required to be licensed in the
Address: ; 6 'LT- I - V ■ jurisdiction in which work is being performed. If the
\ \ q '1 a applicant is exempt from licensing, the following reasons
City/ State/ZIP:
�l f _C)_ \ \ / app .Std —
Phone: ( e D.01 p Fax:: ( ) Yo • 4v 3
E- fail:
. CONTRACTOR - 3 OD
445
Business name: 4 l 3
: ; BUII�DING _PERMIT FEES*
Address:
Please refer to fee schedule.
City/ State/ZIP:
• Fees due upon application
Phone: ( ) Fax: ( )
Amount received •
CCB lic.:
Date received:
Authorized signatu �� 2, i grd , This permit application expires if a permit is not obtained
( within 180 days after it has been accepted as complete.
Print name: 4 . i J 4 !'��', Date: '7/ , t U • Fee methodology set by Tri- County Building Industry
l ` ( Service Board.
i:' Building \Permits\BUP- PermitApp.doc 12/03 440- 4613T(11 /02/COM/WEB)
• . . • V
Building Division
Plan Submittal Requirement Matrix
Commercial & Multi- Family - New, Additions or Alterations
City of Tigard
Type of Submittal # of Plans
(includes new, a dditions 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 parlcing) . _
•
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
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST ,,//
BUP - t 9 - 3s3'
Received 7/ Date Reques d AM PM BUP
Location // Suite MEC
Contact Person Ph ( ) rZdl o20s PLM
Contractor Ph ( ) SWR
`BUILDI Tenant/Owner ELC
noting
Foundation Access: ELC
Ftg Drain /J A �� g( ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling " 0
Roof I
erig*
.• ,• RT FAIL V.
k/-1
,■ =1NG
Post & Beam
Under Slab •
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In . .i 011 k 4/
Low Voltage �� • �� y.����.
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE E Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL