Permit CITY TIGARD BUILDING PERMIT
PERMIT #: BUP2006 -00298
f ll� ' I DEVELOPMENT SERVICES DATE ISSUED: $/1/2006
. : - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 6394171
PARCEL: 2S 102BB - 00827
SITE ADDRESS: 10495 SW JOHNSON CT ZONING: R - 4.5
SUBDIVISION: BROOKSIDE PARK NO. 2 LOT: 003 JURISDICTION: T(G
Project Description: Fire sprinklers. (13D system)
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: SR2.3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 0 BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: N MEZZ ?: N REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: y SMOK DET:U
DWELLING UNITS: 1 FRNT: ft REAR: ft FIR ALRM : U HNDICP ACC:Y
BEDRMS: 6 BATHS: 2 IMP SURFACE: PRO CORR: U PARKING:
VALUE: $ 14,500.00
Owner: Contractor:
KAMMEYER, DALE R + CAROL M WESTERN STATES FIRE PROTECTION
10495 SW JOHNSON CT 13896 FIR ST STE B
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: Contact #: PRI 503 - 657 - 5155
FAX 503 - 657 -5182
Reg #: L1C 104570
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcha 7/14/2006 $15.00
[BUILD] Permit Fee 7/14/2006 $187.50
[FLS] FLS Pin Rv 8/1/2006 $75.00
Total $277.50
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 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: 1V ���
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Fire Protection System 0 ? w ,, � 0 "
Buildin Permit Ai • jlc: irit�l�: � �',;�� ; , .l tlki 01 I IC:i USI (N.1 1
City of Tigard 1 ` Re B` 00,4/
13125 13125 SW Hall Blvd., Tigard, OR 97223 II � 1 i i 61� � Plan Rev' �� / P No. +� _ � ..
Phone: 503.639.4171 Fax: 503.598.1960
U ; 1 tt D1 : % , ' Ot Permit:
Inspection Line: 503.639.4175
CITY OF TI r - � -11 4 f I I Date Read B • ®See a 2 for
Internet: www.ci.tigard.or.us Notified/Methe : Supplemental Information
'BUILDING DIVISION
TYPE OF WORK REQUIRED DATA: l- AND 2- FAMILY DWELLING
® New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10495 SW Johnson Court New dwelling area: 1,550 square feet
City/ State/ZIP: Tigard, Oregon 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Albertina Kerr Center Covered porch area: square feet _
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
_ REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this applica . / n
install 13D residential fire sprinkler system Valuation: $ / }�� �o'?
Existing building area: / b 7 set
New building area: square feet
❑ PROPERTY OWNER ! ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups: ' Sz3
w
City/State/ZIP: Existing: 0 - r
Phone: ( ) Fax: ( ) New: t � �'
0 APPLICANT ® CONTACT PERSON • NOTICE
Business name: Western States Fire Protection Co. All contractors and subcontractors are required to be
Contact name: Darrell Fink licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 13896 Fir Street, Suite B jurisdiction in which work is being performed. If the
City/State /ZQ': Oregon City, Oregon 97045 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 657-5155 l Fax: : (503) 657-5182 p - /
E -mail: darrell.fuit @wsfp.us "/S l 7` t
CONTRACTOR _ �) ----
Business name: Western States Fire Protection Co. BUILDING PERMIT FEES*
Address: 13896 Fir Street, Suite B
Please refer to fee schedule.
City/State/ZIP: Oregon City, Oregon 97045
Fees due upon application
Phone: (503) 657 -5155 ! Fax: (503) 657 -5182
Amount received
CCB tic.: 104570
Date received: 7 t y /y" ADD 4j
Authorized signature' - ` This permit ap icati n e es if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Darrell Fluit Date: July 13, 2006 * Fee methodology set by Tri-County ildinggIndustry
At Service Board. 79 O / � i:\BuildingTermits \FPS - Permit App.doc 12/01 440- 4613T(I I /OJCOSAMrEB) (/
CM /OF TIGARD
BUILDING DIVISION PERMIT #: BUIP2006 -00290
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 81//2006
Phone: (503) 639 -4171 gym,.
Inspection Requests (24 Hrs.): (503) 639 - 4175 -!';`: ��I L .::.
INSPECTION WORKSHEET FOR DATE: 8/17/2006 TIME: 7 :01AM PAGE: 611
SITE ADDRESS: 10495 SW JOHNSON CT CLASS OF WORK:
SUBDIVISION: BROOKSIDE PARK NO. 2 LOT #: 003 TYPE OF USE:
PROJECT NAME: AL BERTINA KERR CEN'T'ER
DESCRIPTION: Fire sprinklers. (13D system)
OWNER: KAMMEYER, DALE R + CAROL M, PHONE #:
CONTRACTOR: WESTERN STATES FIRE PROTECTION PHONE #: 503.657.6165
Inspection Request Scheduled For: Date: 8/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 035041 -01 503- 657 -5155 Y
Corrections /Comments /Instructions: DKVC. C M.-L.—
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PASS n PARTIAL APPROVAL ❑ CANCEL — NO ACCESS
❑ FAIL (^ CALL F INSPECTION — ADDITI NAL F ES ASSESSED
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Inspecto Date: r --i.. Phone #: (503) 718- 7i