11567 SW PACIFIC HIGHWAY-1 '— 11567 SW °acific Hwy. __..
CITYOF T I G A R D -- BUILDING PERMIT
DEVELOPMENT SERVICES DATE
PERMIT
�/3/0�oo1 00003
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 11567 SW PACIFIC HWY PARCEL: 1S136DB-00201
SUBDIVISION: FRED MEYER ZONING: C-G
BLOCK: LOT: JURISDICTION: TIG
REISSUE: _ , F1.00R AREAS ' _ _ EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DEM FIRST:~ sf N: S:— E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: UNK sf N: S: -- E, W.
OCCUPANCY GRP: M TOTAL AREA: 000 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?. MEZZ?: REQD SETBACKS ----ft
_ _ RE_QUIR_ED _
FLOOR LOAD: psf LEFT: ft RGHT:� -ft F-IRSPKL: SMOK DET.
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE. PRO CORR: PARKING:
VALUE:
Remarks: Demolition permit for tenant space being demolished for Fred meyer remodel. A plumbing is ermit is required to
obtain fixture count of all capped fixtures for future credits. All demolition debris must be rer.ioved and the sewer
Owner: Contractor:
WILMINGTON TRUST CO, TRUSTEE ANDERSEN CONSTRUCTION
BY FRED MEYER, INC 6712 N CUTTER CIRCLE
38800 SE 22NpDRAVE
72 2 PpO BOX 677122 g
P Pone N5D3 62 56 5246 P Porie NZ83 67127228
Reg #: uc 61053
_ FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Cap sewer line
PRMT CTR 1/3/01 $62.50 272.00100000 Final Inspection
5PCT CTR 1/3/01 $5.00 27200100000
EROS CTR 1/3/01 $26.00 27200100000
ERPC CTR 1/3/01 $8.45 27200100000
(additional fees not listed here)
Total $110.40
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 perir.it will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 lays 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 952-001-1987. You may obtain a copy of these niles or direct questions to OUNC by
calling (503)246-1987
Pe nn itee
Signature: I)N"
i
Issued By: T�
Call 639-4175 by 7 p.rn. for an inspection the next business day
s
P4,mC
Building hermit Application
wtereccived• ��-03-0/ Pcrmit no.:
i city of Tigard Project/appl.no.: Expire date:
city ofngurd Address: 13125 SWIfallBlvd,Tigard,OR97223 Date issued: By: Receiptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Ca,;-file no.: Payment type:
1&2 family:Simple Complex:
Land use approval:
U 1 &2 family dwelling or accessory U Commercial/industrial l]Multi-family U New construction U Demolition
U Addition/alterationlreplacement U Tenant improvemen U Fire sprinkler/alarm ❑Other
Bldg.no.: Suite no.:
Joh address: I ax map/tax lotlaccount no.:
lot: bdivision: —
Project name:
Descripdon andlbcatinnstt n premises/speciPl conditions:..___ -- -
tKai"WOY11:11mill)
Name:
- .�. 1&2 family dwelling:
Mailing address: - '
State: ZIP: Valuation of work...................... ................. 4 -
Phone:�" . � -ax-
mail: No.of bedrooms/baths..................... ...........
Owner's representative: �
Total number of floors................................. —
Phone'• - Fax: ail: New dwelling area(sq.ft.) .............AOPLICANT
Garage/carport area(sq.ft.)......................... —
Covered porch area(sq.ft.) ......................... ----
Name: - Deck area(sq.ft.) ........................................ _
Mailing address: _ Other structure area(sq.ft.).........................
City: State: lli':
1' mail; Commerciallindaslriallnnilli-famll}:
Phone: Far Valuation of work........................................ $
t '
Existing bldg.area(sq.ft.) .....................•....
Business name: /� ) _ New bldg.area(sq.ft.)................................
Address: �1 Number of stories........................................ —
City: , Stat LIP: Type of construction........................... ........
Phone: ./T/ Fax: E-mail: Occupancy group(s): Existing: ---
New.
CCB no.:
City/metro lic.no.: Notice:All contractors and subcontractors are required to be
t licensed with the Oregon Construction Contractors Board under
/ / -provisions of ORS 701 and may be required to be licensed in the
Name: jurisdiction where work is being performed.if the applicant is
Address: exempt from licensing,the following reason applies:
Cit : State: "LIP: ----
Contact person: _ Plan no.: ---
Phone: I-ax: 1-mail:
Names Contact person:
Fees due upon application ........................... $
Date received: --
Address:
State: ZIP: Amount received .........................................
City: please refer to fee schedule.
Phone: Fax: I E-mail:
NO all jnrixlictians an-epl credit cards,please call inrisdic,",rot mote inramation
1 hereby certify 1 have read and examined this application and the Uvisa o MasterCard
attached checklist. All pmv inions of laws and ordinances governing this Credit cad nMa
work will be complied with,whether specified herein or not.
Date: ___— J Nam of cardholder u shown on credit cad $
Authorized signature: �mormi-
- - Crdhulder aitnatute
Print name: ------
41n161]OAOCOW
Notice:nis permit application expires if a permit is not obtained within 180 days after it has Ircen accepted as complete. /'�
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection I-ine: 639-4175 Busitaess Line: 639-4171
BUP �Oa/-OU��.3
Date Requested_ f �{ 4 _AM PM BLD Y - —
Location Suite MEC ----- T---`-
Contact Person Ph PLM
Cortractor _ Ph _ _- _— SWR
Tenant/Owner - ELC
Retaining Wall EL.R
Footing Access:
Foundation FPS
Ftg Drain SGN �---------— -- -
Crawl Drain Inspection Notes:
Slab ------------ —
SIT
Post Beam •—
--
-- --- _
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation - - -
Drywall Nailing -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
t
S PART FAIL - -- - -VUMBING
Post& Beam - - - -
Under Slab
Top Out - - - - - -_
Water Service
Sanitary Sewer
Rain Drains
Final _
PASS PART FAIL
MECHANICAL - - -- - - -
Pr,st& Beam - - - -
Rough In
Gas Line
Smoke Damper-,
Final -
PASS PART FAIL
_ELECTRICAL - - -
5eniice
Rough In
LIG/Slab --
Low Voltage
Fire Alarm
Final
PASS PART FAIL - _SITE
Backfill/Grading — - "--
Sanitary Sewer
Storm Drain ( J Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Please call for reinspection RE:
Fire Supply Line I J ( J Unable to inspect-no access
ADA --�-
Approach/Sidewalk Data v 'Z--
Other ` EXt3 i
Other _ ---—
Final
PASS PART_ FAIL Do NOT REMOVE this inspection record from the job site.