Permit Il v CITY OF TIGARD BUILDING PERMIT
PERMIT #: 13 12713 2 1 0 2 0 0 6 c - 1: 0561 COMMUNITY DEVELOPMENT DATE ISSUED: 1213/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DD-03400
SITE ADDRESS: 11740 SW 68TH PKWY 250 ZONING: MUE
SUBDIVISION: TIGARD TRIANGE COMMONS LOT: 008 JURISDICTION: TIG
Project Description: OHCA. Fire Spinkler, (156) new sprinkler heads.
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: 68 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: $ 5,974.00
Owner: Contractor:
LEISER, ANNE TRUSTEE DELTA FIRE INC
6009 SW PENDLETON CT 14795 SW 72ND AVE
PORTLAND, OR 97221 PORTLAND, OR 97224
Phone: Contact #: PRI 503 - 620 - 4020
FAX 503 - 620 -1058
FEES Reg #: LIC 64174
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 11/21/200E $100.90
[TAX] 8% State Surcha 11/21/200E $8.07
[FLS] FLS Pln Rv 11/21/200E $40.36
Total $149.33
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: gp , _ , Alp_ J/ ' , Permittee Signature. iii 1 Q ' _/.1,1
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Fire Protection System /17 9 6$ /% #4456
' Building Permit Application FOR OFFICE USE ONLY
� ,� �l Received
City of Tigard = �� ���� D�eiar �. "l�: Permit No.., (A: r7/04-045-- ,
13125 SW HaII Blvd., Tigard, OR 97223 .J Plan Review \
14 • Phone: 503.639.4171 Fax: 503.598.1960 / /-7 Date/BT. ►1) 1 ph, Other Permit:
T 1 G n It D Inspection Line: 503.639.4175 i7
�6 Dale Ready /13y. W tee See Page 2 for
Internet: www.tigard - or.gov C y Y � • Notified/Method/ —4( GE I - ® Supplemental Information
1 6>u, .:
TYPE OF WORK REQUIRED DATA: 1- 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.
❑ I- and 2- family dwelling ya, 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: ll7W) j is Nit,/ New dwelling area: square feet _ stz
City /State /ZIP: ec �, te 1 (\ J Garage /carport area: square feet
Suite/bldg. /apt. no.: , Project name: Co) H b 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
Subdivis ion: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: S 5 9 714
*cce_ f)p inlhlet
Existing building area: square feet
i
New building area: 0 square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups: - 6 ee aec
City /State/ZIP: Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: DeA ' I nc. All contractors and subcontractors are required to be
Contact name:p,.`x` licensed with the Oregon Construction Contractors Board
il" under ORS 701 and may be required to be licensed in the
Address: I L I -rGr.j .L.,,1 7a'� jurisdiction in which work is being performed. If the
{ �C�y,, . n q-7 au applicant is exempt from licensing, the following reasons
City /State/ZIP:
+krii‘ , O apply:
Phone: (50 t,p — ti o a Fax: : (5(3. co 9.0 — 105.6
E- mail: AACIIIVA P13J6Fc►. ec\Ofti.ikCt,. } l'nt(1
CONTRACTOR BUILDING PERMIT FEES*
Business name: 'DnIL 'r`•� _ (Pleoserejermjee.schednle) 6
1 t 1 A. , Permit fee: 100 A
Address: iti 5 79 �f'.„ -
City / State/ZIP: ThfTlf'LY1(� OR 970.19(.1 State surcharge (8% of permit tee): IS � 7
FLS plan review (40% of permit fee): / r
Phone: (503) ( y Fax:(6oV6g6 _165$ (Due upon application.) 4 1 0 ,3(0
CCB lic.: 6 Li 11 ti Total permit fees: I uq. 53
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: f L.,f 6 c1 .1A ate: 1 �� ,Qro CP within 180 days after it has been accepted as complete.
N eLek, �Ca V • Fee methodology set by Tri- County Building Industry
Service Board.
1 :1Building \Pcnuits\ FPS-Penn itApp doc 03/23/06 440- 4613T(11/02/COM/WE01
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Descri be•woik to.be.done:
1.) ❑ New 2.) Modification to sprinkler heads only
[S, Addition ❑ 1 -10 heads: No plan review required.
n Alteration d 11+ heads: Plan review required.
Repair
Number of sprinkler heads: 15(Q
Additional description of work:
Type of System (Complete A, B, 'C or D as - a licable
A:) Commercial Sprinkler
Wet ❑ Dry
Additional Standpipes
Information: Hazard Group Lit-• t— • y q' �
Density (N rl
Design Area A
K Factor S G',
Sprinkler Project Valuation: $ 5 q 711
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) 'Residential Sprinkler (Stand Alone System)
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: N p sq. ft.
Fire Protection. Permit Fees _
Project valuation subtotal (see A, B & C above): $ figl7N
i
Permit fee based on project valuation (see fee schedule): $ 1O cfn
Permit fee based on square footage (see D above): $ A4
State Surcharge (8% of permit fee): $ 8
FLS Plan Review (40% of permit fee): $ ��J� .
TOTAL: $ jyq,33
Plan review requires a completed application and 2 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.
L Building \ Permits \f PS- PcrmitApp.dnx 2
_ i
CITY OF TIGARD
BUILDING DIVISION PERMIT #: SUP200&00561
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/13/2006
Phone: (503) 639 -4171 �I�I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/7 /2007 TIME: 7:18AM PAGE: 57
SITE ADDRESS: 11740 SW 68TH PKWY 250 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGE COMMONS LOT #: 008 TYPE OF USE:
PROJECT NAME: OHCA
DESCRIPTION: OHCA. Fire Spinkler, (156) new sprinlder heads.
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: DELTA FIRE INC PHONE #: 503 - 62.0 - 4020
Inspection Request Scheduled For: Date: 3/7 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
285 Misr. :. inspection 04444401 503-620 -4020 N
Corrections /Co nts /Instructions:
r j PASS % PA' IAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ = • L FOR INSPECTION ❑ ADDITIONAL F S ASSESSED
Inspector: — Date. Phone #: (503) 718-
\\ v
CITTIGARD
BUILDING DIVISION PERMIT #: BUP200G- 0066'I
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/13/2006
Phone: (503) 639-4171 , � bl�le
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/20/2007 TIME: 7:00AM PAGE: 55
SITE ADDRESS: 11740 SW 68TH PKWY 250 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 008 TYPE OF USE:
PROJECT NAME: OHCA
DESCRIPTION: OHCA. Fire Spinkler, (156) new sprinkler heads.
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: DELTA FIRE INC PHONE #: 503- 620 -4020
Inspection Request Scheduled For: Date: 3/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 045080 -01 503-620.4020 N
Corrections /Comments /Instructions:
0 t ( 0 Wil .
i l
\.___________i___
PASS Ei PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
❑ FAIL IN CALL OR IN "ECTION ❑ ADD,ITIO /'Phone AL FE ASSESSED
Inspector: i c�I i Date: ,/ wr #: (503) 718 - L %� �
iv