Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00203
� �I DEVELOPMENT SERVICES DATE ISSUED: 5/28/02
�` 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 17135 SW PACIFIC HWY PARCEL: 2S115CB -04200
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
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: : sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0.00 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 r Z0'
Remarks: Temporary storage of a manufactured dwelling. Temporary Use Permit approved by City of King City.
Owner: Contractor:
TUALATIN VALLEY FIRE & RESCUE OWNER
17135 SW PACIFIC HWY
TIGARD, OR 97224
Phone: Phone: 503 - 306 -1292
Reg #:
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt
PRMT CTR 5/28/02 $62.50 27200200000
5PCT CTR 5/28/02 $5.00 27200200000
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 -0010 through OAR 952 - 001 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Permittee
Signature: 1 , v
I
Issued By: ,._,
Call 639 -4175 by 7 p.m. for an inspection the next business day
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'Building Permit App
City of Tigard
Date received: Permit no.:
Project/appl. no.: Expire date:
City ofTigard 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: l &2 family: Simple Complex:
TYPE OF PERMIT
•
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 New construction 0 Demolition ,
❑ Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm A Other: ' = =-. 111 . � n�
JOB SITE INFORMATION
Job address: ' f 3 . 7, AMEIIMIMIPPPIIMIIIIIIIIMIII Bldg. no.: Suite no.: '
Lot: Block: Subdivision: Tax map /tax lot/account no.: a G 0 0
Project name:
Description and location of work on premises/special conditions: - .. a • �. , - 0 fi •
t ,
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
(Floodplain, septic capacity, solar, etc.)
Mailing address: c 20 _ AnifferrAraMMINIM 1 & 2 family dwelling:
HE 41,M)1, • State:p ( ZIP: - O , 0 Valuation of work $
Phone: , 6 y • 1 Faxso . _ g ;1212BMIRMORI No. of bedrooms/baths
Owner's representative: l' Total number of floors
Phone r , 7 • L , _ - w dwelling area (sq. ft.)
API'LICANT Garage/carport area (sq. ft.)
IEMIIENFFMIIIIIIIMMIIIM Covered porch area (sq. ft.)
Mailing addre s: c 2.0 ANINVOMIRESIAIMMIERII Deck area (sq. ft.)
A M ZIP: , o Other structure area (sq. ft.)
Phones 16 7 � _ = Commercial/industrial/multi- family:
CONTRACTOR a nation of work $
Existing bldg. area (sq. ft.)
6. j New bldg. area (sq. ft.)
Address:
Number of stories •
City: State: ZIP:
Type of construction
Phone: Fax: E -mail:
CCB no.: Occupancy group(s): Existing:
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITEC f!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 0 Visa 0 MasterCard
work will be complied wi wheth cified • erein or not. Credit card number: xpires /
Authorized signature: A.. r Date: (5 & ad. Name of cardholder as shown on credit card
Print name: l 7/ q P r' Mir Cardholder signature $ Amount
Notice: This permit application - pires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6ro0/COM)
• r
A ft , 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.
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PROPOSED ACTION:
Proposed Use: Ternpvra+ry Sl ora j P. a/!t4 +ken $e i - i n use, � Alf:- Owel (n y •
Proposed Plan/Zone Designation:
Proposed No. of Phases (one year each): — • • • • •. • • h S o F use -
Standard to be Varied & How Varied (Variance Only): N/p
•
AUTHORIZING SIGNATURES:
I am the owner /authorized agent of the owner empowered to submit this application and affirm that the
information submitted with this application is correct to the beest of my knowledge.
I further acknowledge that I have read the applicable standards for review of the land use action I am
requesting and understand that I must demonstrate to the City review authorities compliance with these
standards prior to approval of my request.
• , icants •:`.at • Date
/
Owners Si: Date •
TO BE SUBMITTED WITH THE APPLICATION:
• To complete the application, submit fifteen (15) copies of the following:
1. A brief statement describing how the proposed action satisfies the requested findings criteria contained in the Comprehensive
Plan for the action requested
2. Applicable existing conditions and proposed development plan information and materials listed in part _ Chapter _ Section _
of the Comprehensive Plan the information in Section 4.1W which is applicable to a given application shall be determined
during a pre - application confrence with the Planning Department.
•
•
•
•
J
KING CITY
• 15300 SW 116th Avenue. King City. Oregon 97=4-2693
Imomm■I Phone: (503) 639-4082 • FA.( (503) 639-3771
APPLICATION FOR LAND USE ACTION
TYPE OF LAND USE ACTION REQUESTED
Annexation Conditional Use
Plan Amendment Minor Partition
Variance Subdi vision
Planned Unit Development Site Plan
Sim Permit Other 1 0 . . .St>roje. dfl Us 4)/7-
ou&iv- A r e f • °via% i)
OWNER/APPLICANT INFORNLA.TION:
• Applicant:Tylio Valley fire v- Re,sc-oc Phone: (so 649- t 7
Address: QO,65 s.1 (31„,,-, A/J. 1e( 4:::) q1007
Owner: 'Ma IPy Fire. ReSCWe.
Address: 42_,_61,__.s5-,I,L)2‘,,Lf4:filA)h e Phone: (so) 4,i-17-
Contact for Additional Information: C;re-5 Pe e- S Tr . it &-r ice. 5
Op e 5 Mai /) P K 5 0 c2S 9 - 1 .27
PROPERTY LNFORMATION:
Street Locadon: i? 3 -5 5W Pa. c,ir Hwy 9 7 4
• Tax Lot and Map No.: kof * BOO .ticArkf S I
LC-
Existing Structure/Use: Ft r S +6+ ; DA 3 c-r e S vi c-e-s
Existing Plan/Zone Designation: fl Sfituti on al
• •
41 KING CITY
15300 S.W. 116th Avenue, King City, Oregon 97224-2693
Phone: (503) 639 -4082 • FaX (503) 639 -3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: " A. . / _ _ ," • i - jilt/ .
n i
located at: 11(35 SO t'
1
King City Representative
I DSTS KCINST DOC