Permit 11 a , CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2007 -00630
° COMMUNITY DEVELOPMENT DATE ISSUED: 1/2/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 101 AD - 03200
SITE ADDRESS: 12909 SW 68TH PKWY 5 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT: JURISDICTION: TIG
PROJECT: BENEFICIAL LIFE INSURANCE
Project Description: TI - fire sprinkler alterations
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: 2N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 30 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,753.00
Owner: Contractor:
PACIFIC REALTY ASSOCIATES DELTA FIRE INC
15350 SW SEQUOIA PKWY #300 -WMI 14795 SW 72ND AVE
PORTLAND, OR 97224 PORTLAND, OR 97224
Contact #: PRI 503- 620 -4020
Phone: FAX 503 - 620 -1058
Reg #: LIC 64174
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 12/13/2007 $69.65
[TAX] 8% State Surchart 12/13/2007 $5.57
[FLS] FLS Pln Rv 12/13/2007 $27.86
Total $103.08
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 rul s-ai- 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
callin 03.246.66•' •r 1.: t:.
Iss d By: , .4 .iI r / . Permittee gnature: ! ,,
Cali 503.639.4175 by 7:00 a.m. for an inspectio - • t 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.
E1j�13 LIFE 129o 5 41) 68
Fire Protection System
Building Permit Application
Cl},,, of Tigard \� , Received t perm No.:
City P Date/By: / � t D 7 If r. '�1��
° 13125 SW Hall Blvd., Tigard, OR 97223 r, 1 ' \S ., Plan Rev ew
0 Phone: 503.639.4171 Fax: 503.598.196 �, .� Other Permit:
Inspection Line: 503.639.4175 \` \\% Date Read /B 1 • RI See Page 2 for
T I G A R D IPA (� ��` S ' I ��� Notified/ : i � r
Internet: www.tigard or.gov ( ! / ea Supplemental lnformadon
TYPE OF WORK,, ,S _` 66 , .teN ' REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ 6 ' G , - Permit fees* are based on the value of the work performed.
s. ' Indicate the value (rounded to the nearest dollar) of all
® Addition/alteration/replacement ❑ • r er. equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
dwelling Valuation: $
❑ 1- and 2-family g ®C omrierciaUindustrial
❑ 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: 12909 SW 68 Parkway New dwelling area: square feet
City/State/ZIP: Portland, OR 97224 Garage/carport area: square feet
Suite/bldg. /apt. no.: 911 OP Project name: 4. Beneficial Life Ins. 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: I 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 application.
Fire Sprinkler Valuation: $$2,753.00
Existing building area: square feet
New building area: square feet
PROPERTY OWNER I ❑ TENANT Number of stories:
Name: A- _ - - raAi f ' Type of construction:
Address: Occupancy groups:
City/ State/ZIP: Existing:
Phone: ( ) Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Delta Fire, Inc. All contractors and subcontractors are required to be
Contact name: Heidi Scarbrough/Matt Staley licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 14795 SW 72 Ave. jurisdiction in which work is being performed. If the
City/State/ZIP: Portland, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 620 -4020 Fax: : (503) 620 -1058
E -mail: heidis@ deltafire .com/matthews @deltafire.com
CONTRACTOR BUILDING PERMIT FEES* .
— Business name: Delta Fire, Inc. (Please Hier to fee schedule)
Permit fee: 69.65
Address: 14795 SW 72 Ave.
City/ State/ZIP: Portland, OR 97224 State surcharge (8% of permit fee): 5.57
FLS plan review (40% of permit fee):
27.86
Phone: (503) 620 -4020 Fax: (503 -) 620 -1058 (Due upon application.)
CCB lic.: 64174 Total permit fees: 103.08
Authorized signature: Amount received: (Q $ . (j
This permit application expires if a permit is not obtained
Print name: Heidi Scarbrough te: 12 -7 -07 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1: \BuildingnPermits \FPS- PermitApp.doc 03/23/06 440- 4613T(11,02COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only.
® Addition ❑ 1 -10 heads: No plan review required.
® Alteration (31 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 20
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes NA
Information: Hazard Group Light
Density 0.1
Design Area 15000
K. Factor 5.62
Sprinkler Project Valuation: $ 2,753.00
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $ NA
•
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ NA
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: NA sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $ 2,753.00
Permit fee based on project valuation (see fee schedule): $ 69.65
Permit fee based on square footage (see D above): $ NA
State Surcharge (8% of permit fee): $ 5.57
FLS Plan Review (40% of permit fee): $ 27.86
TOTAL: $ 103.08
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.
I:\ Building \Pamits\FPS- PamitApp.doc 0323;06 440-46 I3T(11,02,COMiWEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2007 -00630
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/70008
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/1008 TIME: 7 :02AM PAGE: 5
Oa
SITE ADDRESS: 12909 SW 68TH pKwyAsitr CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: BENEFICIAL LIFE INSURANCE
DESCRIPTION: TI - the sprinlder alterations
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: DELTA F=IRE INC PHONE #: 503-620-4020
Inspection Request Scheduled For: Date: 1/18/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
999 Sprinkler final 063541 -01 503- 956.6290 N
Corrections /Comments/ Instructions:
cTcC.f.) Tc (--t- se 1Q
•
ru .PA : II 'ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ITA CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / /g 08 Phone #: (503) 718- Z-- 6
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2007 -00630
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2/2008
Phone: (503) 639 -4171 Azit i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/11/2008 TIME: 7 :01AM PAGE: 29
SITE ADDRESS: 12909 SW 68TH PKWY - CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: BENEFICIAL LIFE INSURANCE
DESCRIPTION: TI - fire sprinkler alterations
OWNER: PACIFIC'REALTY ASSOCIATES, PHONE #:
CONTRACTOR: DELTA FIRE INC PHONE #: 503 - 620 -4020
Inspection Request Scheduled For: Date: 1/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
235 Misc. inspection 063086 -01 503 -620 -4020 Z .6- --I .1
Corrections /Comments /Instructions:
V '
:A P ❑ • . r IAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ' ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _ =
■ _ Date: l 023' Phone #: (503) 718 -
G� `7
lib
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 13UP2007 -Q0630
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2/2008
Phone: (503) 639 -4171 F it
Inspection Requests (24 Hrs.): (503) 639 -4175 __
INSPECTION WORKSHEET FOR DATE: 1/1012008 TIME: 7 :QOAM PAGE: 1
/DV
SITE ADDRESS: 12909 SW 6OThl PKWY CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: BENEFICIAL LIFE INSURANCE
DESCRIPTION: TI - fire sprinkler alterations
OWNER: PACIFIC REALTY A,hSOCIATES, PHONE #:
CONTRACTOR: DELTA FIRE INC PHONE #: 503.62041020
Inspection Request Scheduled For: Date: 1/10/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
295 Misc. inspection 062986-01 503 - 6204020 N
Corrections /Comments / Instructions:
•l ' . 1 4 I
do &I S t(:: fq C-, T ---
ivii / P' RTIAL APPROVAL ❑ CANCEL El NO ACCESS
FAIL • CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: L■ ■•■ Date:
17 68 Phone #: (503) 718 - 6- /Y
lb