Permit CITY "CAF TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00534
�� DEVELOPMENT SERVICES DATE ISSUED: 12/12/02
N = ` ' ' - 11 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11875 SW PACIFIC HWY PARCEL: 1S135DD -00900
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK: LOT: 021 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: 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:
Remarks: Demolition prior to tenant improvement, remove carpet, drop ceilings and plaster. •
Owner: Contractor: )
HOFFARBER, RAY ALBERT TROYCO
12005 SW HALL BLVD 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 Final Inspection
[BUILD] Permit Fee 12/12/02 $62.50
[TAX] 8% State Tax 12/12/02 $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 -00 9_through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (5 01) 246 -69 or 1- 800 - 332 - 34
.;► 4 1, /� V '
Issued y � � ,
Pe mt itte 101Q-----"-
Signature: (t
Call 639 -4175 by 7 p.m. P .m. for an inspection the next business day
I , ' Building Permit Application •
Date receive:1 Q . Permit no.: jr, „Al _ ' ( City of Tigard d� m - -a�.5' ;t
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard
Projeci/appl.no.: x date:
Phone: (503) 639 - 4171 Date issued: By.' I I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family ❑ New construction ■ JG • molition
0 Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: (;. Sc,o P .1 Pic iJ .1) co: • OQ. • ,t Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: /,t) f / 10 2- HOT/ E
Description and location of work on premises/special conditions: t2rEli1L1 .C,112.1 C.40.4136 i i .,rV6 .
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: ..•' i.( --1 .. (Floodplain, septic capacity,solar, etc.)
Mailing address: Z ^ ..W :, I • GZ..Ac-e 1 & 2 family dwelling:
City: I g t 0 "Ma Wil Weill 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 $ i
Existing bldg. area (sq. ft.)
Business name. New bldg. area (sq. ft.)
UM Address: fb ac neap Number of stories
LEIP:,_11 ; StateOi(L. ZIP: cam 2
Pho r, Fax: E -mail:
Type of construction
Occupanc g rou p (s): Existing:
CCB no.: New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECI' /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: 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 w'th, w e er specified herein or not. Credit card number: / /
Expires
Authorized signature: Date: 12.E izl(r• Name of cardholder as shown on credit card
•
Print name: -Vat / it 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 (6H10/COM)
Gd 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 \fortes \COM- matrix.doc 9/24/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
6
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
CT5 9-- OS
Received Date Requested -3/10 AM PM BUP
Location C2G. C—, C -- 1�,Ai Suite MEC
Contact Person Ph ( ) PLM
Contracto Ph ( ) SWR
4 LDIN ) Tenant/Owner ELC
oT ng
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear (A) , i Framing c / l�K�
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
. 490:4 4
PART FAIL
•ING
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 OR,
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 ) �(
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL