Permit . BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2000 -00473
Av ,,, 11' DEVELOPMENT SERVICES DATE ISSUED: 11/21/00
' I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11308 SW 68TH PKWY PARCEL: 1 S136DA -00100
SUBDIVISION: ZONING: MUE
BLOCK: LOT: 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: : sf N: S: E: W:
OCCUPANCY GRP: 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: 30 dc'
Remarks: Alteration of one fire sprinkler head.
Owner: Contractor:
BENENSON 68TH PARKWAY BASIC FIRE PROTECTION INC
KEY LLC, THE 940 NE LOMBARD ST
BY�FIRST AMERICAN TAX VALUATIO PORTLAND, OR 97211
WPhoneSTER, MA 01615 Phone: 285 -1855
Reg #: LIC 48641
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler inspection •
PRMT CTR 11/21/00 $62.50 27200000000 Final Inspection
5PCT CTR 11/21/00 $5.00 27200000000
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 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 -1987.
Pe rm itee ,
Signature: /9"//(1 droi
Issued By: ��L� „ ��_ �=
Call 639 -4175 by 7 p.m. for an inspection the next business day
•
.
Building Permit Application
f Datereceived: // !/ -) Permit no.:4 - , t/j . „
°• °i '�yi° City of Tigard
- Project/appl.no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By;6 Receipt no.:
Fax: (503) 598 -1960 BGi'f e- - 2r e I / 702 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 New construction 0 Demolition
0 Addition /alteration/replacement llenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITF INFORMATION
Job address: 3+ Sl,.> C80. P ■ , 3 : - • • c. 9 7 2.23 Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: r . ► e_ E F, H • r e. . • h ;. •. ✓ ► Ce_i t'. - - ... 4
Description and location of work on premises/special conditions: ANS I 11 Ot• e PEA!)
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST'
Name: (Floodplain, septic capacity, solar, etc.)
Mailing address: 1 & 2 family dwelling:
City: State: ZIP: Valuation of work $
Phone: Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: . ih ik S C Ic.bat c Covered porch area (sq. ft.)
Mailing address: 9+0 - • (...04-4 8/9Q_ Deck area (sq. ft.)
=roe 01 State:0Q_ ZIP: a 2,11 Other structure area (sq. ft.)
Phone: 2155' - 1 655 Fax: 2 oil E -mail: Cbc Fize6 • • j Commercial/industrial/multi- family:
CONTRACTOR Valuation of work $ _30 0 ,
Er Existing bldg. area (sq. ft.)
4o G l,i.004 rt ',: (? ■ New bldg. area (sq. ft.) -
Address:
Number of stories
En
1, 1 J W State: pt2 Type of construction
Phone: 285 /85S Fax: Z65 oil JIMMIIR Jr• ' Occupancy group(s): Existing:
CCB no.: • : _ • New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
` ” ARCHITECT/DESIGNER— -- "- ` - licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: 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 an • or ces governing this 0 Visa 0 MasterCard
work will be complied with wwhe r• ie e in oI not. Credit card number: Expires
Author SI azure. : --- j pw Date: ///6310 Name of cardholder as shown on credit card
Print name: -- ace ?TOG k At.( 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)
S Pr-1 k
• V •
Fire Protection Permit Check List
A.) ❑ New ❑ Addition ❑ Alteration ❑ Repair
• B.) Modification to sprinkler heads only:
Describe work to 1. 1 -10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required.
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A or B as applicable):
A.) Sprinkler Wet ❑ Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $ .30 0 ,
B.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A & B): $ o . erd
Permit fee based on valuation (see chart): $ (a . SO
8% State Surcharge: $ S. oti
FLS Plan Review 40% of Permit: $
TOTAL: $ G ?• 5 cJ
is \dsts \forms \FPSchecklist.doc 10/04/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP ...1:U
Date Requested L;2.-/ AM PM BLD
Location / x30 0 d ,a ktv, Suite MEC Ea
Contact Person Ph 21f5 i 3- S PLM
Contractor Ph SWR
(UILDING Tenant/Owner � C- �'►t M )-emoo e4 / S t [fsrr✓ ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire rin
Fire Alarm
Susp'd Ceiling
Roof
Misc:
• SS PART FAIL
PLUMBING
Post & Beam _ _
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
PASS . PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date 4. / 9 inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.