Permit A CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00043
�, �,� y DEVELOPMENT SERVICES DATE ISSUED: 2/12/02
---- -- ``- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15862 SW 72ND AVE 200 PARCEL: 2S112DD -00200
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
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: 5N : 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: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 1,490.00
Remarks: Modification of (9) sprinkler heads for tenant improvement.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES DELTA FIRE INC
15350 SW SEQUOIA PKWY #300 -WMI 14795 SW 72ND AVE
PORTLAND, OR 97224 PORTLAND, OR 97224
Phone: Phone: 620 -4020
Reg #: LIC 64174
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough -In
PRMT CTR 2/12/02 $62.50 27200200000 Sprinkler Final
5PCT CTR 2/12/02 $5.00 27200200000
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 -6699 or 1- 800 - 332 - 2344.
Pe rm ittee `tea /_ < —� �/
Signet ttIN,'
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Issu -• By: I /?J, !� %n
y �- - ?
Call 639 -41 by 7 p.m. for an inspection the next business day
r
Building Permit Application
Date received:) /P. 09- Permit no.: 4 ,9yv -09011
<° ,- -.Ail City of Tigard
Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: I &2 family: Simple Complex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory Greommercial/industrial 0 'Multi-family 0 New construction 0 Demolition
0 Addition /alteration/replacement 13'1 enant improvement 57 -Fire sprinkler /alarm 0 Other:
JOB SITE INFORI%IATION
Job address: /5'( o2 703 s 1 /, ... Bldg. no.: Suite no.: 010
Lot: Block: Subdivision: I Tax map /tax lot/account no.:
Project name: J �' GCst Q S,e7QZI. '' .a4CLs £ / .0 'ZGVI. 3
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CIIECKLIST
Name: (Floodplain, septic capacity, solar, etc.)
Mailing address: 1 & 2 family dwelling:
City: IState: IZIP: Valuation of work $
Phone: I Fax: IE-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.)
./—Cl_ Covered porch area (sq. ft.)
Mailing address: /CI 79 5 ,Se 7 2 4, Deck area (sq. ft.)
City: �," f alite) 1 Stater( ZIP:9 76, Other structure area (sq. ft.) •
fr — Fax • 2c -1G E -mail:
Commercial/industrial/multi-family:
Phone: , ial/industrial/multi- family: // Q
CONTRACTOR Valuation of work $ /'r ! D
s . Existing bldg. area (sq. ft.)
Business name: T .
4/ 7 9 `� Sw oZv� _›l New bldg. area (sq. ft.)
Address: J Number of stories
City: -I' &,' ,) State j ZIP: 9 7 :1� Type of construction
Phone: I Fax: 1E-mail: Occupancy group(s): Existing:
CCB no.: Co Lfl 741 New:
-
City /metro lic. no.: 2 9' 3 Notice: All contractors and subcontractors are required to be
A RCI1111:(1 /1I:SIG licensed with the Oregon Construction Contractors Board under
Name: '1 7'4 r './—?:Z provisions of ORS 701 and may be required to be licensed in the
Address: /q79 5 SGJ 7(Lfrt4� jurisdiction where work is being performed. If the applicant is
City;i3 State g7a,�,C exempt from licensing, the following reason applies:
Contact person:�tl:[LG ..5tlan no.:
Phone: (pr- qc)o'ej Fax „ A — 651 E -mail:
ENGINEER
Name: Contact person: Fees due upon application $ _
Address: Date received:
City: (State: IZIP: Amount received $
Phone: I Fax: I 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: E xpi /
A sign n. =�y� ,J� // 'D I Y I Date: 02 - /2 Name of cardholder as shown on credit card
Print name: 3 � At- CGJL.� 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 (MX)ICOM)
Fire Protection Permit Check List
A.) ❑ New ❑ Addition arkteration ❑ 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: i c1 t
Additional description of work: Ii , o-( 9 4Or(\t (QY
S .
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet ❑ Dry ❑ _
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $
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: $
Project Valuation Subtotal (A, B & C): $ 4
Permit fee based on valuation (see chart): $ Go
8% State Surcharge: $ , . Cc)
FLS Plan Review 40% of Permit: $
TOTAL: $ G2 7 .50
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 \FPSchecklist.doc 11/21/01
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