Permit ti
BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2000 -00008
* DEVELOPMENT SERVICES DATE ISSUED: 11/21/00
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12123 SW 69TH AVE PARCEL: 2S101AA -02900
SUBDIVISION: TIGARD CORPORATE CENTER ZONING: MUE
BLOCK: LOT: OOA 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: 0.00 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 23,000.00
Remarks: Fire suppression system
Owner: Contractor:
TIGARD CORPORATE CENTER LTD DELTA FIRE INC
15400 SW MILLIKAN WAY P.O. BOX 4010
BEAVERTON, OR 97006 TUALATIN, OR 97062
Phone: Phone: 620 -4020
Reg #: LIC 00064174
FEES REQUIRED INSPECTIONS •
Type By Date Amount Receipt Sprinkler Rough -In
FIRE BON 12/30/99 $27.40 99- 320784 Sprinkler Final
PRMT CTR 11/21/00 $244.25 27200000000
5PCT CTR 11/21/00 $19.54 27200000000
FIR2 CTR 11/21/00 $70.30 27200000000
Total $361.49
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 nn itee 9
Signature: iclitedI ,iL. .%
in
Issued B
t
Call 639 -4175 by 7 p.m. for an inspection the next business day
i . . , - • 4 .. itil 1 0 g
44i Building Permit Application y
Datereceived: Permit no 7f6
4 1 ►y City of Tigard
° __� Project/appl.no.: Expire date:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Date issued: By: I Receipt no.: \ J
Fax: (503) 598 -1960 i n y C ase file no.: Payment t
mac+ e q D d y type:
Land use approval: 1 &2 family: Simple Complex: C '
TYI'E OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 New construction 0 Demolition
0 Addition/alteration/replacement 0 Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JO13 SITE INFORMATION
Job address: 7,.. ..... .r- —
,. — K Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
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.)
A Garage/carport area (sq. ft.)
Name: Covered porch area (sq. ft)
Mailing address: Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi- family:
CONTRACTOR
Valuation of work .. $ 234tarn .e'
Emmor wrignimmorimrM Existing bldg. area (sq. ft.) a ,,/
/ New bldg. area (sq. ft.) t Y'
Address: s Number of stories E ( '
City: • t &via ZIP: ' fa , J 1
Type of construction
Phone: Z0 - 4 , 20 - e/Z2b Fax: WO /DS3 E -mail:
CCB no.: , / Occupancy group(s): / Exi
Ne w:
City /metro lic. no.: ZIIMIMIMNMIIIMIIINI Notice: All contractors and subcontractors are required to be
ARCIIITECI1DESIGN1l( 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 and ordinances governing this 0 Visa 0 MasterCard
work will be complied with, whether specified herein or not. Credit card number: Expires /
Authorized signature: Date: Name of cardholder as shown on credit card
$
Print name: Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 44o -4613 (6/oo /COM)
+ 4..
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: $
• B.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A & B): $
Permit fee based on valuation (see chart): $
8% State Surcharge: $
FLS Plan Review 40% of Permit: $
TOTAL: $
•
is \dsts \forms \FPSchecklist.doc 10/04/00