Permit A -- C ITY OF TIGARD
PERMIT #: BUP2002 -00295
,�i� DEVELOPMENT SERVICES DATE ISSUED: 7/30/02
-- x.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12220 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00300
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
• 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: NONE : 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: $ 12,000.00
Remarks: Install new freestanding pole sign, 11' 11" x 6' 1".
Owner: Contractor:
GREENWAY TOWNE CENTER TUBE ART
12220 SW SCHOLLS FERRY SEATTLE, WA 98124 EXP/RE
Phone: Phone: 503 - 653 -1133 �/
Reg #: LIC 70956
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Foot/Found Insp
5PCT CTR 7/12/02 $12.68 27200200000 Final Inspection
PLCK CTR 7/12/02 $103.03 27200200000
FIRE CTR 7/12/02 $63.40 27200200000
PRMT CTR 7/12/02 $158.50 27200200000
Total $337.61
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180'days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 t ugh OAR 952 - 001 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6 9 or 1 -801 " 1- 2344. .
Pe rm ittee /'
Signature: .
Issued By: / i , _ _ % , __ R. . 1
Call 639 -4175 by 7 p.m. for an inspection the next business day
If _ ,.., 6Z--
A - -- A ilding Permit Application
,
Date received: 7 /2 09 Permit no.: bij - a); ?s
tc,, +$._-)��� City of Tigard �� `
Atl. / - Project/appl. no.: ' e date:
City nfTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 9
Phone: (503) 639 -4171 Date issued: By Receipt no.: i
Fax: (503) 598 -1960 Case file no.: ` Payment type:
Land use approval: 40-' Cc /l t 1 &2 family: Simple Complex: N
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory ■ - ommercial/industrial 0 Multi- family 0 New construction 0 Demolition
0 Addition/alteration /replacement • Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: •2zo _ .., A, ed Bldg. no.: Suite no.:
..
Lot: Block: Subdivision: , _tea -� ?_,,.. Tax map /tax lot/account no.:
,
Project name: a �? �;t��, o - 1
Description and location of work on premises/special conditions: �r.��lA _.:iJ - .. P . fr.' �-
a
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST .
(Floodplaiu, septic capacity, solar, etc.)
Mailing address: go A c E _ __ � _ 1 & 2 family dwelling:
�om tie • State: Q ZIP: 1;0E0 Valuation of work $
Phone: i _ - /32 =IMO IM E -mail: No. of bedrooms/baths . - ,.......
Owner's representative: L - E Total number of floors _
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
IEMMIl / iP4 Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi - family:
CONTRACTOR Valuation of work $ 141 5 OO
ENNEE Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.)
Address: /7�w /.� ,��
✓/� � f ZIP: -7!/` , Number of stories
Phone: E -mail: Type of construction
� ���� 1 E-mail: Occupancy group(s): Existing:
Tr�
CCB no.: ,: New:
Cr '/ etro lic. o.: 4sr= 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: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
IMMIN ISZNINAMMIN Contact person: , pt/ 0 1 Fees due upon application ' $
Address: atfa Date received:
EMI� t y_ / ' ZIP: j4r Amount received $
Phone: ,„. -:,1 Vi Fax: E -mail: Please refer to fee schedule.
I hereby certify I r ave read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. • • rovisio . • ws and ordinances governing this to Visa 0 MasterCard
work will be complied . th, w / specified herein or not. Credit card number:
I Expires
Authorized signatu r 1 Dat' : Name of cardholder as shown on credit card
Print name: /_t�7i , � . Cardholder signature $
���« Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been cce ted as complete 440-4613 (6I)01COM)
I L it' 7o l been
I (o(e ' 3 I�l
1 Di 331.
•
p��, Commercial Plan Submittal
/�Yi7A0�1� I �'
11 � 1 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.
i:\dsts\forms \COM- matrix.doc 9/24/01
CITY OF TIGARD 24 -Hour
BUILDING I ♦ Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 cJ
NEST
BUP fi
Received Date Requested q AM 4 3 : 34)4 PM BUP
Location / Z Z- ZO S w Sc A e / Suite M EC
Contact Person /X Ph ( ) 863 - f3 .05_ PLM
Contractor Ph ( ) SWR
- BU1t:DTN Tenant/Owner Pa"— J / / - ELC
0o inert. S /yel ELC
ndation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 1 ivti
Drywall Nailing T r
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PART FAIL
' -ING
Post
e r Slab
Beam
Un�XPIRE®
Under
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 be next in.pection. 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 W i "
Approach/Sidewalk Date /3 O Inspector . Ext
Other:
Final DO NOT REMOVE this Inspe ' ion cord from the Job site.
PASS PART FAIL -