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ORIGINAL DOCUMENT E 6Z 8 Z L Z 8 Z Z Z c Z Z 11 O Z 61 8 [ L T J T �' T T E T Z T T T [ T 6 R~ L 9� IIII IIII IIII IIII IIIIIIIIIiIIIIIIIIIIIIIIIIIIIILllILllllll 111 IIII IILIIIIIIII (�{� IIIIIIIIIIIIIIII ���� 1111 �� � IIII ���� Iill�illlIllllilllllllllll1 1 lllliilllllL1� 111IIllillllllllllllllll�lliwl .11lllllllll.11 Il 1l �I� IIIil�11 { td N O (A G) x m m z ca c M 0 M 0 a v i 11920 SW GREE NBUR:G ROAD `s 1 CITY OF T I GA R D CERTIFICATE OF OCCUPANCY DEVELOPMENT SERVICES PERMIT#: BUP2003-00131 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 4/1/03 PARCEL: 1 S135DD-04400 ZONING: C-P JURISDICTION: TIG SITE ADDRESS: 11920 SW GREENBURG RD BLDG 3 SUBDIVISION: BLOCK: LOT: CLASS OF WORK: ALT TYPE OF USE: COM TYPE OF CONSTR: 5N OCCUPANCY GRP: B OCCUPANCY LOAD: 12 TENANT NAME: ISODY IMAGING REMARKS: TENANT IMPROVEMENT Owner: STEVENSON, MICHAEL J + KAY L 2825 DELLWOOD DR LAKE OSWEGO, OR 97034 Phone: 503-658-7927 Contractor: CHAMPION CONSTRUCTIO14 INC 23091 SE BELMONT COURT BORING, OR 97009 Phone: 50 1 658-7927 Reg #: I h' 00096715 This Certificate issued 5/9/113 grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for compliance with the State of Oregon Specialty , odes for the group, occupancy, and a ander which referenced permit w i vlail BUI IN INSPECTOR ----�'^ -- POST iN CONSPICUOUS PLACE CITY OI`TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP Received tate Requested_- . AM— _ PM__ _ BLIP Location _�_ �_ ya _Suite —_ MEC — 61, Contact Person Ph(__ ) f�o _—_ PLM _ Contractor _ ___— — __—_— _ Ph(_—^) _ SWR _ BUILDING _ Tenant/Owner _ -__ —.— ,7!_ — ELC — Fonting EL C Foundation Access: r tg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post 8 Beam Shear Anciors �- -- -- Ext Sheath/Shear Int Sheath/Shear Framing Insulation -- -------- - -- - _� - - - -- ------ - Insulation Drywall Nailing �-- ----- --`-- ----- - ----- Firewall Fire Sprinkler - ---- ----- _-___ -- -- -----_--.-- Fire Alarm Susp'd Ceiling --- - ------ ----..__ _ ---- --- - Hoof Other: ------- ---- --- - _-- ------- RD`S PARTFAIL __---------- -------�- - ._—.__ ----- -- _ SING — Post& Beam ----- - ----_. _-.----__--_ Under Slab - -- ---- - ----- ---------- — ---- - Rough-In Water Service -- -- ----.- ----- Sanitary Sewer Rain Drains -- - - ---- -- - — Catch Basin/Manhole Storm Drain ---- -- - --- --- - Shower Pan Other: ----- ----- -- - Final --- -------- PASS PART FAIL ---i-__ --_-- -_- MECHANICAL `– Post&Beam --�_-�.- --- Rough-In - --- - --- -- ------- ---- Gas Line Smoke Dampers Final - -- PASS P..riT FAIL ---------.A-___. .- --- -- - _ ELECTRICAL Service - - ------------- --- Rough-In --- ----- -- -- - ------ ----- UG/Slab Low Voltage Fire Alarm Final Reinspection fee of$ renuired before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL ----- -------------- SITE - Please call for reinspection RE:.—_ _ _ _ n Unable to inspect-no access Fire Supply Line ADA / �D Approach,'sidewalk Date --- _�3_ Inspector __ -- _-- --- ---- - -_ Ext Other: Final DO NOT RE'10OVE this. Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD ELECTRICAL PERMIT PERMIT#: F-LC2003-00182 DEVELOPMENT SERVICES DATE ISSUED: 3/31/03 13125 SW Hall 81vd.. Tiqard, OR 97223 (503) 639-4171 PARCEL: 1S135DD-04400 SITE ADDRESS: 11920 SW GREENBURG RD BLDG 3 SUBDIVISION: ZONING: C-P BLOCK: LOT : JURISDICTION: TIG Project Description: Installation of(1)200 amp or less service and(12)branch circuits. RESIDENTIAL UNIT TEMP SRVCIFEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNALIPANEL: MANF HMI SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W/SERVICE OR FEEDER: 12 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ PLAN REVIEW SECTION 1000+ amp/vol:: >=4 RES UNITS: >600 VOLT NOMINAL: Reconnect only: SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC: X Owner: Contractor: STEVENSON,MICHAEL J +KAY L MT HOOD ELECTRIC INC 2825 DELLWOOD DR PO BOX 1270 LAKF.OSWEGO,OR 97034 WELCHES,OR 97067-1270 Phone: Phone: 