9600 SW OAK STREET STE 550 moo
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-CITYOFTIFARD
OF
CrTYCOMMUNITY DEVELOPMENT DEPA9TMENT oa�� L � f
19126 SW Hen Blvd.P.O.Box 23397,Tipvd,Orem 97723(603)6394176
��- ^- --- - — PEU ING PERMIT
PERMIT
DATE. ISSUED: 08/20/91
5I TE ADDRESS. . . '3600 SW OAK ST PARCEL: 1 S 135BD-0010 1 �
SUBDIVISION. . . . : ASHBROOK FARM ZONING: C--F'
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :5
CLASS OF WORK. ., :ALT GARBAGE DISPOSALS. . : 1, MOBILE HOME SP'ACES. : +!
TYPE OF USE. . . . :COM WASHING MACH. . . . . . . : BACKFLOW PREVNTRS. . :
OCCUPANC=Y C_3RP. . :B;= C=1-.00R DRAINS. . . . . . . . TRAP'S. . . . . . . . . . . . . . .
STGRIES. . . . . . . . :5 WATER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . :
LAUNDRY 1-RAYS. . . . . . : SF RAIN DRAINS. . . . . : +
SINKS. . . . . . . . . . .2 URINALS. . . . . . . . . . . . . GRE=ASE 'TRAP'S. . . . . . . .
LAVATORIES. . . . . : OTHER FIXTURES. . . . . :
"LIB/SHOWERS. , : SEWER Ll1• '= (ft ) . . . . :
WATER CLOSETS. . : WATER L l NL. (ft ) . . . . :
DISHWASHERS. . . . : 1 RAIN DRAIN (ft ) . . . . :
Remarl-(s : Tenant Mod: Adietion, deletion of interior walls, fifth flr.
Owner-: -__._._.__.______._----.--_._._.___.._. FEES
SUMMIT CONSTRUCTION type amol-tnt by date rer_Rt;
P'RMT 1, 37. 50 JLH 06/20/91 -
P'LCK t 9. ::37 JLH 08/20/91 -
FP $ 1. 66 JLH 0R/20/91 -
Phone #:
ANDERSON P'L U1.1B l NG
--------------------------------
Phone it- 48. 75 TOTAL
Pug #. . 57 ?18
REPU 1 RE D INSPECTIONS
This permit is issued subjeri to the regulations contained in the Rol.tgh-in lrtip
Tigard Municipal Code, State of Ore. Specialty Codes and all other Tori -oLtt l-rsp
applicable laws. All work will be dono in accordance with Final. Inspection
appro•i9d plans. This permit will expire if work is not started
tithin 18d days of issuance, or if work is suspended for %nre
than 180 days,
I'?P r•m i+t e� }�� rI n ai t -'r'e :,/�.��..�--•'�._...__.._._...�__...__ ___.__..�.�____________.._.._. .....�.._.w.�__.__.._»..___.---
I s s u i e d Ely :
Call for inspection •- 639-4175 i<
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CITY OF TIGARD RECEIPT OF PAYME-W RECEIPT NO.
CHECK AMOUN'1 a 4A. 7t
idpME`. �sIJMM'I'I' L,Oh15'f RUC 1"I CIN f.� 481-E AMOUNT + •
nYMENT DATE" 08/20/91
i-,URPrlS': OF F'f1YIIElv'f AMOUNT PAID I.'URPOSH OF PAYMENT" 0MOUNT RAIU
9. 37
I E't_UMEaXNf.; PERM 37. 50 P .AN rCHECK FE
{ T, BUII_I? PER 1. 88
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CITYOFTIVARD
CERTIF'ICATE OF
OCCUPANCY DEVELOPMENT DEPA (�T �,,� 7 P ,M IT et. . . . . . . . BIJP90-0040
13125 SW HWI Blvd. P.O.Ba 23W,TkPA.OrW YT 609 %175 _
-- ---- 1l - — DATE IOSULI)a 04/06/9'
SITE, ADDRESS. . . c 9600 SW OAK ST ,�J 5 v PARC:ELa 1S135SD-0+ 100
SUSS I V I S I ON. . . . i ASHBROUK FARM g Z ON I NG s C--P
BLOCK• . . • . . . . . . a LOT• . • . . • . r • • • • • a J
CLASS OF WORK. a ALT
TYPE OF USE:. . . a CCDM 4
OCCUPANCY GRP. s D2
OCCUPANCY I.-CAD:Ham-' a■�
i
rENANT NnME. . . s ORE 60N NUR£3CS ASSOC:I AT i ON
Pemarkaas Tenwit, Mods addition, deletion of interior walls, fifth flr . `
i
PLAZA WEST
iW-00 SW OAK ST
TICARD 1R 972'23
Ph one As
Contractors
SUMMIT CONSTRUCTION
PO BOK 10345 r
4
PORTL.A14D OR 97210
phor►e Na
Reg #. . 1 E:30.49
Ocr.upmnc:y of the abcove refer,vnc-ed building is hereby Wi4en, wid corti.fie®
the comp,limncae with the. S+tato Of Clreg-m Specialty C ode% fear t;,@ group,
Frcc:,upanty, and ube under which the referenced permit; wa 4 i r—sk.ted.
