Permit Y= BUILDING PERMIT
CITY OF TIGARD
P ERMIT #: BUP2002 -00331
Ali is;�I6' DEVELOPMENT SERVICES DATE ISSUED: 8/1/02
.. II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12950 SW PACIFIC HWY 115 PARCEL: 2S102C6 -03101
SUBDIVISION: FREWINGS ORCHARD TRACTS 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: 5N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 11 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: N SMOK DET:N
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : N HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 7,000.00
Remarks: Remodel restrooms for ADA access and create a small office.
Owner: Contractor:
HENDERSON, MARILYN DOROTHEA MARLAND HENDERSON CONSTRUCTION
JENSEN HUDSON TRUSTEE 12900 SW PACIFIC HWY
11795 SW KATHERINE ST #B -2 Z
TIk F , O% 97224 Tl gone: ( 09A 2 3 2 7 3
Reg #: L 70266
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Electrical Permit Required
PRMT CTR 8/1/02 $110.50 27200200000 Plumbing Permit Required
Framing Insp
5PCT CTR 8/1/02 $8.84 27200200000 Gyp Board Insp
PLCK CTR 8/1/02 $71.83 27200200000 Susp Ceilng Insp
FIRE CTR 8/1/02 $44.20 27200200000 Final Inspection
Total $235.37
•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 co. •l these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -234
Permittee��
Issu - • By: , ■,■,,, i ' „ t' LPL•!
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application
iii,
A Date received: 7 Si l Permit no.: by O -O �• a.,,�lyl; ' City of Tigard
1+1- °: Project/appl. no.: date:
City ojTigard 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 O Fire sprinkler /alarm • 0 Other:
JOB SITE INFORMATION
Job address: EURWIPMErmit t (3% . _/ 0 # , Bldg. no.: Suite no.: •
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: .31 1. t tv
Description and location of work on premises/s • eclat conditions: 1 : ► + • • ' M
. C QO0A/\
OWNER FOR SPECIAL INFORMATION, USE CIIECKLIST
_l t L ( Floodplain ,septiccapacity,solar,etc.)
�u J
Mailing address: _ .` .1 t r &.mac -. , 1 & 2 family dwelling:
IIEEMM2AMIlliall StatepP_ ZIP: - z Valuation of work $
Phone: -, -- o =CM/CM 21121 No. of bedrooms/baths
Owner's representative: .
epresentative: 4 ., . ► Total number of floors
Phone - ),_ Owl Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: State: ZIP:
Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industriallmulti- family:
CONTRACTOR Valuation of work $ 7. DOO
Emen Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.)
Address: . Sal , 'AC {¢w —
Number of stories
JA - •r• ZIP: ' 9-12 Type of construction
Phon• ;, 3Y. Fax: E -mail:
Occupancy group(s): Existing:
CCB no.: • .. -
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
A RCI I ITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
relliMirri 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
EMEI 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 a , : ication and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisio s if la : • ■- rdinances governing this l] Visa 0 MasterCard
work will be complied wi r / /_ lx: +,•. tried herein or not. Credit card number: Expires /
Authorized Si:. atu , . .i Date: r/-470- Name of cardholder as shown on credit card
Print name: _ /Ilff! 01,0A iaoflld0-1 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 (6/00/COM)
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Sr
A ll/id ,�� I , 1\
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
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CITY OF TIGARD
2) Prowde 5" b&'-se Approved F
a) Pro 1th a ., Conditionally Approved
For only the work as described ig
PERMIT NO kiti ri'CO# e° 9 I
• 4 /) PeCIVa le- I Fite..i Eiegist.shefr4-- See , , t to: Follow I I
Job A. 4, A a9h IW . -"Z . '1 -1 tol
By: ,' s-- Date: - 1:410r. 1 --
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•
• • •
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175'
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Q J BUP - Lx) r
Received Date Requested U 1 AM PM BUP
Location / f Suite //S S MEC
Contact Person / ' l Ph ( ) to c J ,s 3 7 40 .2 - h n3 C`)
Contractor ((,3s-' P-< -4 ., h ( 0-e0) 3a - I s`1 WR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain 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
■
sp' ei in
Other:
na
:),,t • RT FAIL
P i BIN .
Post & = eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
st PART FAIL
' HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE D Please call for reinspection RE Unable to inspect — no access
Fire Supply Line 7 6 ADA
Approach/Sidewalk Date Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL