Permit r� BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2002 -00558
4 �;tr� DEVELOPMENT SERVICES DATE ISSUED: 12/31/02
F 13125 SW Hall Blvd.. Tigard, O R 97223 (503) 639 -4171
SITE ADDRESS: 11875 SW PACIFIC HWY PARCEL: 1 S135DD -00900
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK: LOT: 021 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: UNK : 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: $ 2,500.00
Remarks: In -fill windows.
Owner: Contractor:
GEORGE & LEFEVER TROYCO
11875 SW PACIFIC HWY TROY DEAN TAYLOR .
TIGARD, OR 97223 PO BOX 1786
TUALATIN, OR 97062
Phone:
Phone: 503 - 740 -7714
Reg #: LIC 145337
FEES REQUIRED INSPECTIONS
Description • Date Amount Framing Insp
[BUILD] Permit Fee 12/31/02 $72.10 Final Inspection
[TAX] 8% State Tax 12/31/02 $5.77
[FLS] FLS Pln Rv 12/31/02 $28.84
[BUPPLN] Pln Rv 12/31/02 $46.86
Total $153.57
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 -001-0 hr-eugkOAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 03) 246 -6699 0r 1- 800 - 332 -2344.
Issu d By: 9_ / ,V, v 0-441A-01-4/
Penn itte
-
Signature: A - .-
Call 63 -4175 by 7 p.m. for an inspection the next business day
1
Building Permit Application ( . FOR OFFICE USE ONLY
�1 Date/By: // 4 O Permit . No.: ( Q / /I, 00551
Permt �f Ji�?
City of Tigard Planning Approval Other
y Date/By: No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.: ��
Phone: 503- 639 -4171 Fax: 503 -598 -1960 ' ! 1 1 ja
�' Post - Review Land Use
n , Date/By: Case No.
Internet: www.ci.tigard.or.us Contact Juns.: [8:1 See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
LI Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ❑ 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 $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: 1115 6L3 PACVFX.44Wq Total number of floors
New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
Rext(Sj VII t tJ .IS Ant W ALL 141 N01 - c f7 to
Valuation $ Llc w
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
❑ PROPERTY OWNE I ❑ TENANT Type of construction
Name: &er)t2 - rAMiuy tom - - -Uere- Occupancy group(s): Existing:
Address: New:
City/State /Zip:
Phone: Fax: NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
El APPLICANT ❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City/State /Zip:
Phone: Fax:
E -mail: BUILDING PERMIT FEES*
Please refer to fee schedule.
CONTRACTOR
Business Name: — TRO -? o eta. ....t2 t�� pM
Fees due upon application $
Address: p0 Box. 11p)t_o
City/State /Zip: --rte �, I 4 Oa_ 0110622_ Amount received $
Phone (5rj 74O -111 I Fax: Date received:
CCB Lic. #: • As
Authorized
Notice: This permit application expires if a permit is not obtained within
Signature: AA 0 Date:1_2.1342, 180 days after it has been accepted as complete.
—r-t� I
1 1 J �A1/44L *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03
_•
Commercial Plan Submittal
Requirement Matrix
City of Tigard
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 4
(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.
is \dsts \forms \COM- matrix.doc 9/24/01
® -4 -) - c Y C c9 ey
CITY OF TIGARD (Z e.,Ms v e u i ✓t d ow s t t +r. -4; 1(
Approved • ( l
conditionally Approved b�� � -g' i ] `, p
For only the wo c.a 0 i I — 5 eG 6 a clAed c-od t v% r i It
PERMIT NO ../ I
See Letter to: Follow ('0 1 Sfrve 4 1 4- evr qZ (f
Attach " Si ra 1�''rY
Job :A4 irl Date: Z - t "'
By: i
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received Requeste 3 / 2 ! a AM PM BUP
Location 1 c 1 Suite MEC
Contact Person Ph) PLM
Contractor Ph ( ) SWR
ILDIN Tenant/Owner ELC
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: /____]//._ 2 1 tki , J � G SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Oth -
ma-
PART FAIL •
PLUMBING .rfrij
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
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line n
ADA Date 3/ d \ /(_mac,
Approach/Sidewalk I nspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
r PASS PART FAIL