Permit , .
C ITY OF T I G A R D BUILDING PERMIT
PERMIT #: BUP2002 -00436
` ; ,r, DEVELOPMENT SERVICES DATE ISSUED: 10/24/02
� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103DD -00900
SITE ADDRESS: 13855 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT: 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: A3 TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 299 BASEMENT: sf AREA SEP. RATED:
STOR: 1 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: $ 12,000.00
Remarks: Change of use and required modifications for code compliance. From E3 daycare to A3 Church.
Owner: Contractor:
COMMUNITY OF CHRIST CHURCH OWNER
5321 WINDSOR TERRACE SIGNED RESPONSIBILITY
WEST LINN, OR 97068 FORM IN FILE
Phone: 503 - 245 -1796 x 131
620 -2086 Phone: 620 -2086
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Plumbing Permit Required
[BUPPLN] Pln Rv 10/7/02 $103.03 Framing Insp
[FLS] FLS Pin Rv 10/7/02 $63.40
Insulation s Bor Insp
yp Board Insp
[BUILD] Permit Fee 10/24/02 $158.50 Final Inspection
[TAX] 8% State Tax 10/24/02 $12.68
Total $337.61
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: etc_ . J 4
Perm ittee n y
Signature: _44/
`w/
Call 639 -4175 by 7 p.m. for an inspection the next business day
. - As iZ
. Bath 'ng Permit App
• . Datereceived: 0,2 Permit no.:�/e/ ;J --�'j 0 1.
'� ° I � City of Tigard
_�.j- Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By:. Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
i I, TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family Cl New nstruction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm Other: GN/ 01; ta51✓
JOB SITE INFORMATION
Job address: 1'32,55 5.1 1. P f GI R(. 1-t 14 1, (7'+ • Bldg. no.: Suite no.:
Lot: I Block: (Subdivision: I Tax map /tax lot/account no.: 2310 3 D.0/9 00
Project name: 60 M M u -I l'r 1' o 6 H p..4 -r GNAW-Lk
Description and location of work on premises/special conditions: l.(- ): 6..M.. 'Ot (.1e3E 12- icqu I l2-E-b
M DV) Fat (.44 n I N ev .OL C.bhE G81-4 PL1.44L =�
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: 6,01-.1 HUN irr OP i•t 1214.r (Floodplain,septic capacity,solar, etc.)
Mailing address: 3 3 21 1..114 •501 rF1z1 NGF 1 & 2 family dwelling:
City: jI4 s./ LA ti State:Dia ZIP: - p . Valuation of work $
Phone: a 5- -y79/p X /3/ Fax: E -mail: No. of bedrooms/baths _
Owner's representative: ,4444 5H.012..T' Total number of floors
• Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: , 141 1-0 LI N G1 M E- - W N. G+ WC,. Covered porch area (sq. ft.)
Mailing address: p 0. t+tDx 23 Z4' ' Deck area (sq. ft.)
City: • State. • ZIP: 9 2$ Other structure area (sq. ft.)
Phoae:(pQp— E -mail: Commerclal/industrial/multi- family: tro
CONTRACTOR Valuation of work $ 12. 000
Existing bldg. area (sq. ft.) I 12S • Business name: plrtihle12 New bldg. area (sq. ft.) — I 12 5
Address: Number of stories I
City: I State: I ZIP: Type of construction V — P4
Phone: I Fax: I E-mail: Occupancy group(s): Existing: E. - 3
CCB no.: New: A-- 3
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /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: I ZIP: exempt from licensing, the following reason applies:
Contact person: I Plan no.:
Phone: Fax: E -mail:
ENGINEER
IME IMMIMI Contact person. • . • r .. ees due upon application $
Address: $' (j, Box 2.3764. Date received:
City: '(' „,A. 12AD IStateio Z IZIP:. 2, 1 Amount received $
Phone: 62,o _soy, IFaxes- 3( o 3 c,I,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 Cl visa 0 MasterCard
work will be complied with, whether specified herein or not. Credit card number-. 1
Expires
/
Authorized Sig ig Date: 161.1) Z Name of cardholder as shown on credit card
$
Print name: ■ )t M At-4 1^) r2-mW y Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. 440 - 4613 (6i00rc
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
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 plan sets for distribution purposes (for Contractor, City of
Tigard, Washington County, and Tualatin Valley Fire & Rescue).
Total # of
TYPE OF SUBMITTAL Plans KEY:
Submitted
S = Site Work (must include
S (New, Add or Alt) 4 location of all accessible parking)
B (New, Add or Alt) 1 B = Building
F (New, Add or Alt) 3* F = Fire Protection System
M (New, Add or Alt) 2 M = Mechanical
P (New, Add or Alt) 2 P = Plumbing
E (New, Add, or Alt) 2 E = Electrical
New = New Building
Add = Addition
Alt = Alteration to existing
building •
* "New" requires that plans bear the original seal of an Oregon licensed fire
suppression engineer, or NICET level "3" technicians.
I: \dsts \forms\matrxcom.doc 10/10/00
CITY O ''rARD 24 -Hour
BUILD Inspection Lip: (503) 639 -4175
INSPECTION _• Business Line: (503)439 -4171 MST
BUP g ,aa 73.
/I°
/
Received Date Requested / AM PM BUP
Location / 3 SS6' Suite MEC
Contact Person al& MLI Ph ( ) 6 t a-6 PLM O ' 6C V67
Contractor Ph ( ) 7 5 7 — 4 / 6 / 1) SWR
BUILDING Tenant/Owner ( s., A ELC
Footing
Foundation ELC
Ftg Drain ACC s� p (Y j3 0 ELR
Crawl Drain
al
t,
Slab Inspection N tes: „ l SIT
Post &Beam ��`�
Shear Anchors _ J
Ext Sheath/Shear . O�✓`
Int Sheath/Shear
Framing
Insulation LOCK /� 60% c i r('/I ov
Drywall Nailing J � 1
Firewall . A/ 4 P- 1 / 00 ,p g13 7
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
=ART FAIL
Pos =7 -= �
Under S .b ?A- -/2 _ 1ANAM A
Rough
-In
Service
Water Service ' —
Sanitary Sewer fJffriNgi .
Rain Drains ;
Catch Basin / Manhole
Shower Pan I P •
Other:
; ra PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final J 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 ,,ll
Approach/Sidewalk Date // V
/ ? j D -- Z inspector , 7 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL