Permit CITY BUILDING PERMIT
OF TIGARD PERMIT #: BUP2003 -00396
� DEVELOPMENT SERVICES DATE ISSUED: 6/26/03
':W 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15115 SW SEQUOIA PKWY 150 PARCEL: 2S112DA -00800
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
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: : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 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: $ 40,000.00 .
Remarks: Tenant Improvement
downsize tenant for a new small tenant
Owner: Contractor:
•
PACIFIC REALTY ASSOCIATES H L GREEN
15350 SW SEQUOIA PKWY #300 -WMI 15350 SW SEQUOIA BLVD .
PORTLAND, OR 97224 STE 300
TIGARD, OR 97224
• Phone:
Phone: 624 -7717
Reg #: LIC 41328
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 6/26/03 $395.80 Electrical Permit Required
[TAX] 8% State Tax 6/26/03 $31.66 Plumbing Permit Required
Framing Insp
[FLS] FLS Pin Rv 6/26/03 $158.32 Gyp Board Insp
[BUPPLN] Pin Rv 6/26/03 $257.27 Susp Ceilng Insp
Total $843.05 Final Inspection
.05 .
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:. / / / -
Pe rm ittee I'
Signature: «� /�� _ �1�� /I� - _ ,
J - .
Call 639 -4175 by 7 p.m. for an inspection the ne • siness day
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- - - over ‘ -z c -o' 5P
. 1uildingPerY tAppli tion. - _
4. • Dateteceived Pen uitn
�la� l og am3�� 396 . .
;- _'1 & _ - City of Tigard ProjecUappl.na.: Expire date:
Cityogard Address: 13125 SW Hall Blvd, Tigard, OR 97223
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Phone: (503) 639 -4171 Date issued: By:. I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: I &2 family: Simple Complex:
TYPE OF PERMIT _
0 1 & 2 family dwelling or accessory 0 Commercial/ industrial 0 Multi- family -0 New construction 0 Demolition
❑. Addition /alteration/replacement ATenant improvement 0 Fire sprinkler/alarm 0 Other
' JOB SITE INFORMATION .
Job address: , .1 _,� r ✓ � j` Bldg. no.: Suite no.: ;
Lot Block: Subdivision: Tax map/tax no.:
Project name: W i% 4 114r Alw r
Description and 1 lion of w n miser/ ial ndr ' L
:`:. OW1\TR FOR SPECIAL INFORMATION, USE CHECKLIST
Name:. P a cT ru s t - (Floodplain, septic capacity, solar, etc.)
Mailing address: 15350 SW Sequoia Pkwy. , #300 -1' & 2 family d w e l l i n g - - - - - - - -
City: Portland . I state: OR VIP: 9 7 2 2 4 Valuation of work $
503 I Phone:? 6;24 :63GO O(Fax$2. ' E -mail: No. of bedrooms/baths . -
Owner's representative: D e n n i s P a q n i Total number of floors
' Phone: Same . Fax:.. Same . E -mail: New dwelling area (sq. ft.)
;', APPLICANT - Garage/carport area (sq. ft.)
Name: P a c T r u s t Covered porch area (sq. ft.)
Mailing address:1 5350 SW Sequoia Pkwy ., #300 Deck area (s q• ft-)
City: Port 1 and State: OR !ZIP: 97224 Other structure area (sq. ft.)
503 Phone:6 2 4 - 6 3 0 0 Fax6 2 4 - 7 7 5 E-mail: Commercialfmdustriallmulti- family: t00::'
CONTRACTOR Valuation of work $ - .1f )
Existing bldg. area (sq. ft.)
Business name: H. L. Green New bldg. area (sq. ft.) / i,_g_tQ /
Address: 15350 SW Sequoi a Pkwy. , #300 /
City: Portland I State: 0 R I ZIP: 97224 Number of stories
503 ) Phones 2 4- 7 717 I Fax: I E-mail: Type of construction ��
CCB no.: 41328 Occupancy group(s): Existing:
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: J 0 h n R O m i S h provisions of ORS 701 and may be required to be licensed in the
Address: 15 3 5 0 SW Sequoia Pkwy. #300 3 0 0
jurisdiction where work is being performed. If the applicant is
City: Port l and State: OR ZIP 9 7 2 2 4 exempt from licensing, the following reason applies:
Contact person: Plan no.:
503 ) Phone: 6 2 4-6300 Fax:624- 775' mail : . ohnr @tact.usti t.co
ENGINEER
Name: Contact person: Fees due upon application $
Address: - Date received:
City: (State: (ZIP:. Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
/ I hereby certify I have read and examined this application and the 'Not all jurirdcdoas accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances 'gave ing this 0 Visa 0 MasterCard
work will be complied - th, whether s citi. erein o no, Credit card number: / 1
P
Authorized signatu ,, r /� /,/� 4/ Ii ' /j S - '•" - /- e Name of cardholder as shown on credit card
war
' Print name: :..1Z 7 7-0 / / . I' cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 44o -4613 oduoiCOM)
•
CITY OF TIGARD 24 -Hour
BUILDING :i Inspection Line: (503) 639 -4175 MST
INSPECTION1DNISION Business Line: (503) 639 -4171 M J
Received 1 a ; 1.0 -P Date Reque; ted / 2 7 -0. 9'AM PM BUP
Location - -- ' ��_ .. Suite / 370 MEC
Contact Person L� . __.�. Ph (F`) Z c2 —7 S 4 PLM
Contractor C A N Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: /�// SIT
Post & Beam Ja��
Shear Anchors c cue 1 0442,0--4_,
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm •
Susp'd Ceiling
Roof
Pala PART FAIL
PL U = ING
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
Anal ❑ 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 /- 7 V
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.. -
PASS PART FAIL