Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00372
;���; DEVELOPMENT SERVICES DATE ISSUED: 6/18/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S101AD -02400
SITE ADDRESS: 12753 SW 68TH AVE.
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 032 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 3N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 354 BASEMENT: sf AREA SEP. RATED:
STOR: 2 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: $ 6,329.00
Remarks: Fire alarm and smoke detectors for tenant improvement.
Owner: Contractor:
WESTERN EVANGELICAL SEMINARY OWNER
PO BOX 23939
PORTLAND, OR 97281
Phone:
Phone:
Reg #:
FEES REQUIRED INSPECTIONS
Description Date Amount Electrical Permit Required
[BUILD] Permit Fee 6/18/03 $110.50 Fire Alarm Insp
rm
[TAX] 8% State Tax 6/18/03 $8.84 Final Inspection
[FLS] FLS Pln Rv 6/18/03 $44.20
Total $163.54
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 -i 2-. -:--99 or 1-800-332-2344.
trl\ k 1 � r
Issue 1 O �
Pemiit 11106‘
Signature: )c
Call 639 -4175 by 7 p.m. for an inspection the next business day
L ire Protection System
7 13(i&ting Permit Application F012.OEEICE USE ONLY
R ece i ved Building
Date/By: (o � D Permit No.: UM1, 3-D 3 72--
City Of Tigard PlanningAp. ,val Other
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Revie`� Other
Tigard, Oregon 97223 Date/13y: a - /8 s Permit No.:
Phone: 503- 639 -4171 Fax 503 -598 -1960 0� '''. '�'i1 Post-Review eW Land
—
Noe
Internet: www.ci.tigard.or.us Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information
T�CPE OF WORK
. ;. :: ; • � '' • . - REQUIRED'DATAr
❑ New construction ❑ Demolition lc-.841 FAMILY DWELLING , ;
ig Addition/alteration/replacement ❑ Other:
t = : Of CONSTRUCTION ` Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling 1i 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 - Family
❑ Master Builder ❑ Other: Valuation $
.!'. ;JOB`SITE.INFORKATION and' LOCATION- `;; No. of bedrooms: No. of baths:
Job site address: 12 5 ) 6g/17 s-- Total number of floors
New dwelling area (sq. ft.)
Suite #: / 0 0 / 1 Bld /Apt. #: Garage/carport area (sq. ft.) ,.
Project Name: Po r )Ll.. £tn' / .p,„,,,de / Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
7.Z h D`� 7�
SI- 4 J d � p p J _ ti ,/_ 66 / - Other structure area (sq. ft.)
REQ , q a • i ;DATA:
COMMERCIAL I SE CHECKL1 T "`,
Subdivision: West Porf"�ce- 11444k/5 Lot #: 3 Z .
Tax map /parcel #: 2S- I- l A 0-- _ 2 NOO Note: Permit fees* are based on the total value of the work performed. Indicate
' '11 •..'.? '-. . DESCRIPTION OF °WORD . .; . the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
/ e -i -es-1 / L'✓� 4) V il h ) 1-- CC'
Gawk Z OO Si' "/ Valuation $ 6(3 Za
Existing building area (sq. ft.)..9.7.8.6.. .....
New building area (sq. ft.) — '
Number of stories
A' PROPERTY' OWNER , �, _' ..1' 0' TENA.1sm,,. Type of construction - N
Name: 6 . e o l i,k Ua i 0.0-5;olv Occupancy group(s): Existing: $
Address: 0/g/ / !J. / 4Pt'clp,n ✓v B 4 4 New: a + R
City /State /Zip: w De q71) Z_
Phone: jai S� /y Fax: SD 3 -S. / Zoo nd subo required to be
licensed NOTICE: with All the co Oregon tractors Const contract Contractors rs are Board under
s.,ALAppLICANq ., ' , ` • , ❑ CONTACT . Y. * provisions of ORS 701 and may be required to be licensed in the
Business Name: ( }. cf l �O � ((Jn' ✓er5 g �J/ jurisdiction where work is being performed. If the applicant is exempt
Contact Name: D'h _c- 4,1) / from licensing, the following reason applies:
Address: L/ 1I/ N. /1iJ.efi' 01;4o S+
City /State /Zip: /AJe44/ e g 07,3 Z
Phone: 5V3.S.0/ 2v/ Fax: 50.3.53 Z-Do
G1 S t;� � � �-o1JC PL i� ✓l �'$UILDIIYG E � . 3"� �� "� ;..
E-mail: v 7 C 4 ,Pleasksefer hedj a
. -' cONTRACTO _ .
Business Name: Dv, t'te f ` Fees due upon application $
Address:
City /State /Zip: Amount received $
Phone: I Fax: Date received:
CCB Lic. #: I
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i : \Dsts\Permit Fornis\BldgPermitApp.doc 01/03
Fire Protection Permit Check List
Describe work to be done:
A.) ❑ New B.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
CU Alteration ❑ 11+ heads: Plan review required.
❑ Repair Number of sprinkler heads:
Additional description of work: _ i '] I d I q �1 / �L
c.1-KsiA!/ Sw -o l�-e l .a t'I , 1 .crv, S9Iro s 1 p,// do 14041 /
;1„ T'I h � �r(g- L �, c-tyek der ev�I rye l b,ild;Aj J �
Type of SystemjComplete A, B, C or D as applicable):
A.) 'Commercial Sprinkler -
Wet ❑ Dry ❑
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B ),'. Type l - Hood Fire Suppression System ,
Hood Project Valuation: 1 $
Submittal shall Battery Calculations Yes El
include: Individual Component Yes i
Cut Sheets
Fire Alarm Project Valuation: $ G 3 Zei . 0 0
D) Residential Sprinkler .(Stand Alone ;System) n.'
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Project Valuation Subtotal (A, B & C): $ 6,3 Z°I , oo
Permit fee based on valuation (see attached chart): $ (l 0 .
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $ d 134
FLS Plan Review 40% of Permit Fee: $ 4 4. ZA
TOTAL: $ 163.-�`j
Plan review requires a completed application and 3 sets of plans at submittal.
Plan review fees are required at submittal.
"New" fire protection systems require that plans bear the original seal of an Oregon
licensed fire suppression engineer, or NICET level "3" technicians.
is \dsts\forms \FPScheddist.doc 02/28/03