�. 0, _
FIRE DEAR?MINT _ -�-;,I..v r
-INSPECTOR
1='()GT IN CONSPICUOUS PL.ACF
: ,.,.�
17
P�PZTWIAU
IN TUALATIN VALLEY FIRE & RESCUF.
AND
BEAVERTON FIRE DEPARTMENT
FIRE MARSHALS OFFICE -
,� (503) 526-2469 POSTED
&Rjjjj
ESGJ � r
OCCUPANT a'. ` J 1u —
`'
CONTRACTORBLDG. PERPIIT 16
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PROJECT NAME V I ,� T PLAN REVIEW It
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LOCATION �� rf
JURISDICTION: 1= Be. 2= Du. 3= I:,C. 4= Ti. 5= Tu. 6= Sh. 7= Wi, 8= CC 9= WC 0= PIC
COVER FINAL SP FOLLOW-UP/REINSPECTION ATTVIPTED FINAL
` ❑
Framing ❑ Separation Walls ❑ Sprinkler System
❑
Shaft
❑ Fire Dampers (Overhead/Underground)
❑ Alarm System El Hood' Extag Systems ❑ Conference
❑ Spray Booth ❑ Ceiling Cover
❑ Other
V
Date: Inspector. ) T 7
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MECHANICAL f�
C11YOF TIVA� 1'F'RI*IIT `
70REGON
RD1 PERMIT 0. . « : MEG"�0 0041 •
COMMUNITY DEVELOPMENT DEPARTMENT � PRIM. PE:RMI*T
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13125 SYV F1dl BNox d. F.O.B23367,Tlpaid,Oregon 07223 1:=)&W-4176 T'�', •�-� p�.1C,t I F�I)
-- _
PARCEL:
: 1S 1 3t;TcD -00:I.0,i_1
SITE ADDRESS. . . . 9GOO SW 0 A K S T ZONING: C-r'
SUBDIVISION« . . « e ASHBROOK f"ARhI
° BLOC V.. . , « . . . . . . :' l..Ll'.. , . « « « « « « . « . «
_..._._;_._.._._.._._. FLOOR FUTON. . . » EVAP COOLERS:
CL.ASS OF WORK. « :ALT UNIT HEATERS- - c a VENT F AMS. . • a
TYPE OF USE« . . « :COM VENT SYSTEMS:
OCCUPANCY URS'« . aB2 VENTS W/O APDL
". �• F.�OxLERS/GC7rlr�'F•�F::�:i�:>I:IRS HOODS. . . . . . . :1
S'TORIES. . . . « . « « ..5 DOMES. INCINa
;F ....
;FUEL T•YPES_._._.."'--"'*"-_. .......... 4d 3 HE'« , .. , ;;
::3-•'15 HP- « . COMI'IL.« INCIN.
11 T :'.� 3t� 1AP.. •• •• . REPAIR UNITSa2
MAX INPUT: NTU WOOD5TOVES. « a °•,
� . -� 30.._;0 HF'« , « . :
FIRE DAMFERS: . « ;N CLO DRYERS. . :
GAS N'RE BSUF�h. «
E - "
0+ HP. . . . "
AIR hiAhlDl_IhIG UN:C'TS OTHER UFII'TS« a
NO« OF UNITS-- - GAS OUTLETS. a
F"URN < 100N. BTU , <-- 10000 cfma
Fl.1RN >-'J.(�0K BTU: > 10000 cfm:
r,emarEr.ssa Tenant Mod '. acldj.tj.cani, cdc+!.cati.c�� of i.ni't�rj.c�r Walls, fj.ftI�
FEES
(awne•r a __._..._.....__....._..._._..._..._.__._..__._....._.._ .._-_...__......"._... date rec:p'l':
type amount by a
SUMMIT' CONSTRUCTION F I M'T' $ 26. 50PLCK
! !
/ !
Phone 0".
CONTRACTOR NOT ON FIC.E.
34. 45 TOTAL
Phone #
Req #« .• _._....._...._ REQ .._ -
REQUIRED INSPECTIONS -- ----
contained in the Mechanic_aI Insp ...._.... ...-_..__.._.._.._.--• .._
This permit is issued subject to the regulations
Fia>,1 Municipal Code, 'State of Ore. Specialty Codes and all other I'ieatinq Unit 11-ISP .........".....
_._..._.._"___-•.-•-.•-••.,_- -
Ar, iicable laws. All Mork Mill be done in accordance with coolinq Unt Insp __._._•• -" ""�-'-" "' -"-
ppraved plans. This permit will expire if work is not started Fi.re Damppr Insp �__ _.._____._. _ •-__-
within IAS days of issuance, or if work is suspended for more Fil7c
a1 Inspe 'r:tc)I" -------
than. 188 data. ._.._.....__._.._.__. ..._.__......._....._._...__....__._._..
[•'ermi.tis! t _. `r...... _.-_ _ ._.._..._. __._.._.__......____..___.._.. _T._
F.r;S c.c e ci H 1 ........-_._._ ..__..._._..._ _...._._......_.__..._.__.............___....._ __ _ ___._.. _.__....
fic�r in!;per. Fi3 417 i
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I ;I"fY OF TI11r^,RD RE:CTIPT 1.')F P' )YMENT FECE11"T No. 4 '
l G[lECr AMOUNT z '�4. 4
IJAME a AIR FATE C ONT ROL. INC (_ASIA AMOUNT C
ADDRESIS 1 S. E. !1111 AVLhlIJf: F'AYME:NT DATE
N='CP"R.-AND. CIG' 97:"!1SW ()(4% ^Tr:EUT !(
PURF•'ME OF F*AYMENT i;r'iCal.TI, PAID 4"IJFtF'01,;E; 01,*� PAYMENT AFIf')UM, PAI:I) l
MECH1AN I C;AL. PE_ f),)41 5 ;31". `P-J 1 LD 7
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TUALATIN VALLEY !FIRE & jtESCUE
AND e
l BEAVERTON FIRE DEPARTMENT__
FIRE. MARSHALS OFFICE
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(503) 526-2469 POSTED
OCCUPANT
BLDG. PERMIT 11
CONTRACTOR
PROJECT NAME PLAN REVIEW
'�l UI�C) GQ K 5 7)
LOCATION _
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JURISDICTION: ;1= Be. 2= Du, 3= P..C� 4--�T�� 5= Tu. 6= Sh. 7= Wi. 8= CC. 9- WC 0=„PiC (�
COVER FINAL SPECIAL FOLLOW-UPIREINSPECTION ATTEMPTED FINAL
❑ Framing
❑ Separation Walls ❑ Sprinkler System
❑ Shaft
❑ Fire Dampers (Overhead/Underground)
❑ Alarm System ❑ Hood' Extng Systems ❑ Conference
El Spray Both ❑ Ceiling Cover ❑ Other
Ode
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Date: � � q,,U Inspector:
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INSPECTICjV NOTICE
City of 1i9nd Building Department
- aDe
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P.O. Box 23397
Tig'Ard, Oregon 972K
Phone: 639-41;5
Type of Inspectionf
�� � rr
Date Requested —!.2 7U Time�r. A.M. P.M.
Address --- � Permit # �a
Owner_-- � —
Lot #
Builder --------._.�_
The following Building Code deficiencies are required to be corrected:
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Presented to I
- _ Approved
J
!nspector -J _ r; Disapproved
Date
CALL FOR REINSPECTION
❑ YES NO
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date Requested =_�� 6?6 Time
Address U _ Permit
Owrsr /. ® Lot #_
Builder
w
The following Building Code deficiencies are required to be corrected: "
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Presented to _ z Approved
Inspector Disapproved
Date
CALL FOR REINSPECTION
C_1 YES ❑ NO
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639.4175
Type of Inspection _ f -2 ,_
Date Requested `--� _�` �l� Time A.M._ P.M.
�1 �r
Address �-;4 42 �,: Permit #_
Owner _ Lot # _
Builder = -----
The following Building Code deficiencies are required to be corrected:
r
Presented to — Approved
Inspector Disapproved
v�S -
Date ___ C
CALL FOR REINSPECTION
YES ❑ NO
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TUALATIN VALLEY FIRE & RESCUE
AND
BEAVERTON FIRE DEPARTMENT
4755 S.W. Griffith Drive• P.O. Box 4755 • Beaverton, OR 97076• (503) 526-2469• FAX 526-2538
,
March 8, 1990
Summit Construct-i.on
P.O. Box 10345
Portland, Oregon 9721.0
Pe: Oregon Nurses Association
y600 S.W. Oak
Tigard, Oregon �
Gentlemen:
This is a Fire and Life Safety Plan Revi;w and is based on the 1985
editions of the Fire and Life Safety Code !UBC), Mechanical Fire and Life
Safety Code (UMC), Uniform Fire Code (IJFC) , and other local ordinances and
regulations.
Plans are approved as resubmitted.
1. Exit Door Hardware: All doors shown on the drawings must be
" openable from the inside for immediate exit at all times without
the use of a key, special knowledge, or effort. UBC Sec. 3304
2, Exterior Exit Door: Hardware for the exterior doors and key
operated deadlocks may be permitted where there is a sign posted
on or over the door reading, "THIS DOOR MUST REMAIN UNLOCKED
DURING BUSINESS HOURS" in letters not less than one-inch in height
on a contrasting background, UBC Sec. 3304
3. Fire Extinguisher Requirements: Not less than one (1) approved
J fire extinguisher(s) with rating of not less than 2AlOB:C shall be
provided for each 3,000 square feet of floor area or fraction
thereof. The travel distance to an extinguisher from any portion
of the building shall. not exceed 75 feet. UFC Standard 10-1
4. Approved Plans on Job Site: One set of approved plans bearing the
stamps of th% building deparCment issuing the construction permit
and this office must be maintained on the project site throughout
!' all phases of construction and must be made available to building
and fire inspectors for reference during required construction
inspections. UBC Sec. 303
"Working"Smoke Detectors Save Lives
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�'4� „�$ :�t�a��'y����� _ : ,�'�'`�' � a• r`�k�r '�J?" ��y�i,�xP��Aiq��M1����� �I 9�1 ° �;,,. '..
l �
ARIA
, J
Summit Construction '
March 8, 1990
Page 2
5. Required Occupancy Certificate: Prior to the use and occupancy of
the project. (space) , a certificate of occupancy or other. written
instrument of approval must be obtained from the building
department issuing the construction permit. UBC Sec. 307
, `
7f I can be of any further assistance to you, please feet free to contact y�
Mme at 526-2502.
Sincerely,
Gene Birr..hill
Deputy Fire Marshal
GB:kw
cc: Tigard Building Department
Wardlussey/Gibbons, Iric.
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INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 629-4175
Type of Inspection i
Date Requested _ Time A.M..P.M.
Address ���C/��.l�c-�' ,�"1�-' 1
Permit ---
7e
Owner _ Lit
Builder.
4
The following Building Code deficiencies are required to be cr,rected:
-
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Presented to
_- _. ApproaeJ
Inspector Disapproved
Date
CALL FOR REINSPF CTION
CJ YES I-] NO
dil
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INSPECTIQN NOTICE 'riga
City of Tigard Building Department
P.O. Box 23397 !
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection
Date .i,.quested -,3 %�- i' Time _ A.M. P.M.
AddressPermit # ' ilk
—�
Owner _ l J Lr� t Y� r Lot # AIS
Builder
The following Building/Code deficiencies are required to be corrected:
K
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i
Presented to . _._ _-- ApRroved I
0. r , .
Inspector �-
taM.;M�.aw,� wr •,:�; - - -_ ___.__ �IDisepproved
Date - / `.
