Permit (114) � � CI OF TIGARD BUILDING PERMIT
PERMIT #: BUP2001 -00460
vi DEVELOPMENT SERVICES DATE ISSUED: 4/22/02
1,L F.� II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16200 SW PACIFIC HWY Y PARCEL: 2S1156A -00101
SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: M TOTAL AREA: 0.00 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: $ 50,000.00
Remarks: Interior walls, paint, carpet and store fixtures in existing space.
Owner: Contractor:
BIT HOLDINGS LTD PARTNERSHIP MALONEY & BELL GENERAL CONTRAC
BY FORUM PROPERTIES INC 11390 SUNRISE GOLD CIRCLE #700
FIVE CENTERPOINTE DR STE 290 RANCHO CORDOVA, CA 95742
L h o OSWEGO, OR 97035 Phone: 916 - 635 -7600
Reg #: LIC 137834
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Electrical Permit Required
PLCK CTR 12/14/01 $306.02 27200100000 Framing Insp
Gyp Board Insp
FIRE CTR 12/14/01 $188.32 27200100000 Final Inspection
PRMT CTR 4/22/02 $470.80 27200200000
5PCT CTR 4/22/02 $37.66 27200200000
Total $1,002.80
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 - 1987.\ You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
S ittee ;r - - • c4 s t--- A
Sign t ru e: A ��
lssu By: k______I '4.41 ,
Call 639 -4175 by 7 p.m. for an inspection the next business day
4 1 ,, E 1z 17 0, .
' . � Wring Permit Application
K� AR ►i Date received: (P 'I 2 j f / Permit no.: F(,(7�� .- L19 cf� \ ,
i City of Tigard
Address: 13125 SW Hall Blvd, Tigard, OR 97223 Project/appl.no Expire date:
City of Tigard \
Phone: (503) 639 - 4171 Date issued: By: Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
N
Land use approval: l &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family ❑ New construction 0 Demolition
.Addition/alteration/replacement ❑ Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION ■
Job address: 16249 - -_-_--.11,Aa( 44 44 KU - Bldg. no.: Suite no.:
Lot: I Block: Subdivision: I Tax map /tax lot/account no.:
Project name:IDO((Ae 1 - rblolzb `t U[)1UP g6 L APJ
Description and location of work on premises/special conditions: ( iVSRMUG" AlccU Oi7c .4it > /ils P,or
; OWNER, FOR SPECIAL INFORMATION, USE CHECKLIST
Name: 14A1ZS. -4 (N (J --W, • • i,. — (Floodplain, septic capacity,solar, etc.)
Mailing address: 112 1 I\5J s Aj .3riekr I & 2 family dwelling:
City: /�/b State �I ZIP:��S Valuation of work $
e
Phon aff I IFaxgal /rl49tnail: No. of bedrooms/baths
Owner's representative: S1 ik ROVE II i Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
' APPLICANT Garage/carport area (sq. ft.)
Name: � Ire�.ALt) RA iiuS Covered porch area (sq. ft.)
Mailing address: ( 1 3QC) SUN'R. Ste,. Dt.a ete€,t.E 9v 11i PO Deck area (sq. ft.)
City: Rp i(e• c ? .`,, State:. I ZIP:457'4A Other structure area (sq. ft.)
Phone: f (, . 55.76, , • F. d' i . A , 'v.' E-mail:
Commercial/industrial/multi-family:
CONTRACTOR
Valuation of work $ 56 MO
� gl 8 Existing bldg. area (sq. ft.)
Business name: New bldg. area (sq. ft.)
Address: (1'390 �j tJN � t2/3 t'Jl b OH2eLE A to Number of stories
City: k p M ate• I ZIP: 4.57¢d! Type of construction
Phone , )414'j - 4,0D I Fa/07/6 65S- ail:
Occupancy group(s): L,I Existing:
CCB no.: / i3y ( /o - 7_, : y 1)
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
___ARCHITEECI: /DESIGNER licensed with the Oregon Construction Contractors Board under
Named &Uv,r ReCAZ (6ruc2 'RI pG provisions of ORS 701 and may be required to be licensed in the
Address: i
Z. 7 \ .I srVaa'p1111a • jurisdiction where work is being performed. If the applicant is
City: N State: I ZIP: /� exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone:7 -3 (te Fax: i '321 -• F _ .'
ENGINEER
Name: Q)4 C Contact person: Fees due upon application $
Address: Date received:
City: (State: IZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ visa ❑ MasterCard
work will be complied with, whether specified herein or not. Credit card number: / /
Expires
Authorized signature: Date: Name of cardholder as shown on credit card
Print name: Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/00/COM)
2e-1) . 3 0(0 .o --
4-7q , i • 6 V (..-A/
•
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
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 plan sets for distribution purposes (for Contractor, City of •
Tigard, Washington County, and Tualatin Valley Fire & Rescue).
E w - Midi # of ' • , .� . .
�• • • • 'TYPE OF S ' Plans KEG: _
5 Submitted'
S = Site Work (must include
S (New, Add or Alt) 4 IocatPon of all acce'es $ble.parking)
4 17.'1 w
B (New, Add or Alt) • 1* • • B' = ¢uil�iiry ` ;'% " �
F (New, Add or Alt) 3 ** FS "=: Fire lF'-rotection System
M (New, Add or Alt) 2 M = Mechanical
P (New, Add or Alt) 2 • •- - • .:Y• 'P -= Plumbing.'
-, •�;. e ,
E (New, Add, or Alt) 2 E =•8Jeetrioal • •;»
New = New
' , Add = ' A u dition'• - t • •
• ' • •
• .Alt 1 . "Altetat'ron to existing'•
building
*For over - the - counter commercial tenant imRrpveMe s; "s uamit'2'sets ofpllam,,: • .
** "New" requires that plans bear the original seal of ar•.0regorr=li.eensed f.- •� i
suppression engineer, or NICET level "3" technicians.
I: \dsts \forms\matrxcom.doc 10/27/00
CITY OF TIGARD 24 -Hour
Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Li (503) 639 -4171
Received Date Req sted S / AM PM d . 200(00 'Y c
Location /6 ZO C� Suite MEC
Contact Person 10 A / Ph ( ) 79 3 94 PLM
Contractor Ph ( ) 1 / 4(7 l' 4SWR
BUILDING Tenant/Owner • D&-P ! ELC arism
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
Ot -r:
JO - ART FAIL
• BING
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
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 $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date V Inspector Est t
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL