Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00377
� ��;� DEVELOPMENT SERVICES DATE ISSUED: 8/5/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15350 SW SEQUOIA PKWY 200 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2 -1 HR : 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:. /old• OD
Remarks: Adding (1) fire sprinkler heads for TI.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES DELTA FIRE INC
15350 SW SEQUOIA PKWY #300 -WMI 14795 SW 72ND AVE
PORTLAND, OR 97224 PORTLAND, OR 97224
Phone:
Phone: 620 -4020
Reg #: LIC 64174
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 8/5/2004 $62.50 Sprinkler Final
[TAX] 8% State Surcharl 8/5/2004 $5.00
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 , - • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 01 -0010 thr • • h OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
..fling (503) 246 -669• •r 1- 800 -33 -2344.
p • ddr
S '- - ��
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
I It
Building Permit AlarlS FOR OFFICE USE ONLY
City of Tigard UG 0 5 2ooIk. Received
Date/B : . Peg �� P No.: 1 iL 0 • 7
13125 SW Hall Blvd., Tigard, OR 9722
Phone: 503.639.4171 Fax: 503.598.1960 GOO /Yer i p Plan Review
A \ Date/By: Other Permit:
Inspection Line: 503.639.4175 C,� 11.\100 , Date Ready /By: 3 ® See Attached Checklist for
Internet: www.ci.tigard.or.us 901531°G 901531°G D _. Ready/By:
Supplemental Information
• • TYPE OF WORK REQUIRED DATA: I- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
ddition/alteration/replacement ❑ Other: equipment., materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling Commerciallindustrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /53 C J���/ / o ( a -f _r New dwelling area: square feet
City/ State/ZIP: " Garage/carport area: square feet
Suite/bldg. /apt. no.: 9Q/'y Project name Covered porch area: square feet '
Cross street/directions to job site: 1 Deck area: square feet
ir
a ' \ Other structure area: square feet
REQUIRED DATA: COMM -USE CHECKLIST
Subdivision: I Lot no.: Perm fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
- ,� OF WORK work indicated on this application. te
-
) / 6 Uf I (7 4 ] `- ✓7 / K t Valuation: $ / r
tsil ( �f �/ I / l Existing building area: square feet
New building area: square feet .
' - _ g:‘.--PROPERTY OWNER ❑ TENANT Number of stories:
Name: ` /� 7—aLS1 --- Type of construction:
Address: I Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( )
New:
- APPLICANT ❑ CONTACT PERSON NOTICE
Business name: j
All contractors and subcontractors are required to be
Contact name: J ` licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: / (,,( 7y 70/ jurisdiction in which work is being performed. If the
City/State/ZIP: ` � O(2 Q applicant is exempt from licensing, the following reasons
` — l ?� apply:
e) y Fax:: �J`
(e F) W Cb
Phone: )( � "'
E -mail:
CONTRACTOR ' . •
Business name: [-' .lam
BUILDING PERMIT FEES* ::,,,
Address: /t/'7 Q V 4 -7)1",/ ,�
City/ State/ZIP: (^ , a q79- Please refer to fee schedule
S5 )) � (50-23 fO Fees due upon application (07- ,,)
Phone: . /�� Fax
CCB lic.: 0241 7 7 � ` �'�� Amount received
e Date received: .
Authorized signature: This permit application expires if a permit is not obtained
+ ^, � `o within 180 days after it has been accepted as complete.
Print name:�ljj /- /f Q / C �' ar- f- ncOlpate: e (' f ( .( • Fee methodology set by Tri -County Building Industry
CC ` "(/� t Service Board.
i:\ Building \Pemuts \BUP•PennitApp.doc 12/03 440- 4613T(11/02/COM/WEB)
CITY V 24 -Hour
Inspection Line: (503) 639 -4175
INSPE • !VISION Business Line: (503) 639 -4171 MST
BUP DC��Sa
•. -w.
Received Date Requested �o AM PM BUP 7054 '
Location S TI Suite 200 MEC 24°4-- C 5d4
Contact Person / Ph ( ) 3657— a ( CS PLM
Cont - - - Ph ( ) SWR
Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewa I
e S i
Fire Alarm
Susp'd Ceiling
Roof AV:
�Ot�h: v /i ce-
r AS PART FAIL I•r
PLU = ING
• st & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS _ FAIL
CHANICA
Rough -In
Gas Line
Smoke Dampers
Fi
PART FAIL
TRICAL
Service h- i ,
Rough-In f/
UG/Slab
Low Voltage I.I/ • �, Io'
Fire Alarm
Final ❑ 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
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL