Permit CL'Y'DE TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00257
Awek DEVELOPMENT SERVICES DATE ISSUED: 6/24/2004
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S112DD -01400
SITE ADDRESS: 15686 SW SEQUOIA PKWY
SUBDIVISION: MARRIOT ZONING: I -P
BLOCK: LOT: 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: 5 -1 HR : sf N: S: E: W:
OCCUPANCY GRP: R1 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: $ 3,363.00
Remarks: Type I hood.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES SIMPLEXGRINNELL LP
500 108TH AVE NE 6305 SW ROSEWOOD ST
P 0 BOX 3646 LAKE OSWEGO, OR 97035
BELLEVUE, WA 98009
one:
Phone: 503 - 683 -9000
Reg #: LIC 149921
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 6/3/2004 $81.70
[TAX] 8% State Surchari 6/3/2004 $6.54
[FLS] FLS Pin Rv 6/3/2004 $32.68
Total $120.92
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: _
Permittee
Signature: !�
Call 639 -4175 by 7 p.m. for an inspection the next business day
10(112004 2 FA AX - 5 5041960 CITY OF TIGARD 511001
17/R R to Ter • •
Fire Protection Sjste
Building Permit AuulElEQEIVED FOR oFFl(I: i'SE ONI.
City of Tigard JU 3 2004 °i ` '
13125 SW Han Blvd., Tigard, OR. 97223 osteB , 6^ '� l �� other Prnnit
Phone: 503.639.4171 Fast: 503598.1960 i � !2t sae Pegs l for
Inspection Line: 503.639.4175 CITY OF TIGA =11 Date R adyBy: Supplemental ags2fnrormodoa
Internet www.ci.tigard,or•us BUILDING DIVI • ■ Nod5edIMedod �
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.I; IJ .r�,�: ' S � ! ' - T✓��: .. : : .4''1: i d.... p� + '
Demolition Permit fees are based on the value of the work performed. O
❑ New construction Indicate the value (rounded to the nearest dollar) of all
overhead, the profit for the
� A Addition/alteration/replacement ❑ O ce °I2 thtsUPE labor, ad and
�. uiptnent,m J atedal
1 c 1 - .p �.: ;: 1; ; ,, .i ^ • ; ln(� red
? i i i)i �s.,. ;.( P !:9•:,S:S a Valuation: 5
❑ 1 and 2- family dwelling - •
Comtrtercial/industrial ...0
Number of bedrooms:
❑ Accessory building 0 Multi - family
['Master builder 0 Other um - be of floors
_ ,., , .u 4.a!t:. `:��;• : ' :ia.; •` � Total bathrooms:
_ •
'r.' 3 ' ` .s,. p :h5'i .t : i . ioc1►`rko1+1• • ' .. 1 :; ;:;r.
;.:,::•: ":. : < • ..:. . .. ., � °� �' � ew dwelling area: square feet
N in
lob site address: / '� 5:-0 S e 9 . 1)..),:_s_ P ,--- �'
G arage/carport arcs: square feet r
eiry/stattt/znP:' � , y ,,,.4 ri � 5' 7 22_1
Suite/bldg. /apt no.: 0 - e . P ro j e c t n a m a : C J QrA �pf` AI - Coveted porch area: square feet
Cross street/directions to job site Deck area: square feet
Other structure area: square feet
--
Subdivision I Lot no.: Permit 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
:r.. I'�.a* application.
s33 . :� ;• •• ! • ,,,;..:.. , , :i r :., ' : ,;:' �,� indicated on this app
a ':.. i e;. , . :.:�� I i... x
: Valuation: _ /J gJ LZ Sties M
�� / Existing building area: square feet
; ..,...,,.p: .,..:•. , building ca. square feet
. ..., ... :: � � • !:•::; • . , / ,_ � a ' i - _ • New b
.r•; I I. .: :•: Number of stories: s
.•. , .. [ ; .'I OpB ! O; lij .� 4�: ;I• , I J aN ,1'''r:: ea0 . a .i:_ . >'�. _
Name: _ _ Type of construction:
Address:
Occupancy groups:
City /State/ZIP. Existing:
Phone: ( ) V8R: ( New:
,;... .,, ... ':I... r . , .;,.. �^.� ,p,: . , � t.;!• �:�.; �. , � .. . : F: � h ••- . 1 ";.40 �I 'IIlr, ;0 I +t; :I ti = a . 6.*.PERS. I � i 1111' •mr!:�. .'.• ' :P ,,•_•' 1t:., =° ':E�!•�li r:�i: "r... �� .. ;; , :•r:01 o1 < :!!.. , 'P:�� .r...: .. -. '! .�. •'. .4:..•. ,1 ,'.� u
Business names ; cti &r r.JP/ I All contractors and subcontractors are required to be
gU b I� ,/1t y .. lc' licensed with the Oregon Construction Contactors Board
Contact Hama: [ _ under ORS 701 and maybe required to be licensed in the
Address: (j 5 L.J k pj...0'I jurisdiction In which work is being performed. If the
Ctity /SoatsJZIP: � 5).1 � UK � / 1
� applicant is exempt from licensing, the following reasons
�C apply:
Phone: () 6 3 _ e) �v . (Fax: // : ( ) C12 C12
E -mail:
..[r. .�.� � I �, '�: °. I• . !:,:. .: ,,,�� pj� 4 ,1ii ' . ti •
I. :o a4' ' ; ..g ; ;I 1•1ii:. . "t4fi .0,11 +" lG :!i`,: i.; . ,.G :
Business name :I l t 11': 'a . : i$'' ig! :' . • G A YE'
Address: Please refer w fez schedule.
City/State/ZIP: Fees due upon application I
Phone: ( ) I Fax: ( ) Amount eaccived
CCB lie.: y q S 21 — Date received:
Authorized S ignature: /f � 2 / �% 6- 2— v(1 This permit application expires if a permit is not obtained
/// � " t� G within 180 days after it has been accepted as complete.
I Print name: L ,.r L �et S I Date: I ' Fee me set by Tri Building Industry
't '' Service Board.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (5 ) 175 ,
MST
INSPECTION DIVISION Business Line: (5 71
,.0?o0 4 1— boas
Received Date Requested 6 - 3 v AM BUP
Location 1.S7.0 '4' .l -L-c2 _) Suite MEC
I. /
Contact Person L � i..._1L Ph ( 17/) SO (o - 8'9 3 7 PLM
Contractor Ph ( ) SWR
Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing , �' S /�/��
Insulation �� ` , 1/4 Drywall Nailing I
Firewall
u --
ire Alarm (. --vtil
Susp'd Ceiling
Roof
Ot.:,•
in
P.(_ PART FAIL
• BING
Post & Beam f
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains i f
Catch Basin / Manhole
Storm Drain
Shower Pan c)
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 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA / VO
Approach/Sidewalk Date [ 3 Ins Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS. PART FAIL