Permit CITY TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00219
1i 1 DEVELOPMENT SERVICES DATE ISSUED: 5/26/2005
,.� I � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S1 12 DC -00500
SITE ADDRESS: 15895 SW 72ND AVE BLDG B 100 ZONING: l -P
SUBDIVISION: FANNO CREEK ACRE TRACTS LOT: 040 JURISDICTION: TIG
Project Description: Relocate (4) 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: 5N . sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 25 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: $ 650.00
Owner: Contractor:
PACIFIC REALTY ASSOCIATES FIRESTOP CO
15350 SW SEQUOIA PKWY #300 -WMI PO BOX 230545
PORTLAND, OR 97224 TIGARD, OR 97281 -0545
Phone: 503 - 624 -6300 Phone: 503 - 620 -6140
Reg #: LIC 63846
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 5/26/2005 $62.50
[TAX] 8% State Surcha 5/26/2005 $5.00
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 -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: � / Permittee Signature: ..., A
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.
l
Fire Protection System
Building Permit Application FOR OFFICE USE ONLY
g
City of Tigard , GE II�J j Received
City DateBy3 U� � Perini[ No �I��D OD / 1
13125 SW Hall Blvd., Tigard, OR 1 9 6 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 , ,- loo ,n y4 K° ,i Date/By: Other Permit:
Inspection Line: 503.639.4175 \..N b.. r✓ y. r'f I. Date Ready/Sy: Jura. r E3 See Page 2 for
Internet: www.ci.tigard.or.us r T1p� Notified/Method: � V Supplemental Information
OW( LNG- C0.3� °�
'� 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.
❑ 1- and 2- family dwelling Commercial /industrial
Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION : . , _ . Total number of floors:
Job site address: /51 (s go- 72Na ,4,/r S u / i /0a New dwelling area: square feet
_City/State/ZIP: 17411-740 / D/ 9783 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: r: A1015/1 Covered porch area: square feet
Cross street/directions to job site: ?Zab 1 e /Lft .h72 , Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: 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
• /2r fi l Al DESCRIPTION OF WORK d 2 / work indicated on this application.
El o � 0 ,X rsilN 4 k N�& Valuation: $ 69)—
r - -7 , ,s Ariz_ Fr Existing building area: square feet
V, New building area: square feet
❑ PROPERTY OWNER-. ' 't''TENANT Number of stories:
Name: `r_ AO / ` Type of construction:
Address: / !'g - 't t) 7Z"4 kte Occupancy groups:
City/State/ZIP: / /G4a f 0A ( 17Z23 Existing:
Phone: ( ) Fax: ( ) New:
.1X APPLICANT ❑ CONTACT PERSON .NOTICE
Business name: F 2E rW 1' CO. All contractors and subcontractors are required to be
Contact name: 5QI( (r .0-0m) licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 700-t C1,0-4 ✓7,4Qf ' ili ST , jurisdiction in which work is being performed. If the
City/ State/ZIP: V7to /M0 0 9 7223 applicant is exempt from licensing, the following reasons
,/ i apply:
Phone: (r 3) (,20 _ 4/ 40 Fax:: ( 03) 6204/4/
E -mail:
CONTRACTOR ,
Business name: , / fp�0 � - •
' � � � , , Y� '�• BUILDING PERMIT 'FEES *,
Address: 4/341/0- refer to fee schedule.
City/ State/ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
CCB lic.: 6,3g4 Amount received
Date received:
Authorized signature- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: f uer- e , /With J Date: r ,Sior * Fee methodology set by Tri-County Building Industry
/ !! Service Board.
i:\Building\Permits \FPS- PermitApp.doc 12/03 440- 4613T(11 /02/COM/WEB)
Fire Protection Permit Check List
Describe , work to be done
1.) ❑ New 2.) odification to sprinkler heads only:
El Addition a• 1 -10 heads: No plan review required.
Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
kE(oekir 4- s
. Type of System (Complete A, B, C or D as applicable):
A.)'' Commercial Sprinkler • •
a Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density o /
Design Area l S
K. Factor •
Sprinkler Project Valuation: $ (0g0 e0
"B.):.-Type I Hood Fire 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(S tand,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: sq. ft.
Project Valuation Subtotal (A, B & C): $
Permit fee based on valuation (see attached chart): $
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $
FLS Plan Review 40% of Permit Fee: $
TOTAL: $
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.
i:\ Building\Forms\FPSchecklist.doc 12/24/03
C1TY-.OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: BUP200S -00219
Phone: (503) 639 -4171 ����4���i 5!26/2005
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
6/1/2005 7:15AM 15
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 15895 SW 72ND AVE BLDG B 100 LOT #: TYPE OF USE:
PROJECT NAME: FANNO CREEK ACRE TRACTS 040
DESCRIPTION: T- MOBILE
Relocate (4) sprinkler heads.
OWNER: PHONE #:
CONTRACTOR: PACIFIC REALTY ASSOCIATES, PHONE #: 503.624 -6300
FIRESTOP CO 503-620.6140
Inspection Request Scheduled For: Date: Pour Time:
6/1/2005
Code # Inspection Description Confirm # Contact # Message
999 Sprinkler final 008107 -01 503-320-8601 Y
Corrections /Comments /Instructions: 5--trotE.
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIO AL ; ES SESSED
Inspector: /
p \ Date: ✓ Z 6 one #: (503) 718 -