Permit •
v 4 CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00391
..r` 'IA DEVEL ACES 503-639-4171 DATE ISSUED: 8/11/2005
-- 13125 SW PARCEL: 2S103DD -00800
SITE ADDRESS: 13815 SW PACIFIC HWY 80 ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Demo (1) wall.
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: 2N : 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: $ 5,000.00
Owner: Contractor:
D.W. SIVERS COMPANY GSK CONSTRUCTION LLC
4730 SW MACADAM AVE 18244 NW WALKER RD # E
#101 BEAVERTON, OR 97006
P Pco eAND„ OR 97201
Phone: 503 - 997 -8348
FEES Reg #: LIC 152754
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 8/11/2005 $91.30
[TAX] 8% State Surchan 8/11/2005 $7.30
Total $98.60
This permit is issued subject to the regulations contained in the Tigard Municipal Code, S - - if OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. his perms ill expire if work is
not started within 180 days of issuance, or if work is suspended for more than 18' day.. ATTENTIO : Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification -nter. os- rules are set orth in OAR
952 -001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of trese rules o \dir :ct questions o OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344. _0
. Issued By: ,�QS' ,M Permittee Signatur Ird")
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.
' I' BuiluinQ Permit Application of KA.: USE ONLY
,
\ '. D
City of Tigard _,, ,
. -;,v 11r�■- Receiv , !
Dale /B . ^ U � 1 '14 Permit 1 �r' ` d v9 ,
13125 SW Hall Blvd., Tigard, O 17223 Plan Review
;
Phone: 503.639.4171 Fax: 503.598.1960 �,,�� i�g ., ii ii, DateB . Other Permit:
Inspection Line: 503.639.4175 ?_ ! Date Ready/By. El See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYpIN 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
R Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling Commercial /industrial
Valuation: $
❑ 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: 1 381 s► �"' `3 QC New dwelling area: square feet
City /State/ZIP: T� ` Garage /carport area: square feet
Suite/bldg. /apt. no.: B oject name: - Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: 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.
t`� \
O � �'�� p s . Valuation: $ a �.,
p��S Existing building area: square feet
-Q. New building area: square feet
❑ PROPERTY OWNER TENANT Number of stories:
Name: ') �; ( 6 ` Type of construction:
Address: Occupancy groups:
City /State/ZIP: Existing:
Phone: ( SQT 4_ 3 c 3$ Fax: ( ) New:
X APPLICANT ❑ CONTACT PERSON NOTICE
Business name:
P'J( All contractors and subcontractors are required to be
Contact name: C��`�'�. Ge h \ licensed with the Oregon Construction Contractors Board
r7�— • under ORS 701 and may be required to be licensed in the
Address: I 3 14 1 ,54,.. w -ti . 2 c 3 jurisdiction in which work is being performed. If the
City / State/ZIP: R � 0 applicant is exempt from licensing, the following reasons
apply:
Phone: ' 2 3 ,�ij$5 Fax: : (SOS 94
E -mail:
CONTRACTOR
Business name: . S ■ V< (ceo . t, m J BUILDING PERMIT FEES'
Address: 19 .---3)" ; LQ_i
Please refer to fee schedule.
City /State/ZIP:
Phone: (LjQ� �' 3 I Fa ( ) Fees due upon application h
CCB lie.: �. _ / 7 �V Amount received g Y‘ IS b
l Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: C . yte Case. I Date: g ( OS • Fee methodology set by Tri -County Building Industry
Service Board.
i:\Building\Pennits\Bl1P -T1- PennitApp.doc 12/03 440- 4613T(II /02/COM/WEB)
- ° �t
Building Division
Aso Plan Submittal Requirement Matrix
Commercial & Multi - Family - New, Additions or Alterations
• City of Tigard
Type of Submittal # of Plans
(Includes new, additions 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 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�Building�PenniIs TI- PetntitApp.doc 17/03 440.4613T(II/02/COM/W®)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2005 -00391
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/11/2005
Phone: (503) 639 - 4171' 1I�li
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/11/2005 TIME: 7 :08AM PAGE: 85
SITE ADDRESS: 13815 SW PACIFIC HWY 80 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DONUT SHOP
DESCRIPTION: Demo (1) wall.
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: GSK CONSTRUCTION LLC PHONE #: 503- 997 -8348
Inspection Request Scheduled For: Date: 10/11/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 017927 -03 503 -463 -4500 N
Corrections /Comments /Instructions:
•
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIO AL FEES ASSESSED
Inspector: Date: ( 1 "✓ Phone #: (503) 718-