503-622-1305 Reg #: ELE 3-517C -- -- LIC 147640 _ FEES _ "till 48285 Description Date ` Amount Required Inspections c IT1'OF Tic i SRU%11:NU t .11 n3 $160.10 --' --- I I I.I'LCK) IA('I'In Iter 3131103 $40.Q3 Elect'/ Seivice I S) S Stair I;r� I nt $12.80 Rough-in Elect'/ Final Total $2'12.93 This Permit is issued subject to the regulations contained in the Tigard Munidpal ;ode, State of OR Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if wrj*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 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 copies of these rules or direct questions to OUNC at(503)246-6699 or 1-800.332-2344. I Issued By: Permit Signature: 1K OWNER INSTALLATION ONLY Ilii? installation is being made on property I own wh!ch is riot intended for sale, lease, or rent. c OWNER'S SIGNATURE: DATE:- CONTR TOR INSTALLATION ONLY SIGNATURE OF SUPR.//E``LEC'N: DATE: LICENSE NO: Call 639-4175 by 7:00pm for an inspection the next business day Electrical Permit Application Date receive1'crnut no.: City of Tigard Project/appl. no.: a date: Citi,o/Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: BLReceipt no.: Phone: (503) 639-4171 — Fax: (503) 598-1960 Case file no Payment type. Land use approval: U I &2 family dwelling or accessory J Commercial/industrial J Multi-family Tenant improvement U New construction J Addition/alterattorn rettlacentcni J ruiner: J Partial Job address. 110t20 Sys jeo (� �(G Bldg. nc, ~tote no.: X50 1 it\ neap til\ lot/account no.: Block: Subdivision: Project name: 7TDcscriplion and location of work on premises: d,18�1- 1Mp(2otJENiaNT FOQ Estimated date of completion/ins cction: _S IS 03 r1 t ostq CC t Job not Fee Nina Business name: M+ ry 0111• total no.lnvp Nest V Address: PQ (�p� ) p dovelllnstunit.Include+attached garage. City: Wt\GlLy 7IP: A7067.12 Serlicelmiuded: Phone:sej,ett 1,301Fax:41 & ISS4 C-mail:Mt,l,ea,1„�rarae I000s .A.orless _ 4 CCB no.: 476 k p Elec,bus, tic.no: viva w.rti Each additional Slots .fl.or portion thereof Limited energy, residential 2 City/lnetro lic.no.: 6 91 b U Limited energy, non-residential 2 i L 3t b3 _ Each monufnoured home or moclular dwelling 3ignnit "-of au hosing tncinn (required) tale Service nndror feeder 2 Sup acct.naic(print) — License no: `/ Service%orfrrderv-Invtallotlon, elterat Inn or relocation: 100 nm s or less q0.�� 2 Natne(print): 201 amps to 400 amps 2 Mailing address: 401 strip!.to 600 amps 2 601 amps;to 1000 amps 2 City: State: ZIP: Over 1000 amps or volts 2 Phone: Fax: E-mail: Reconnect only I Owner installation: 'rho installation is being made on property I own I empors rr,e,-vtcev or fredery- which is not intended for sale,lease,rent,or exchange according to installation,alleration,tit relocalion: ORS 447,455,479,670, 701. 200 amps or less - 2 201 atmos to 400 amps 2 (Renee's si mature: Date: 401 to 600 ams 2 Branch circuits nen,alteration. or exlension per panel: 7Addtc,,: ^�___ A. Fee torr branch circuits with purchase of sorvice nr feeder fee,each branch circuittate: Zip: B. Fee for branch circuits without purchase - of service or feeder fee,first branch circuit: 2 Phone: Fax: F maul. Each additional branch circuit: M isc.(Service or feeder stilt Included): J Service over 225 mops-commercial licallh-Cate lacilm Each pump or irrigation circle 2 J Service over 320 anlx•mhng of 1&r2 U Hazardous location Each sign or outlux:lighting 2 I'.tmily dwellings U Building over 10,000 square feet four or Signal circuit(q)or it limited energy panel, J Systern liver 6(x1 volts nornmal more residcniinl units to one sinicturc alteration, or ertensinnv _ - Y 2 U fluilding over three voncs U Feeders,400 amps or more •ncscri nnm y O Occupant load over tit person. U Manufactured structures or RV park Each addiflonat Inspection oder the alluuotrbr in and of the abode: U Iegm".Aighting plan U Othe' Per inspection_ I Submit vets of pians"Ith ane of the above. Investigation fee Ilse above are not applicable to iternporstry construction service. Other Ne,Cbl jurodiclions accept credit cards,plem call jun+dicuan rot more information Notice: This permit application Permit fee ..,.........`... LN eJ Visa U Mastercard expires if a permit is not obtained flan review(at g�j %) 5i y0 •C.3 _ credal card number: _ /_ within 180 days after it has been State surcharge(8%) \plre9 -$ -' - TTimr a-TcaidFi;fdei iM r-Flown oo cieJtt carol.__ accepted as complete TOTAL.........................$ S s aTiuturc Jimount aa041,15 1 n lal coAt l i SEE 35MM ROLL# 23 � FOR LARGE DOCUMENT ou i `Z ? -r �'Tl I b w i d r � o N -� -tk N AL I� II cl e t s w Y r fillh a V ti J� r 0 Z W m Ir `a cy Q (� L 7 WLLca z W �_ � r 7a m CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2003-00120 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/1/03 SITE ADDRESS: 11920 SW GREENBURG RD BLDG 3 PARCEL: 1S135DD-04400 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: 2 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: F SINKS: 1 URINALS: 1 GREASE TRAPS: LAVATORIES: 3 OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing tenant improvement: relocating (1) lav, (1)toilet, (1)2" floor drain, (1)water heater, adding (1) sink, (2) lays and capping (1) urinal and (1)2"floor drain. FEES Owner: Description Date Amount STEVENSON, MICHAEL J + KAY L 2825 DELLWOOD DR ll'I.UMIiI I'crm � frr i 4/1/03 $$11.40 LAKE OSWEGO, OR 97034 IIA\I 8°/�Slutr I a� 4/1103 $11.95 Total $161.35 Phone Contractor: PENINSULA PLUMBING PO BOX 16307 PORTLAND, OR 97216 REQUIRED INSPECTIONS Phone : 503-761-0500 Rough-in Insp Top-out Insp Reg #: MET 00001804 Insp existing/capped fixtures LIC 2244 Final Inspection PLM 26-64PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 rules adopted by the Oregon Issued By: `�� _ ' �( ;>! Permittee Signature: Call (503) 699-4175 by 7:00 P.M for an inspection needed Cie next business day -21-2003 011:27 FROM PENINSULA PLUMBING TO 5036587927 P.02 e �Me ' Aa4rsc . �'W iit.: '••. sir: '�:,. -�-j�.aAgWl as •�41r�� .�_..; �J�a•qlp er. ���' _� wom mpr �• .'Inti-Giw7Y J�:..ca�.hUeMM tl 1�0NAorM�eralaahgit�+aco� a+wod now 0 caw. � srioe��- !"= SMS w�114 hNMow.r p.7 --- — SFR p 1 by ° man --� _- rL�,ipb.,,.a So.Arad n _ —�7t—+b b ep z "� an— CM�- .oaaam ._._._1___—___- - - -ft-- lY�eWIIIA >� vill_ - - Mubw - -� rli >� HM,Mb MF Vm.a = _ A M Mdc b re a!e Moa Md p I de by""v earta�s w k�ipwa(vw�.aa.am O.#K 4"1. — UAW ow. V lit>./ aNim K. Pon*b mm sholw A wom In a"MAW a wo Tom - --•1��'�'.�aZi ' —. rsMt�i�Maar 7 �� ��4�� CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 -- BUP _ Received _____— Date Requested S=�—_ AM___ —nnPnnM — BUP l-ocation --Suite_ MEC Contact Person Person _.._ �__ __�_—_ ___�_ h(—_—.__) — :#7 ___— PLM Contractor ---------_-- ` _- -- Ph �L54 SWR _ p—`— BUILDING Tenant/Owner _W_—_ __ ELC 3 Footing Foundation ELC -------__-- _ Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT _ J` Post&Beam Shear Anchors - - -- -_-- Ext Sheath/Shear Int Sheath/Shear Framing - - --- Insulation Drywall Nailing -- Firewall Fire Sprinkler - -- -- - _ -- . - --- - ----- ---- Fire Alarm Susp'd Ceiling --- ... --- -- --- -- ------- ------- Roof Other: -------- - ------- Final PASS PART FAIL -- . . - - --- -_- -� - -- PLUMBING 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 Post8 Ream---- ---.... _- -------._-----�--�_ __-_-------�- Flough-In --- --- -- - ----- Gas Line Smoke Dampers �.— Final PASS PART FAIL - ------- ----_ ELECTRICAL Service - Rough-In - -- -- ------ - --- --- ---- — - UG/Slab Low Voltage - -- - ------ — -------- --— --- Fire Alarm n Reinspection fee of$ —__ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. _ PART FAIL —- - r r -_�- -__ .____ Unable to inspect-no access ADA _ Line _ -� Please ca l for reinspection RE: _--- �� Fire Supply Line 'I ADA �/ ''"' Approach's 5 w idewalk Datq J T InspeCto _ — 1-!Z `7 Ext - - Other Final DO NOT REMOVE this Itnsprectlon record from the J b sitar. PASS PART FAIL { CITY OF TIGARD 24-Hour i UILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-417'. BLIP Received ___ _Date Requested�l� — AM PM.