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ASL /� `(Z' — I ' Cj„ Approved ..................._.._......._..._.._.................................<.! T ltd 3 C � L ( 1u[ APT ° S
Conditionally Approved ................................. [ J
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PERMIT NO 1 �"! A p
See Letter to: Follow...... ..... .........�
Attach .
. ....... .... .......... ( ] �.� V �-� (V T l� ��► C. 'i' O C� , LLL
Job Address:
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-SOS # 00a ccs 1555 f
NOTICE: IF THE PRINT OR TYPE ON ANY �T� ( � � 1 � I � ( � � ( � I � ( � � � ( II � � � � ( � ` r( i i ( iii ' t lt .r .��� �_� i..l � ��r � � � ► I ► IIII [ -T int °1Ii t ► r i ! t 1111111 Tfl T] T�TI � � � i i.1 � r .� ����� r� � j _�t .r T i i i i i i i i i
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IT IS DUE TO THE QUALITY OF THE __- - _ — -- --- No.38 � �, , ,,,t
ORIGINAL DOCUMENT — ---
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14715 SW 109TH AVENUE # 3
Building Division
Applicant Request to Cancel Permit RECEIVED
City of Tigard
OCT -2� 2003
TO: CITY OF TIGAM), BUILDING OFFICIAL CITY OF TIGARD
13125 SW Hall Blvd., Tigard, OR 97223 BUILDING DIVISION
Phone: 503.639.4171 Fax: 503.598.1960 RECEIVED OCT 2 11
FROM: Applicant Name: �� �w� .ck-,.rt, , L L
Mailing Address: PO k-3 ox F-7-6 y1
City/State/Zip: PC f,E-(o,,,eA� c)e C( �g-L-
Phone
Phone No.: 20l — 0-51g-7
Fax No.: ` 03 Z?'2 —� 0?,q
PLEASE CANCEL PERMIT APPLICATION AND REFUND PERMIT FEES, IF ANY,
FOR THE FOLLOWING:
Permit No.: >h uta Zoo 3- noL(e( - ----
Type of Permit: �'4a txk,^v --- -
Site Address: ! 910 (c ?0-
Subdivision:
Lot No.. _
EXPLANATION:
Signature: UZ� _ Date:
Print Name: Erf t— (-4,44,
E USE ONLY
Route to Admin.:
Permit Canceled: Date: _ _ B
Refund Processed: Date: _ II
1003
is\BuildingV-ornuVtegGncelPermit.doc 04103
CITYOF TIGARD _ BUILDING PERMIT _
DEVELOPMENT SERVICES DATE ISSUED: 8/7/03PERMIT#: 8/7/03 3-00481
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171
SITE ADDRESS: 14715 SW 109TH AVE 'mit `' PARCEL: 2S110AC-00500
SUBDIVISION: TIMBERLINE APT. ZONING: R-12
BLOCK: LOT: JURISDICTION: TIG
REISSUE: _ FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: REP-�� FIRST: sf N_ S: E: W:
TYPE OF USE- MF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N 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 SETBACKSREQUIRED
FLOOR LOAD: psf LEF'r:— 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: #09,00 ,0D
Remarks: Deck repair,
Owner: Contractor:
SECURITY CAPITAL PACIFIC TRUST HUTH CONTRACTORS, LI-C
BY PALMER GROTH 4- PIETKA INC PO BOX 82609
ATTN TODD S LIEBOW MAI PORTLAND, OR 97282
PORTLAND, OR 97204
Phone:
Phone: 503-239-7195
Reg #: LIC 155599
FEES _ REQUIRED INSPECTIONS__
Description Date Amount Framing Insp
IWILD] Permit Fee 8/7/03 $62.50 Final Inspection
1'AX]8%State TaN 8/7/03 $5.00 ^�
1 13UPPL.N] Pln Rv 8/7/03 $40.63 J
IFI_;] l-i.S Pln Rv 8/7/03 $25.00
Total $133.13 I
I l
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION. Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503)246-6699 or 1-800-332-2344.
Issued By:
Permittee
Signature: - —'
Call 639-4175 by 7 p.m. for an inspection the next business day
i.
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Building Permit Application FOR OFFICE USE ONLY
Receivecy l i u,i.h,,g
Date/B Z$� _C� Permit NL L,i
City of Tigard Planning Approval Other
Date/By: Permit No.:
1312 SW Hall Blvd. Plan Revie Other
Tigard,Oregon 97223 -Date/By: `O Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land use
Internet: www.ci.tigard.or.usDateB : Case No.
