Permit I
A CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2006 -00374
DEVELOPMENT SERVICES DATE ISSUED: 9/28 /2006
- I I 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 2S 102CC -01100
SITE ADDRESS: - 13680 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Co locate wireless equip.
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: UNK sf N: S: E: W:
OCCUPANCY GRP: UNK 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: $ 20,000.00
Owner: Contractor:
TIGARD LODGE NO. 207
OF AF + AM
ATTN JOHN HAVERY, SECY
TIGARD, OR 97281
Phone: Contact #:
FEES Reg #:
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 8/4/2006 $235.30
[TAX] 8% State Surcha 8/4/2006 $18.82
[BUPPLN] Pln Rv 8/4/2006 $152.95
Total $407.07
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: P e rmittee Signature: � I ii ��
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
/3i /368 RaGs ?Ow/
Building Permit FOR OFriel{ usl•: ONLY ,
City of Tigard `' E I/ i . -
Y g Date/B : • Mi i ; s1 O ._ i i • ♦ D
13125 SW Hall Blvd., Tigard, OR 17�� Plan Revi-
998$3 u M � s ./� ii' �( �= ✓� Other Permit:
Phone: 503.639.4171 Fax: 503.5 0 2 Q 6 p ate/$
Inspection Line: 503.639.4175 Date Ready : Jur' ® See Attached Checklist for
Internet: www.ci.tigard.or.us °QTY OF TIGARD Notified/Method: Supplemental Information
BUILDING NG DIVISION
TYPE OF WORK REQUIRED DATA: 1- AND 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
KAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling KCommercial/industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: V3 /043p SIP Tat 1L.1 i+ New dwelling area: square feet
City/State//ZIP: .""1.. /�j q led ( C7720 q''j,Z Garage/carport area: square feet
Suite/bldgJapt. no.: v I Project name: • I T, ani s. W:5 6 Covered porch area: square feet
Cross street/directions to job site: 4,- » die% Iet Deck area: square feet
SW w % VI I!_ 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.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: 45 102. C G D Roo 00
equipment, materials, labor, labor, overhead, , and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ Z 0 zoo
co. locate. ware.%ess. egultowmaak vrot. IS
`
alma AIM e X i s'7I r Le. l t wine Existing building area: square feet
New building area: / square feet
APROPERTY OWNER I ❑ TENANT Number of stories:
Name: T a L 4 a Type of construction:
Address: t 6 �tr ` • Occupancy groups:
City /State/ZIP: Ord O t gt ""' 'y Existing:
Phone: ( ) Fax: ( ) New:
pc APPLICANT igt CONTACT PERSON NOTICE
Business name: R n ` a T � G All contractors and subcontractors are required to be
Contact name: .1�.� " h Lt irsvH d licensed with the Oregon Construction Contractors Board
^ under ORS 701 and may be required to be licensed in the
Address: S s 01 ME. 1, CA" , Slit A.. , jurisdiction in which work is being performed. If the
City /State/aP: v (o V vee WA q B( 2. applicant t is exempt from licensing, the following reasons
apply:
Phone: c''pis cr 36 - 3$Zd I Fax: : sb 324, I b$(
E- mail :d k arsdin & cosca 416- a ios, c-owl .
CONTRACTOR
Business name: p it , - r
�(} aG \ w l 65
BUILDING PERMIT FEES*
Address:
Please refer to fee schedule.
City/State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
+ 5
D ate received: Amount received /�
CCB lie.: 1 r 0 /q / ,t, ?L ci / e 1
Authorized signature: / V-. This permit app ca n expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: SAN I Date: r -0 6 * Fee methodology set by Tri- County Building Industry
SAN Service Board.
i\ BuildingTermlls \BUP- PermitApp.doc 12(03 440- 4613T(1t/02/COM/W®)
1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2000374
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9!28/2006
Phone: (503) 639 -4171 u �' C�t�
Inspection Requests (24 Hrs.): (503) 639 -4175 p'- -! .
' INSPECTION WORKSHEET FOR DATE: 12/12/2006 TIME: 7 : 01AM PAGE: 52
i
SITE ADDRESS: 13680 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CELL TOWER
DESCRIPTION: Co- locate wireless equip.
OWNER: TIGARD LODGE NO. 207, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 12/12/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 040914 -01 817- 313 -9277 N
Corrections /Comments /Instructions: _11* .,
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL m� OR INSPECTION ❑ ADDITIONA FE S ASSESSED
Inspector: Date: tv !Phone #: (503) 718-,