CALL FORREINSPECTION
P—FOYES F77 NO
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UK-
CITYOFTIFARD C�� 410
COMMUNITY DEVELOPMENT DEPARTMENT « = f
13125 SW FW e1rd.P.O.Box 23397.ngwd.Oregon 97243( )639-4175 -`
(TTY 0Z TIGA__Rn—_RATT bjr, p RMTT — — — -—
PERMIT #.. .. . .. : BUP90-0046
PRIM. PERMIT #.: BUP90-0046
DATE ISSUED: 03/01/90
SITE ADDRESS. . . : 09600 SW OAK ST PARCEL: 1S135BD-00100
SUBDIVISION. . . . . ASHBROOK YARM ZONING: C-P
BLOCK.. .... . . . . . LCT. . . . . .. . . . . . . :5
----------------
REISSUE: FLOU". :+REAS---------- EXTERIOR WALL CONSTRUCTION-
CLASS OF WORK. :ALT FIRST.. ..: of N: S: - E: W:
TYPE OF USE. . .aCOM SECOND.. . : of PROTECT OPENINGS?----------
TYPE OF CONST. :2-IHR THIRD. . . . : of N: S: E: W:
OCCUPANCY GRP.:B2 TOTAL------:6124 of ROOF CONST:B FIRE RET?-.Y
OCCUPANCY LOADs82 BASEMENT. : of AREA SEP. RATED:
STOR.:5 HT. 60 ft GARAGE. . . : Cf OCCU SEP. RATED:
MEZZ?•N REQD SETBACKS-------- REQUIRED----•--------------- r
BSMT?:N III
FLOOR LOAD.. . . :50 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:Y PARKING:
i
Remarks: Tenant Mod: addition, deletion of interior walls, fifth flr.
Owner:
----------------------------------- ----------------- FEES -----------•---
SUMMIT .7ONSTRUCTION CO. type amount by date recpt
2130 N.W. YORK ST. PRMT $ 427.00
PLCK. $ 277.55
PORTLAND OR 97210 FIRE $ 170.80
Phone #: 223-9703 5PCT $ 21.35
PAYM $ 448.35 JHJ 01/29/90 107104
Contractor: ----------------•------------- PAYM $ 448.35 JLH 03/01/90
W W
-------------------------------------- i
Phone #: $ 896.70 TOTAL
Reg #. . .
------- REQUIRED INSPECTIONS -------
This permit is issued subject to the regulations contained in the Slab Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Framing Insp
applicable laws. All work will. be done in accordance with Insulation Insp
approved plans. This peLzrit will expire if work is not started Gyp Board Insp —
within 180 days of issuance, or if work is suspended for more Susp Ceiing Innp
than 180 days. Final Inapection
Permittee Signature:
Issued 9y: -- --- L -- - --- _ -----
Call for inspection - 639-4175
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CITY OF TIGARD _ Rf CF_1P1" CIF Pi-Wr1ENT REC NUx 00107547-, (I �
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CWEf.k: AMOUNT a 44ES.75
.
t.WM{ t SUMMIT CONSTRUVION CAaW AMOUNT o .CIO
�aC�C�F'ES5: PAYMENT DATE s 0,$--01—cW
PORTLAND. OR 9721.0 EL.OLK NO/AI1LiR: r:
1 (x600 SW UAV, {
PUPPOSE" OF F('o'MENT AMOUNT PAID PURPOSE Or PA4-MEN7 AMOUNT PAIL)
i�HA)ING PERMI I (90-0046) 427.00 ;Tf4TL BUILD PERVIT TAx
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TO1AL 01,10UNT PAID — — 446,77
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Pt�N vq TUALATIN VALLEY FIRE & RESCUE
AND
BEAVERTON AFIRE DEPARTMENT
FIRE MARSHALS OFFICE
503) 526-2469 POSTED:
ARE
OCCUPANT C;
k'
CONTRACTOR BLDG. PERMIT 0
PROJECT NA.1E V� �S .) PLAN REVIEW 0
LOCATION _ D 3 Oak �
JURISDICTION: 1= Be. 2= Du, 3= Ii,C. 4= Ti. 5= Tu. 6= Sh. 7= Wi, 8= CC 9= WC 0= K
COVER) FINAL SPECIAL FOLLOW-UP/REINSPECTION ATTEMPTED FINAL
Framing ❑ Separation Walls ❑ Sprinkler System
❑ Shaft ❑ Fire Dampers (Overhead/Underground)
El Hood' El Conference
El Alarm System g Systems
i
❑ Spray Booth ❑ Ceiling Cover ❑ O har f
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bnf.e: inspector:
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INSPECTION NOTICE l_--
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-4175
Type of Inspection -`Rr'`�-" ----_
Date Requested Time_ A.M. P.M.
Address —� � Permit # ^
Owner _�__ - _ Lot #
Builder
The folir.wing Building Code deficiencies are required to be corrected:
Presented to _ ----.___—_--- ---_ Anpiove.d
Inspector [ 1 Disapproved
Date --
CALL FOR REINSPECTION
eORYES ❑ NO
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.,v..,.n.rtkaMvnv+MwMN+Prh.4,'Mr4o+•w., ... -•:......,.- .. . : ,.i"f.,.,Wnww,al�.4"MN�M��. --. a ,- .