---..- BUP Location ._ 1 12 �.,1�1.2 Pih i� I�- Suite MEC Contact Person -_. 04 at4,L111 - Pl 2 f 5-S/a C2_ PLM Contractor '�---_,Pah( ) �- - SWR --_- — BUILDING Tenant/Owner � `�`�`t '1 r�r� ELC 3- D U 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 ---�� (.- Firewall Fire Sprinkler — Fire Alarm Susp'd Ceiling -- ------ - - - -� _�—� Roof Other: ----- -- - - ---- - _— _ — _ 'r=ival �-�-- - PASS PART FAIL PLUMBING _ Post&Beam Under Slab Rough-In - Water Service - - -- - - --- Sanite,ry Sewer �^Pain Drains ----- - -- -- Catch Basin/Manhole Storm Drain - - _---_-----__-_ --. Shr,wer Pan Other. Final - - PASS PART FAIL__ - -MECHANICAL Post& Bearn -- - - Rough-In -- ----_-_.. Gas!-ins _ Smoke Dampers _- Final --- ----- ------- PASS PART FAIL Wouyti-ln UG/Slab - - -- -- - Low Voltage Fire Alarm Final Reinspection fee of.$ required before next inspection. Pa at Ci Hall, 13125 SW Hall Blvd. SS PART FAIL f -1 P -- q P Y City SITE Please call for reinspection RE:.— Unable to inspect-no access Fire Supply Line ADA ApproschlSidewalk Dab - 1 __ Ins p or G��'% � Ext_ Other: Final DO NOT REMOVE this Inspection record from the 166 site. PASS PART FAIL CITY OF TIGARDBUILDING PERMIT PERMIT#: BUP2003-00131 DEVELOPMENT SERVICES DATE ISSUED: 4/1/03 13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 1S135DD-04400 SITE ADDRESS: '11920 SW GREENBURG RD BLDG 3 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ALT FIRST: 1,513 sf N: S: E: W: TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? TYPE OF CONST: 5N sf N: S: E: W: OCCUPANCY GRP: B TOTAL AREA: 1,513 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 12 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: N SMOK DET:N DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : N HNDICP ACC:Y BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 75,000.00 Remarks: TI Owner: Contractor: STEVENSON, MICHAEL J + KAY L CHAMPION CONSTRUCTION INC 2825 DELLWOOD DR 23091 SE BELMONT COURT LAKL OSWEGO, OR 97034 BORING, OR 97009 Phone: Phone: 503-658-7927 Reg #: LIC 00096715 FEES REQUIRED INSPECTIONS Description Date Amount Mechanical Permit Require I13U1'PLNI I'In 16• _ 3/21/03 $398.46 Electrical Permit Requireu TLS] FLS PL• R%, 3/21/03 $245.21 Fire Alarm Permit Requirec Plumbing Permit Required [BUILD] Permit Fee 4/1/03 $61302 Framing Insp I FAX]8'%,State Tax 4/1/03 $49.04 Insulation Insp Total $1,305.73 - Gyp Board Insp Final Inspection 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 wit:i approved plans. This permit will expire if work is n it started within 1E' 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: ' l i Permittee Signature: Call 639-4175 by 7 p.m. for an inspection the next business day FOR OFFICE USE ONVY Building Permit AppligagUII Received Building q _ L- Permit Nn: CI Cit of Tigard `p Planning Approval Other City g Date/By: Permit No.: 13125 SW Hall Blvd. } Plan Review Other — Tigard,Oregon 97223 Date/13y: _ Permit No.: Phone: 503-639-4171 Fax: 5g3t�98419Ct<1' Post-Review Land Use Internet: www.ci.tigard.or.uS 1� f-;'-, Date/13 : Case No. Contact loris.: See Page 2 for 24-hour Inspection Request: U3639.4175 Name/Method: Su r dcmentul Information _ TYPE OF WORK REQUIRED DATA: New construction _ t)emolition— t &2 FAMILY DWELLING Addition/alteration/re laecment LJ Other: ---CATEGORY OF O_F CONSTRUCTION Note Permit Pecs*are based ou the total value of the work performed. Indicate _ 1 &2-family dwelling _ommereial/Industrial the value(rounded to the nearest dollar)ofall equipment,materials,labor, � Accessor�Building Multi-Family overhead and profit for the work indicated on this application] ❑ Master Builder Other: I A Valuation......................................................... $ _ JOB SITE INFORMATION and LOCATION hMlNo.of bedrooms: No.of baths: — ` Total number of floors............. .. Job site address: �0 5 f���C�.i , r k , -- �--- New,dwelling area(sq. fl.)