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C I T OF T I G A R D BUILDING PERMIT
PERMIT #: BUP2002 -00217
A DEVELOPMENT, SERVICES DATE ISSUED: 10/22/03
�- I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16875 SW PACIFIC HY PARCEL: 2S1156D -02600
W
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: NEW FIRST: 2.600 sf N: NR S: NR E: NR W: NR
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 3N sf N: N S: N E: N W: N
OCCUPANCY GRP: M TOTAL AREA: 2,600 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: 15 ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: N MEZZ ?: N REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: N SMOK DET:Y
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: N PARKING:
VALUE: $ 90,720.00
Remarks: New 2,600 sq.ft. convenience store w/ 3,240 sq ft canopy & pump island.
Owner: Contractor:
SPACE AGE FUEL INC MENG- HANNAN
PO BOX 607 5906 SE 122ND AVE
GRESHAM, OR 97030 PORTLAND, OR 97236 -4607
Phone: 503 =665 -5693
Phone: 435 - 752 -7031
Reg #: 208- 478 - 447283
FEES 761 S QUIRED INSPECTIONS
Description Date Amount Foot/Found Insp Structural masonry final rer
[BUPPLN] Pln Rv 5/31/02 $694.20 Foot/Found Insp Final Inspection
FLS FLS Pln Rv 5/31/02 $427.20 Footing Drain
[FLS] Masonry Insp
[FLS] Addl FLS PlnRv 10/22/03 $49.92 Masonry Insp
[BUPPLN] Addl Pln Rv 10/22/03 $81.12 Framing Insp
(additional fees not listed here) Framing Insp
Framing Insp
Total $3,540.66 Gyp Board Insp
Susp Ceilng lnsp
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: , . ' I w 11 A ' ` ./1DJI i0 /%
Pe rm ittee
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
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PI et•CP /0 -15 05C
B u i ld i ng Permit Application
Date received 31 10 Permit teite . � 7
�.. t °� 11 City of Tigard
r!- %:! Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: 503 598 -1960 '
Fax: ( 503) u Case file no.: Payment type:
Land use approval: ! �/ l &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory )(Commercial/industrial ❑ Multi - family ''New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement CI Fire sprinkler /alarm Cl Other:
JOB SITE INFORMATION
Job address: , i 7 ,_ ten _ it Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.: 261 15er, ,a'
Project name: . Ada . - n A
Description and location of work on premises/speciia conditions: ' ' 3 s. rr '/�i e],ICCE *2.gM _
��gtvr 1*tt k'e +ter a
OWNER FOR SPECIAL INFORMATION, USE CIIECKLIST
Name: 5PAce Q4 ! _AeZ hie. ( Floodplain ,septiccapacity,solar,etc.)
Mailing address: fb gD� ,O 1& 2 family dwelling:
City: / g 1 M IState:PE IZIP: of ]Q -p Valuation of work $ _
Phone: G,G, 56o I Fax: 6,6,-174/1E-mail: No. of bedrooms/baths
Owner's representative: r , ,-;: • -, _ ��. _ _ Total number of floors
Phone: , , - p Fax: ,-, 5 New dwelling area (sq. ft.)
APPLICANT - Garage/carport area (sq. ft.) -
Name: Sj,�CE 4 ,tgz /tie_ Covered porch area (sq. ft.)
Mailing address: Pp & 60'7 Deck area (sq. ft.) 14 O
City: GP..e. (4 I State: I ZIP; ) 7o5c> - Other structure area (sq. ft.) ,a
Phone:( , - Fax f f� _ r • / E -mail: Commercial /industrlal/multi- family: Z ) aJ
. CONTR ICTOR Valuation of work, $
Existing bldg. area (sq. ft.) 4. . N uf� —
or Business name: �.jSy(1�� t�C�dj•l New bldg. area (sq. ft) �2 Cal +' z'' , . F 443-
Address: rp f3ox 60-7 Number of stories I
City: G j p M I State: cg I ZIP: 6)7 030 Type of construction V Id
P j- oj c � 1 I I E -mail: $
Occupancy group(s): Existing:
CCB CB n no.: : 1 New: M
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCI IITECL /DESIGNER ' licensed with the Oregon Construction Contractors Board under
Name: S14 14/e51" provisions of ORS 701 and may be required to be licensed in the
jurisdiction where work is being performed. If the applicant is
Address: Z55 lj}/ --30.9 KIST
City: 1...04 ,q N exempt from licensing, the following reason applies:
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Contact person: Iild I State: Uri ZIP: � 32 Plan no.: .
Phone- 5Z- 03 Fax 752 :z..5
Name: l /ill Contact person:* JNS Fees due upon application $
Address: 8J1 I./ e. Date received:
City: / , 0 , 4 aj-a" LO State: 11 IZIP:. 83201 Amount received $
Phone: &3-45-4613 I Fax: 245 - 678}£ -mail: 4617 Please refer to fee schedule.
I hereby certify I have read and examined this application and the Na all jurisdictions accept credit cards, please call jurisdiction for more information
attached checklist. All provisions of laws and ordinances governing this 0 visa ❑ MasterCard
work will be complied with, w �< er :. - ified : -.! not. 'f Credit card number. �P I
Authorized signatu , : _ �
•'/ i. �1� / ` fa� te: � ✓ Q z Name of cardholder as shown on credit card
� Ttta/ � iv __ _ Cardholder signature $
Print name: —. ..e.ra i� _ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has beee accepted as complete. 440 (6o0rc crag
20
f `l d il°
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
CP --Z. - 00 , 4 7
Received / • Z Z D ate Req ted 6 " 2 I 9 AM PM BUP
Location / ? 5 ' Suite MEC
Contact Person Ph L ) 4.5` er24004 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner c2# CSC _ ELC
Footing a
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors ' cg ', .. it N y fit /s ti !— rt. 1-3 cp ? -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
G PART FAIL
`I I =1NG
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line / /
ADA Date Et 0 1 0/
Approach/Sidewalk Inspector Ext
Other:
Final O NOT REMOVE this inspection record from the job site.
PASS PART FAIL
Commercial Plan Submittal
' Red irement(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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