Permit V
CITY OF TIGARD
• DEVELOPMENT SERVICES BUILDING PERMIT
/�n.,r;ei kn�s,�i• ) `I�
�+�-� ' �.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 HERMIT #t..... BUP96 -0640
DATE ISSUED: 03/13/97
PARCEL: 1S135DA -01100
SITE ADDRESS...; 08540 SW FFFAFFLE ST
SUBDIVISION....: METZGER ACRE TRACTS ZONING:C - -P
BLOCK........... LOT....... ...... :20
REISSUE: ,(Q� FLOOR AREAS • - - -- EXTERIOR WALL CONSTRUCTION –
CLASS OF WORK. : hl.ZW •
FIRST....: 0 sf N: 5: E: W:
TYPE OF USE...: COM SECOND...: 0 sf PROTECT OPENINGS?----- I
TYPE OF CONST.:5N ...: 0 sf N: S: E: W:
OCCUPANCY GRP.:U2 TOTAL . 0 sf ROOF CONST: FIRE RET ?:
OCCUPANCY LOAD: 0 BASEMENT.: 0 sf AREA SEP. RATED:
STOR.: 0 HT: 0 ft GARAGE...: 0 sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD • 00 psf LEFT: 0 ft RGHT ; 0 ft FIR SPKL: SMOK DET.. :
DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM: HNDICP ACC:
BEDRMS: 0 BATHS: 0 IMP SURFACE: 0 PRO CORR: PARKING: 0
VALUE. $ : 23000
Remarks: AT &T Wireless 80' monopole
Owner: FEES
DONALD M SCHAEFER & type amount by date recpt
MICHAEL T MUNCH PRMT $ 0.00 JSD 12/19/96 96- 287985
10505 SW TIGARD ST PLCK $ 103.03 JSD 12/19/96 96-287985
TIGARD OR 97223 FIRE $ 63.40 JSD 12/19/96 96-287985
Phone i #: MISC $ 2860.00 DRA 03 /05/97 97-291235
PRMT $ 158.50 B 03/13/97 97- 291680
Contractor: ------- •-- - - - - -- -- - - --
PACIFIC NATCOM INC .
2110 SUNKER RIDGE RD S
SALEM OR 97036 -- - --- - - --
Phone #: 503--982 -5058 $ 3184.93 TOTAL
Reg #..: 081130
-- - - - - -- REQUIRED INSPECTIONS -----
This permit is issued subject to the regulations contained in the Foot /Found Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Misc. Inspection ,
applicable laws. All work will be done in accordance with -
approved plans. This permit will expire if work is net started
within 188 days of issuance, or if work is suspended for more
than 188 days.
Permittee Sir nature: CN alit M — — _ .—�
.1�.0
Issued By: ' _ .
Call for inspection – E,39- 4175
..., ( )
// Commercial Buildin p ication (1\1 0
, e , p„ ) C r , of Tigard 13125 SW Hall 9Ivd. Tigard. OR 97223
��I "'"--'" /?l ''`� � (503) 679 -4171
Jobsite Address: I S 1 135 D A - (I 00 OFFICE USE ONLY
Tenant: ATE utt�� -t:S Sui te # Planck/ # � T
IF-
Valuation: it c23 G.y..>v Permit # O `- 6- ---
1✓tICI.►.., w T. M VMC H I S ( -- 3c - ,4- — ) .. 1 ... `�
C c,A,ST - tE:lrcJIc -c-S Ma &TL#
Owner:
Apprpvals Required .
Address: 10 5t5- Ski — Tie, rN - 54• .
! /..
Planning �,, r 9 �7 - . . 0
' P'(�T� , DR Z23 . .:. . 9 . ..m., ,i c r'•
Telephone:
::-Othair - ti.i...(:':i4ki:iiHi&a,„0
Contractor: -0".11.1";,.: �1 L 7
Address: 1v la K �/o COVY.
? I i o '5ttnJzM WAG Type of constr:
Telephone: / Occupancy Class: 1
COT - lg4'7 °� /,
Contractor's License # Op.' ? )O ,I g7 w - Sprinkler? Yes No
(attach copy of current Oregon license)
'—i-GH`` n "0"' Sq. Ft Of Project: '—f P
.:ontact name & telephone: (s(-- 2-1 - o oS
Story (1st, 2nd, etc.):
Architect & Engineer: CLtIJ ' i t T C e / ( P U j
Proposed Use:
•
Address: 16&o so 1 f4 de . C , P (( �� / C
Previous use:
► 4A.r1D , or z. 9
Note: Plumbing & mechanical plans must
Telephone: £ -) 3c--)6 – to r"g Z_. be submitted at time of building permit pQ
application.