...... .. .................... Suite#:- Bld ./A t.#: - :. � Garage/carport arca(sq. fl.).......................•.... Project Name: __fid La,.t.c f„ Covered porch area(sq. ft.)...................•. ....... Cross street/Directions to b tt: Deck area(sq. fl.)........................................... — Other structure area(sq.fl.)........................... REQUIRED DATA: — COMMERCIAL-USE CHECKLIST Subdivision: Lot#: — Tax map/parcel#: 13 5'A6 Note. Permit tees'are based on the total value of the work per(i,;med. Indicate DESCRIPTION OF WORK the value(rounded to the nearest dollar)of all equipment,materials,labor. — N overhead and profit for the work indicated on this application. AFF Valuation......................................................... $ ZS DO t - --- — Existing building area(sq.ft.)......................... -- --- -- New hnildin2 are-' Number of stories.................... ... f— _— PROPER'L'Y OWNER T_EN A_NT Type of construction...................... ................ J- Name: iSockOccupancy group(s): Existing: 1 Address: -.►��,<-rAt -- -- -- New: - Cit /State/Zip: _ Pl ne: fax- NOTICE: All contt tctors and subcontractors are required to be Jn APPLICANT CONTACT PERSON licensed with the Oregon Construction Contractors Board under - provisions of ORS 701 and may be required to be licensed in the Business Name: L��a �i �-) �t- L.L t.— jurisdiction where work is being performed. 11-the applicant is exempt Contact Name: -, � �t�2���4�S ^— from licensing,the following reason applies: Addras:;L3c)ft Sf._�e ----- City/State/Zi : go r , f `J?d -- Phone:Q S, ?')rZ7 Fax: Sc,_,-t _ BUILDING PERMIT FEES" E-mail: l 8 — -610 4•rt nl .. CONTRACTOR - Please refer to fee schedule. - - - ------------ Business Name: iA4,t.4 _ _ Fees due upon application......... ................... Address: City/State/Zip Amount received.................. •...................... PhonFax: Date received: i CCB Lic. #: 1I S_ d 1-9!1 --- -- - l Authorized / Notice: This permit application expires If a permit is not obtained ssilhin Signature: _ G L Date: 7 ZL-(�`3 IRO dais after It has been accepted as complete. ����-��S_ ZZIw , •Pee mclhodologv set M'rrl-(bunts Building Industn tienicc Board. (Please print name) ; flu i:\DstskPcrmit FormslnldgPermi1App.doc 01/03 k4.✓jet t. �L 5 �►r5 •a-I I[7 Commercial Plan Submittal ., Requirement Matrix Cite 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. Atter plan review approval, the Pians Examiner will contact the applicant to request additional sets of plans for aistribution 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 Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP _ Received _ Date Requested_--_ ✓.. _—__ AM-- _PM BUP Location .- � _— Suite- — MEC Contact Person ___. _ G -- --,.-- h(_____—_) 3l�— (c,_7 S1 PLM Contractor __— — — __. _ Ph(--�) SWR BUILDING Tenant/Owner ---------�� r — ELC --- F-noting ELC Foundetion Access: - Fig Drain ELR Crowl Drain ---� -- Slab Inspection Notes: SIT Post& Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear -�-"- --`--- -- Framing _- Insulation Drywall Nailing ------ - - --- ---- --. - ----- -- .-. -- --- Firewall Fire Sprinkler — - - -- -�---__- - - ___--- Fire Alarm Susp'd Ceiling - ---- - - - -- -- - Root Other �, ----- -Fine; PASS_ PART FAIL -�- -- PL_U_MBING Ihrder Siab --- Rough-In Water Service Sanitary Sewer Rain Drains -- ------- - - Catch Basin/Manhole Storm Drain ----- - -- ---- - - .. _- __ - - - - -- Shower Pan Other: --- ---- ------ - -_ PA _PART FAIL ----- ---_ - - - - ---__..__------ -- M HANICAL Post&Beam Rough-In —_ --- ----- --- - - Gas Line -- ------------- - Smoke Dampers Final PASS PART FAIL - - - -- - —_-- ELECTRICAL Service Rough-In l►C;/Slab -- ---- ---- -- ------ _ _ -�_� --- ---- Low Voltage _- Fire Alarm - Final El Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd, PASS PART FAIL SITE _ C� Please call for reinspection RE E] Unable to inspect-no access Fire Supply Line l 7 AGA / Approach/Sidewalk DateInspeeo -� Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP Received __. Date Requested– S _ _?