INSPECTION NOTICE
City of Tigard Building Department
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-41x5 t
Type of Inspection -�t��.____ __ •C-1�c-���_ ���.u'� iy`.�'`
Date Requested ).me — A.M. P.M. •
Address �!� 1��— �� --� � Permit #
Owner
Lot # x, +st gr
— -- - �,.
Builder
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a Yid + r
I�
��; The following Building Code deficiencies are required to be corrected:
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Presented to � Approved
Inspector � 1�--- �_ Disapproved
Date �� 2 ✓ — —
CALL FOR REINSPECTION
d L1 YE5 L1 NO
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—C' ®F T'��RD
c n OFTUAm PLAN Ct1ECK APPLICATION
COMMUNITY DEVELOPMENT DEPAR—MENT `0�'" PLAN CHECK N 74C'-
13M&W.HA Blvd-P.M Sm 2Mr.Tiqwtk Omgm 91 .(SW)MMYS
74C 13Ms-w.wAwvd-P_MSm2Mr.Tgwd,Omgmssm.(SW)MMYS PERMIT N
DAft ISSUED
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JOB ADDRESS: I(POC� vL,� �p _- TAX MAP/LOT
SUB: _ LOT: LAND USE:
VALUATION:
i
OWNER SPECIAL NOTES
NAME: I L�J5(.ht l Ar•1 UJ °` Y.'` 1=i L'L REISSUE OF:
ApDRCSS: ,g(� )Lk LAST REISSUE:
Qn ort-4 fl�I? FLOOD PLAIN/
—'I It 50 TO AUL. SENSITIVE LAND:
PHONE: q ( 7 a —
APPROVALS RE R
CONTRACTOR PLANNING:
_-5 — Y
NAME: S)0A& 7 ENGINCCRING:
T
ADDRESS: ,?6-06- IC,34 _ FIRE DEPT _
i1 ) 61'7 2.', OTHER. _
PHONE: ZZ-5--6j-765 _ ITEMS REQUIRED
BUILDERS BOARD N: to3 z4 EXP DATE: LIST/SUBCONTRACTORS:
BUS TAX: _
ARCH/ENGINEEr2 CALCULATIONS:
NAME: _ W P"t 7� SL- 62 r/aid t1 1-4$ TRUSS DETAILS:
ADDRESS: I SL)J -ri1 qLUW- `'T . LIT(' 10-6 OTHER:
9'7 LuS '657
PHONE: — � - 7
COMMENTS: 14'
//////
SUBCONT ACTORS: PLUMB: MFCH:
I PERMIT N ACCT N DESCRIPTION AMOUNT (1MCIINT PD. BAL. DUE
10-432 00 Buildim Permit Fees '�i�7• �v
10-431 00 Plumbing Permit Fees _
10-431 Ol Mechanical Permit Fees K
10-230 01 State Building Tax (5%) %• - 2/S S
Building _
Plumbing
Mech
10-433 00 Plans Check Fee ?7�SS_ Z7l SS
j Building
Plumbing
Mech _ —
i. 30-202 00 Sewer Connc±ction
30--444 00 Sewer Insfx±ction
51--448 00 Street System Dev Charge (SDC)
52-449 00 P- z C-ystum Dev Charge (PDC) I
31-450 00 Storm Drainage Syst Dev Chrg (SSDC)
10--230 06 F ire i KU
TOTAL
REC N /0 / _4_._____
APPLICANT SLGNATURE
Received By• -� Date Received:
cn/3587P/19P `
4 A
6.j
TORT WWFWANRWK
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CITY OF TTGAND RECEIPf [IF PAYMENT r�LC 1,10. 00101104 ( '
CHECK' AMOUNT : 448.:7r.,
11AME: SUh111.1I CON TRUCTTON f;A +H AMOUNT ,CSU � T
HDUIz•ES;.i: F'q F+fiX 1Cl?.4a 1='(iY'MEt4 DNTf� s i11
PORTI_r+NT1. OR 1r72-0 1
I,' I
F:iit'+0SE OF F'ra'iMENT AMOUNT PAM FIJFF'OSE: Oa i•(i'WENT 1.00UNT PA.11) I I
F T1 =I
I.rel l L:HF:CFi FEE (1 �4C:) _ .:`.� .h ..r�T'I N W 41..1..'r FIRE p: F:f=!a� U 1;17.GO �
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