JOB DESCRIPTION: .� N4TA L., `-- C! 1 J Co-kt r-ir'LJ ''SU I 40f%4 dFbt_E
1 C Lo ICY( s't'i t.,t cr L)c O + bL E * & s L C 'tart t D CL E
(Applic ignatu Tele ne Number)
------____--, E / 5 6
Received by: Date Received:
l
r
PERMIT# y A�ccount Description Amount Amt Pd. Balance Due
(5 96 -D(o Building Permit (BUILD) j U (p36
Plumbing Permit (PLUMB)
Mechanical Permit (MECH)
° State Tax (TAX)
Bldg.
Plumb.
Mech.
I0 Plan Check (PLANCK) 1 9J 0 /0
I Bldg.
Plumb. 01/4164-1C1
Mech. "
Sewer Conne tion (SWUSA) sr
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (T1F -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (TIF -I)
Institutional TIF (TIF -IS)
w
Office TIF (TIF -O)
Water Quality (WQUAL)
Water Quanity (WQUANT) •
U /�
Fire Life Safety (FLS) 19 (0�, (•J
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
I ----
TOTALS:
\ \611 -= - - - - -_
•
.a
Plan Review # I' — 4 CITY OF TIGARD
Date / �79�o OREGON
Structural Special Inspections
The owner or architect or engineer of record shall complete Parts B & D of this form and then return it to the Building Division for
approval prior to issuance of a building permit. (Please note that a separate soils special inspection form may be required and
additional special inspections may be required for contractor design items.)
Project Address: 0-...4c) 5J pFA F6 Project Name: PfA FFCC - RD . eG S/7Cr
Architect of Record (Firm): C N <A/Mgrr � A Phone No: 6./8, 2..
Engineer of Record (Firm): Leo Robert p . E . Phone No: q I Q_3 -5135
The following special inspections and structural observations shall be performed acc rding to the State Building Code and the
City of Tigard's Municipal Code Chapter 14.06.010 - 14.06.040 unless a schedule of inspections is submitted by the Engineer of
Record and approved by the Building Division.
•
A. t Reinforced Concrete ❑Prestressed Concrete
tructural Steel OStructural Masonry, fm =
Q.1 leld Welding ❑Fireproofing
❑ Shop Fabrication S her TGRCUE t J l (2CME�I /'7s
approved testing agency to perform the special inspections Y1(6
B. Indicate the special inspector or a
pp ng g ncy pe peci pections noted in Part A above,
including addresses and phone numbers. Submit names, qualifications and certifications of the special inspectors
assigned to the project. The special inspector or inspection agency shall submit a final signed report to the Building
Division stating that all items requiring special inspection and testing were fulfilled and reported and, to the best of his/her
knowledge, in conformance with the approved design drawings, specifications, approved change orders and the
applicable workmanship provisions of the U.B.C. (see U.B.C. 3318 for soils special inspection final report requirements).
Items not in conformance, unresolved items or any discrepancies in inspection coverage (i.e., missed inspections,
periodic inspections when continuous was required, etc.) shall be specifically itemized in this report.
G ScI , ,, . • 0% 7 .
C. ❑ Structural Site Observation by Engineer of Record 444 -3¢Czlo
D. The-owner hereby agrees to employ the special inspector, approved testing agency and/or engineer for the above -noted
special inspections and/or structural observation.
..ii ! _ ■I. J ' _ed �L ._. - . WPM .... L L ; awne))
Sig - ture of Owner
Print Name -K�� hl-e,e.n (x r1 -\ Phone No. 7L{RO
Firm i V & T Lo\ re \e S Se-r\) Cce S Date
Structural Plans Examiner signature , 0.06-lo„„Ds,s, DOC
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
f ' 11 " 6 ` /L ' s c9. :
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Fo ng Rain Drain Cover /Service FINAL:
Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: r/
Date: A.M. _37-/ lq 7 P.Iv(. i ` Enry:
Address: SS yU
Tenant: S : MST: c
5 S f .7 8 LI/ BUP:
Con /Own: 1 MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
•
Ins.e . • v` Date: s e'
PROVED _ DISAPPROVED /CALL FOR REINSP. CF CO