— AM PM_ BUN Location _/t/1 ..– -Suite MEC Contact Person 7h PLM Contractor - __._—___��.___�_. 'e--_ Ph( ) 12 A-2 _ SWR BUILDING TenantJOwner , _ _ _ ELC Footing - -- ELC -- - -- Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam ' SliearAnchors --� Exl Sheath/Shear Int Sheath/Shear Framing -- - - --- --- ---------..--------- --- Insulation Drywall Nailing --- ------- - ----- - --- ------ Firewall Fire Sprinkler --- - -- --- - =-- - - - ---- -- -� Fire Alarm i Susp'd Ceiling ------ Root ,- -- Other. - -- -. -------- iij A - Final PASS PART FAIL LUMBO Post& Ream Under Slab -------- --- - Rough-In Water Service — �;anitary Sewer Rain Grains -- 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 - ELECT_RICAL Service _- ---..-- -----____-. _---- Rough-In - -- -- --- -- ---_ - Fire Alarm -` -------- ----------.�..-_- TAS Reinspection fee of$___ required before next inspectiun. Pay at City Hall, 13125 SW Hall Blvd. a ART FAIL BITE e Please call for reinspection RE:_.. --____. -��_______, �� Unable to inspect--no access Fire Supply Line _ � ��IZ4 ADA /. G- -' � CApproach/Sidewalk Date - /__- InspectorExt ._-.-. Other: Final DO NOT REMOVE this Inspection recon) from the job site. PASS PART FAIL ELECTRICAL PERMIT- CITY OF TI GARD RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT#: ELR2003-00108 13125 SW Hall Blvd..Tiqard, OR 97223 (503)639-4171 DATE ISSUED: 4/10/03 SI 7E ADDRESS: 111120 SW GREENBURG RD BLDG 3 PARCEL: 1S135DD-04400 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG Prosect Description: Install low voltage (voice&data cabling). A.RESIDENTIAL B.COMMERCIAL _ AUDIO & STEREO: AUDIO& STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATAITELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL#OF SYSTEMS: 1 Owner: Contractor: STEVENSON, MICHAEL J + KAY L TELECOMM MANAGEMENT INC 2825 DELLWOOD DR 15611 PARTRIDGE DR LAKE OSWEGO,OR 97034 LAKE OSWEGO, OR 97035-3121 Phone: Phone: 503-639-8209 Reg#: ELE? 3-463CLE. LIC 135355 FEES Required Inspections Description Date Amount Low Voltage Inspection jFLI'RMTj ELR Permit 4/10/03 $75.00 Elect'I Final jTAXj 81%0 State Tax 4/10/03 $6.00 Total $61.00 This Permit is issued subject to the regulations contained in the, Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 mom than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throue Permittee Signature Issued by g OWNER INSTALLATION ONLY The installation is being made o,i property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: __ DATE: CONTRACTOF INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N _ DATE: LICENSE NO: — Call 639-4175 by 7:00 P.M. for an inspection needed the next business day FOR OFFICE (ISE ON VV EleGtriltal Permit-Amlieation Received J.fi pd' I I��trt�al .moo Date/By: W�G�—O?, I'cnnit No /0 Cit of Ti and Planning Approval Sign Y b Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other — — Tigard,Oregon 97223 Date/By: Permit No.:? � � -UD t 41 Phone: 50.1-639-4171 Fax: 503-598-1960 Post-Review Land Use Uate/By:__ Case No.: Internet: www.ci.tigatd.or.us Contact Juns: See Page 2 for 24-hour Request:Inspection Re t: 503-639-4175 p � Name/Method: � S1i tlj cmcntal Information. TYPE OF WORK PLAN REVIEW Please check all that apply) New construction i T�] Dcmolition Service over 225 amps- health-care facility commercial C:]hazardous location _ ©Addition/alteration/replaccmenl LJ Other: []Service over 320 snips-rating of ❑Building over 10,000 square feet, _ CATEGORY OF CON TRUCTION I &2 family dwellings four or more residential units in ❑ 1 &2-family dwelling 0 Commercial/Industrial ❑System over 600 volts nominal one structure ACCeSSo l3uildin Multi-Camil ❑Building over three stories ❑Feeders,400 snips or more ._ �'_ — Y _ ❑Occupant load over 99 persons ❑Manufactured structures or RV park Master Builder. Other: ❑Fgress/lightin plan sets of plansIEl h any of the above. — JOB SITE INFOR_MATION and,],,OCATION — The abuse are no(applicable to temporary construction service. Job site address: �'' —� (-7 __ FEE*SCHEDULE Suite#: Bld ./ : _Number_of ins)cctions�Lcrmit allowed Project Name: uescrt Unn Qh Fee(ea.) total '— Cross street/Directions to job site: New residentlol-sIngle or ntula-fondly per dwelling unit.Include,attached garage. Service Included: 1000 sq IL ur less _ 145.15 _ 4 Lach additional 500 sq.ft.or riion thereof 33.40 1 Subdivision: _ Jot:#: _ Limited enengy,residential 75.00 2 _ Limited energy,non residential 75.00 2 Tax map/parcel #: Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or Ieeder90.90 2 nn '- Srvlcc%or feeders-Installation, aiteration or relocation: 20'a0 snips or less 80.30 2 201 snips to 400 amps 106.85 2 401 amps to 600 ams 160.60 PROPERTY OWNER TENANT 601 ams to 1000 ams v 240.60 2 ---`— - Over I(n amps or volts _ 454.65 2 Name: _ _ Reconnect only 66.85 2 Address: Temporary services or feeders-Installation, - alleretlon,or relocation: City/State/Z[p: 20fl amps or less 6695 1 Phone: FaX: 201 amps to 400 amps 1110.30 2 APPLICANT I Ll CONTACT PERSON 40!to 600am s 133775 2 - Branch circuits-new,alteration,or Name: cc( 1 Wlal ttn c extension per panel: f F:;?,(r A.Pee for branch circuits with purchase of Address: -rQ sL Gr c'C'••'7 C(✓° roc( service or feeder fee,each branch circuit 6.65 2 City/State/Zi 1 B.Fee for branch circuits without purchase of service or feeder Ice,first branch circuit 46.85 2 Phone: aX: Each additional branch circ-,it 6.65 2 E-mail: Misc,(Set,ice or feeder not included) CONTRACTOR Pachlu�or ircigation circle 53.40 2 -- -- - Fach sign or outline lighting_— 53.40 2 Job No: _ e Signal circuigs)or a limited energy panel, Business Name: Tesler a►nr^— ti (A wt �I alteration or extension _ Page 2 2 Description: Address: iS611 ?cv1re.Jce 0,tU-C Esch additinnal inspection oser the allowable In any of the above: City/State/Zip: oe 1 C 03� Per ins coon r hour(min. I hour) 62.50 Phone: - 7 rt-SZ c' rax: Investigation ice: CCB Lie. #: 1 3,3 5_ Lic. #: I&5 CE(F other: Electrical Permit Fees* Supervising electrician _ Subtotal S ___ signature required: 0 _TA Plan Revicw(254'6,of Permit Fec S Print Name: 10 l Lie. #: 20W &6 _ State Surcharge 806 of Pern Fn:e S t. _TOTAL PER_MiT FEE S 1 !7( .Authorized � /) ,n � Notice: This permit application explres If a permit 1%not obtained wlthin ! Signature: ` Date: IT 4�L Dy 180 dols after It has been accepted as complete. O •Fee methodology set by Trl-County Building!Indusrrl Scsice Board. (please print name) -- -- i\DstsTerrrnn ForrnsTicPermltApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIUEN'17AL WORK ONLY: Feefor all systems............................................................ $75.00 Cherk 7:vpe of Work Involved: Audio and Stereo Systems* iwrglar Alarm (iarage Door Opener* I leating,Ventilation and Air Conditioning System* Vacuum Systems* t)thee - - COMMERCIAL WORK ONLY: Feefor eac system.......................................................... $75.00 (SI,-I;OAR 918-260.200) Check l ype of Work Irnalred: Audio and StercO Systems L� Boiler Controls Clock Systems Data Telecommunication Installation i:ire Alarm Installation HVAC ❑ 1115n UTICntation ElIntercom and Paging Systems ElLandscape Irrigation Control* El Medical ElNurse Calls Outdoor landscape Lighting* Protective Signaling F-1 Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Usts\i'ermit Forms\FlcPermitAppPg2.doe 01103 CITY OF TIVARI 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP -- Received Date Requested � �� AM--- -PM _ BUP Location suits r 9 a d - _Suite l MEC Contact Person ._ kL' Ph PLM Contractor - Ph SWR BUILDING Tenant/Owner __ _ ELC FooYrng �-- ELC Foundation Access. Ftg Drain ELR Crawl Diain Slab Inspection Notes: SIT _--- Post& Beam _. . - - --- - �.