13560 SW HALL BLVD y/.•,
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CITYOF TIGARD __ BUILDING PERMIT
DEVELOPMENT SERVICESPERMIT#: BUP2003-00005
DATE ISSUED: 1/6/03
13125 SW Hall ,.'.Ivd., Tigard. OR 97223 (503) 639-4171
SITE ADCRESS: 13560 SW HALL BLVD PARCEL: 2S102DD-00200
SUBDIVISION: EDGEWOOD ZONING: R-12
BLOCK: LOT: 00l JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DEM FIRST: sf N: S: E:– —WT
TYPE OF USE: SF IECOND• sf _ PROJECT OPENINGS? _
TYPE OF CONST: UNK sf N_ S: E.:
OCCUPANCY GRP:
TOTAL AREA: 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:
Remarks: Demolition of 456 square foot shed/garage. All demolition debris is to be removed from site.
Owner: Contractor:
CITY OF TIGARD OWNER
13125 SW HALL BLVD SIGNED RESPONSIBILITY
TIGARD, OR 97223 FORM IN FILE
Phone: 503-639-4171
Phone:
Reg #:
FEES Y� REQUIRED INSPECTIONS
Description Date Amount Final Inspection
IWIL.D] 11cr11111 1-(-(- 1/6/03 – $62.50 –
I,1XI R";,statc I as 1/6/03 $5.00
Total $67.50
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 'n 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 adapted by the Oregon Utility Notification Canter. Those rules are set forth In OAR
952-001-0010 throuCn .-)AR 952-00 1-0100. You may obtain q copy of these rules or direct questions to C UNC by
calling (803)246-6699 or 1-800-3327-344.
Issued By:
Pennittee
Signature:
Call 639-4175 by 7 p.m. for an inspection the next business day
Building Pp; mit Application F01110MCIP
— -- —. Iteceivrd Building
Date/lid— �0 :�- Permit No.: 6uNd0o3'
City Oi F igai-d PlanningApprov I Other
Date/B Permit No.:
13125 SW (fall Blvd. Permit
Review Other -- -
Tigard,Oregon 97223 Ualc/B Permit No.:
Phone: 503-639-4171 Fax: 503-5925-190fl Post-Review Land Use —
Internet: www ci.tigard.or.us Date/By: Case No.
Juris.: See i' is ffor
24-hour Inspection Request: 50 3-639-4175 Contact Name/Method lila �Iemrntal Information
TYPE OF WORK _ REQUIRED DATA: —v
New construction _ Demolition — I &2 FAMILY DWELLING
Addition/alteration/replacement — Other: — — --- —
_ CATEGORY OF CONSTRUCTION NoW Permit fees*are based on the total value of the work performed. Indicate
1 &2-Family dwelling Commercial/industrial the value(rounded to the nearest dollar)of all equipment,materials,labor,
--
Accesso Building Multi-1�amilY _ —_ overhead and profit lift the work indicated on this application.
Master Builder Othcr: Valuation................................. ...................... $ _
JOB SITE INFORMATION and LOCATION No.of bedrooms: No.of baths:
Job site address ,'35lod Total number of iours.................................. ..
-- --- -- -- New dwelling area(sO. ft.). ..............
..........._
Suite #: Bg./A
ldpt.#: ----
- -- ---- —-- Garage/carport area(sq. fl.),..........................
Project Name: Covered porch area(sq. ft.)............................
Cross street/Di rec t ions to job site: Deck area(sq. ill)............................................
Other structure area(sq. ft.)................ -...... .
REQUIRED DATA:
COMMERCIAL-USE CHECKLIST
Subdivision: -- -- Lot #: _ _ —--- ----- -- -..--
Tax tna i arcel #: Note Permit Ices'are hascd on the total%slue of the-irk per6rrmed. Indik air
DESCRIPTION OF WORK the vulu,(rounded to the nearest dollar)of all equipment,materials,labor,
— overhead and profit for the wort.indicated on this application
Valuation.... ......... .......................................... S
Existing huilding arra(sq. ft.).........................
— --- .._.. ----- - New building area(sq. f).)................ ........ .
Number of stories................................ .... .... .
PROPERTY OWNER _ 7 TENANT _ Type of construction................................. ..... _
Name:_��1'• _ — Occupancy group(s): Existing:
Address: New: - -
City/State/Zip:r -
�_ required to be
Phone: Pax: NOTICE: All contractors and subcontractors are re q
licensed with the Oregon C'onFtruction Contractors Board under
APPLICANT CONT4CTPERSOi`? provisions of ORS 701 and may be required to be licensed in the
Business Nanie: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: — from licensing,the following reason applies
Address:
Cit /State/Zi :
Phone;
E-mail: --- —_ — BUILDING PERMIT FEES*
r1NTRACTOR -- — Please refer to fee schedule.
Business Name: ,, jyw Fees due upon application...................... ....... S
Address: —
City/State/Zip: Amount received... . .. ..................... ........... $
_Phone: _— Fax: —_ — Date received:
CCB Lie. #:SigAutho
nature:
re: /� Notice, chis permit application ecpircs if a permit is not obtained within
Signature: Aa(/ — Date: �� O� 180 days after It has been accepted av complete.
— 1'�W --� ------ •Fee methodology set by Tri-C'runly ffalidinR Industry service Board.
(Please print me) -
i:\Dsts\Permit Forms\Bldt,,'crmitApp.doc Of 10;
Commercial Flan Submittal
r, Requirement Matrix
Cirf of Tigard i
TYPE OF SUBMITTAL # sof Plans
(Includes New, Additions or Alterations) Required at
Submittal
Site Work 11
(must Include location of all accessible parking)
Plumbing - Site Utilities 2
Building •1
Fire Protection Systern 3**
Mechanical .�
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).
*dor 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 -`ire suppression engineer, or NiCET level "3" technicians.
iAdsts\fomes\COM-matrix.doc 9/24/01
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Lire: (503) 639-4171 MST
Blip
Received - -__Date Reque tee.- �/_AM_ __ PM BUP
Location __�,�3���' Suite___ MEC
Contact Person -'Lf Ph( _) Z � __- PLM
Contractor—_ y� (J _ Ph( ) R _ - --
BUILDING Tenant/Owne _ -__ —_ —_—__ _ ELC
Footing
Foundation Access: /, ELC
Ftg Drain ��ir/!'I �� ��' � PFJ 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 2
Susp'd Ceiling - - - ---
Roof
Other._�-1'h-� - --- -------.-
AS )PART FAIL
A - - --- - --- -----___-- __.
f'os1& Beam
Under Slab ----
Rough-inWafer Service
Sanitary Sewer
Rain Drains
Catch Basin i Manhole
Storm Drain --- - --- -- _ _
Shower Pan
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$_-T_--required before next Inspection. Pay at City mall, 13125 SW Hall Blvd.
PASS PART FAIL
_SITE _ _ Please call for reinspection RE:.---. E] Uneble to inspect-no access
Fire Supply Line
ADA -7 .,
Approach/Sidewalk Date--= -. f�--- _ Inspoctor ���_
Other-
Filial
Final D;a NO REMOVE this Inspection rer.ord from the Job site.
F'ASS PART FAIL