Contact Juris. See Page 2 for
24-how Inspection Request: 503-6394175 Name/Method: Supplemental Information
TYPE:,OF WORK, +" e1oa: t - Pa
�.� 1J1RED�D41TA
New construction Demolition "l
t
PLOSL
1d_dit_ion'alteratt n're lacement' Other: `�' """ -- -
- CATEG 2_S•- IM[I_ON, _ Note: Permit fees'are based on the total value of the work performed. Indicate
1 b 2-Family dwellin Commercial Industrial the value(rounded to the nearest dollar)of all equipment,materials,labor,
--- — -- -- overhead and profit for the work indicated on this application.
Accessory_Building_ Multi-Favi lv
Master Builder Other: Valuation......................................................... $
�3ITIP,MfgI A O N�ancfl[OQNo.of bedrooms: No.of baths:
.lob site address: 1-17L5- 1,l p ,, X&-e Total number of floors...,.. i
New dwelling area(sq.ft.)..............................
Suite#: Bld ./A t.#: ?� - -- -
Garage/carport area(sq.ft,)............................
Project Name: ,,,,v�jo{- r Covered porch area(sq.ft.
Cross street/Directions to job site: Deck area(sq.ft.).............
(OC14 in / Other structure area(sq,ft.).................
UIRE DATA:
COMMERCIAL-I[JSE,,e_13 tXLIST
Subdivision: Lot#; - --- —
Tax map/parcel #: Note: Permit fees*are based on the total value of the work performed indicate
I1J�SCRI�T70NAOlf bR14 _ W the value(rounded to the nearest dollar)of all equipment,materials,labor,
overhead and profit for the work indicated on this application.
Valuation......................................................... $2 t SOU
-- - - -T Existing building area(sq.fl.).........................
---- --- ----- New building area(sq.fl.) —.
Number of stories............................................
1P .OPERTY NF-Ii Type of construction.......................................
_ T-----------
------ •: ,TEN NT..-�_ .` r .-!
arae: L,)?L- /� SUS 1 a+-e S Occupancy group(s): Existing:
Address: i 1--( -14q S "l tNew:
. a w-e City/State/Zip:7� Z V(—L-22itV _
Phone: Fay: NOTICE: All contractors and subcontractors arc required to be
`t _ �4'UNTAC'i PERS licensed with the Oregon Construction Contractors Board under
-'��- -- --- provisions of ORS 701 and may be required to be licensed in the
Business Name: ��y � ti}r cwl{ LLL jurisdiction where work is being performed. If the applicant is exempt
Contact Name_ Y-� ���(,�— from licensing,the following reason applies:
Address: P'U, 2 0_c1 —
City/State/Zip: 1 ur a r cl —
Phone: 23rt
41:ILDING 111:10111 1, ,
E-mail: Please refer to fee whedule.
�CONVMTCTOR
Business Name: 1.. ��, i
- � t'` u�� �� Fees due upon application...._
Address- P,U, pC
Cit /State/Zl 4 r t- r O IZ 11-_J Z f62 Amount received.......... ...... ............. g _
Phone: 090 (j-7/ Fax: Date received: _
CCB Lic. #: I SSS yy ^--_-- _-�
Authorized ` Notice: This permit application expires If a permit b not obtained r%ithln
Signature: Date-V/7180 dais after It has been accepted n complete.
---- ..— - -----------__--�—_ —_.__—_ •Fee methodoingy set by Trl-Counts Building Indwtr•v Ser%lce Board.
(Please print name)
i�Dsts Permit Forms\BldgPermitApp.doc 01103
Flan Submittal Requirement Matrix
Commercial & Multi-Famil.,
Ciq,of Tigard New, Additions or Alterations
TYPE OF, SUB;MITTAL ,.` # of Plans
(Includes New, Additions or Alterations) °Requiredl-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.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution 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:\Building\Forme\Plan3ubMatrix.doc 04103
SEE 35MM
ROLL # 21
FOR
OVERSIZED
DOCUMENT
tM� e TIMBERLINE APARTMENTS"
14*703-14799 SW 109 Avenue
of a
FMZ 6188E
Road
NOTE:
on Lowe
99E 4 located on Upper Floor.
Preliminary Drawing
This drawing has been done by the M
draw team prior to station review. it Is
not complete and should be
reviewed,
necessary information added and 1471
:,��etumod to the DT for final completion.
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LAST UPDATE 3/01
From Station
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SAVED AS
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