--- --- ----" ---_ Shear Anchors -" _--- Ext Sheath/Shear Int Sheath/Shear Framing - - --- - -- -- -- Insulation Drywall Nailing ---- Firewall S� Fire Sprinkler - --- -- - -- Fire Alarm -n r _d Susp'd Ceiling - Roof Other- Final therFinal PASS PART FAIL -- - -- PLUMBiNG Post$ Beam Under Slab - -- --- - Rough-In Water Service - ----- - Sanitary Sewer Rain Drains - - - - - --Catch Basin Basin/Manhole Storm Drain - - - --- - — Shower Pan Final PASS PART FAIL __---"- MECHANICAL Post$ Beam Rough-In -- - - - ta„s Line ';mOke Dampers - -- - -- . - --- ----- - 1 innl PASS PART FAIL - --- --- - - --- --- ELECTRICAL ---------- solvice Flotrt�R -- ------------ i IG/Slah I �roti•Voltage Firs Alarnp F U Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. _ PART_ FAIL SITE _ C7 Please call for reinspec)ion RE Unable to inspect-no access Fire Supply Line ADA /// G/�/n Data -/` �� Ins ctil �� �LGy'LZ l -Ext Approach Sidewalk Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL Accumulative Sewer Tally Tenant Name: Body Imaging This SWRA N/A _ Site Address: 1192.0 SW Greenbury Rd This PLM# 200300120 I ixture Value, Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off#S count # value #s values Ba tise /Forst Y 4 0 0 0 0 0 _ Bath- rub/Shower 4 0 0 0 0 0 _ -Jacuzzi/Whirlpool 4 0 0 - 0 0 0 Car Wash-Each Stall 6 0 0 0 0 0 - Drive through 16 0----.—. 0 0 0 0 Cuspidor/Water Aspirator 1 0 0 0 0 0__ ()ishwasher- Commercial 4 0 0 _ 0 0 0 - Domestic; 2 0 0 0 _ 0 0 Drinking Fountain 1 _ 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink-2 inch 2 0 1 _ 2 _ 0 -1 -2 3 inch 5 0 0 0 0 0 4 inch 6 0 0 0 0 _ 0 Car Wash Drr 6 0 0 0 0 _ 0 Garbage Disposal _ _ Domestic(to 3/4 HP) _16 0 0 0 0 0 _ _ Commercial (to 5 HP) 32 !0 0 0 0 0 _- Industrial(over 5 HP) 48 0 0 0 0 0- ice Machine/Refri erator Drain 1 _ 0 0 0 _ 0 0 Oil Sep(Gas Station) 6 _ 0 0 0 0 0 Rec.Vehicle Dump station 16 0 0 0 0 0 Shower-Gang (per head) 1 0 0 0 0 0 - Stahl 2 _0 0 0 _ 0 0 Sink-Bar/Lavatory _2 0 0 2 4 2 4 _ Bradley 5 0 0 _ _ 0 0 0 Commercial 3 0 0 — 0 0 0 Service _ 3 0 0 1 _ 3 1 3 Swimming Pool Filter 1 _ 0 0 0 0 _ 0 Washer-Clothes 6 _0 0 0 0 0 Water Extractor u 6 0 0 0 0 0 Water Closet -Toilet 6 0_ 0 G 0 0 Urinal 6 0 1 6 _0 1 -6 Previous EDU Count 1 16 16 Capped EDU Credit 0 TOTALS 1 0 16 1 2 1 8 3 1 7 1 15 Current Fixture Value 15 divided by 16 = 0.9 Current EDU 1 EDU - $2.300.00 Previous Fixture Value 16 divided by 16 = 1.0 Previous EDU Change -1 divided by 16 = -0.1 over (under) $ (230.00) Enter EDU Change Here -0.1 HISTORY Notes: Per acct, 1 EDU PLM# _ _ EDU# ^_ SWR# P*- # EDU# _ SVIR# "LM# ^� j EDU# SWR# Name: 4,M J) Date: rgnatur",fr' atcalculated this tally sheet and date pe r med is required r March 28, 2003 CITY OF TIGARD Champion Construction � � � � � L� 23091 SF Belmont Ct. t OREGON Boring, OR 97009 Re: Body Imaging — Tenant Improvement Pr*cct Information Address 11920 SW Greenhurg Type of Construction: VN Permit # BUP2003-00131 Sprinklered No Occupancy B Fire Walls None Occupant Load12 Floor Area: 1,565 Sq Ft The City of Tigard Building Division has reviewed the submitted building plans for the above referenced address in accordance with the Oregon Structural Specialty Code (OSSC), 1998 edition and Uniform Fire Code (UFC) as amended by Tualatin Valley Fire & Rescue. The plans are approved subject to the following conditions 1. Doors shall be openable without the use of a key or any special knowledge or effort. OSSC 1003.3.1.8 2. Minimum 2A, 1013C fire extinguishers shall be provided throughout the building so the travel distance between extinguishers does not exceed 75 feet. UFC Standard 10-1. 3. A copy of the approved plans shall be on the job site at all times and available to the City of Tigard inspectors for inspection purposes. OSSC Section 106.4.2. 4. A final inspection and Certificate of Occupancy is required prior to occupying for the intended use of this building or parts thereof. OSSC Section 109.1. If you have questions regarding this review, please contact me at (503) 718- 2448. Sincerely, Gai Lampella Building Official C. Hap Watkins, Supervising Inspector File 13125 SW Hall Blvd,, Tigard, OR 97223 (.503)639-4171 TDD (503)684-2772 — ----