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Permit ., F. 4,, CITY OF TIGARD PERMIT PERMIT #: BUP2003 -00284 -1 1 DEVELOPMENT SERVICES DATE ISSUED: 5/20/03 13125 SW Hall Blv Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112DD -00400 SITE ADDRESS: 15946 SW 72ND AVE PRV17 SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L BLOCK: LOT: 017 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 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: $ 200.00 Remarks: Relocate (2) sprinkler heads for TI Owner: Contractor: KAUFMAN, LOTTIE L + FIRESTOP CO SUBOTNICK, RUTH ET AL 9384 SW TIGARD ST BY PACIFIC REALTY ASSOCIATES TIGARD, OR 97223 PORTLAND, OR 97224 Phone: Phone: 620 -6140 Reg #: LIC 63846 FEES REQUIRED INSPECTIONS Description Date Amount Sprinkler Rough -In [BUILD] Permit Fee 5/20/03 $62.50 Sprinkler Final [TAX] 8% State Tax 5/20/03 $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 • e : - e • h OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by calli .2 23 i - # 503) 246 -669' or 1- 800 - 332 -44. / i, a i, Permittee c--, , Signature: // 2,_,, /11 ∎ L_st • r ' Ca ,19 -4175 by 7 p.m. for an inspection the next business day il Fire Protection System • FOR OFFICE USE ONLY Building Permit Application Received Building o?O o� D Date/By: PermitNo.: t(1�1J0'j'l'j1�4 g Cl of Tigard Planning Approval Other g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 - - "- ': i i- Post - Review Land Use f I Internet: www.ci.tigard.or.us '' Date/By: Case No. Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 Name /Method: _ Supplemental Information TYPE OF WORK REQUIRED DATA: ❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING IL Addition/alteration /replacement ❑ Other: CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate ❑ 1 & 2- Family dwelling ® Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi- Family ❑ Master Builder ❑ Other: Valuation $ JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths: Job site address: f 5q' i 5i,t) Ead AU-e.h LL,Q, Total number of floors New dwelling area (sq. ft.) Suite #: kid . Apt. #: 17 Garage /carport area (sq. ft.) Project Name: 30 c & `J ei2 { [j34 , ► G Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) 0 (a .gDY) 6 U 5 t.rkk s Pale.. I Other structure area (sq. ft.) REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: 1 Lot #: Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. Valuation $ ZOO 92 Existing building area (sq. ft.) New building area (sq. ft.) Number of stories $I PROPERTY OWNER 1 ❑ TENANT Type of construction Name: PA C-T2 LLST Occupancy group(s): Existing: New: Address: 15350 sh) sett l I A PAPtuALI ii 3no City /State /Zip: Pb2TC. , 012. '1 Phone (r) (&i4- 63b 0 Fa(`, )024 -7 '7 S S NOTICE: All contractors and subcontractors are required to be [� APPL CANT ❑ CONTACT PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Name: F 112 STD P C.n_ jurisdiction where work is being performed. If the applicant is exempt Contact Name: 13e_t.1cp P from licensing, the following reason applies: Address: q 3 (14 Svc) -[ (F,4 jJ) &I , City /State /Zip: '! ©p___, q ? 2 3 Phone:( j ) ( - l4 D Fax: (S(p) 620- ( BUILDING PERMIT FEES* E -mail: — Please refer to fee schedule. CONTRACTOR Business Name: pi 2E�'`1 bP C.D • Fees due upon application $ 67 So Address: 6 1 "NA 5( T(C b - City/State /Zip: - e_b o--- ql2 . Amount received $ Phoney) 62D- L (UD Fax: O (,2(3' 10 ( I Date received: CCB Lic. #: (,3gt( J Authorized — r Notice: This permit application expires if a permit is not obtained within Signature: / / /.L� �� .� . � 1 Dater 180 days after it has been accepted as complete. 7 F ' S J ZF71 DR .r *Fee methodology set by Tri -County Building Industry Service Board. Please print name) i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 Fire Protection Permit Check List A.) LI New Li Addition I1Alteration Li 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: vt 1 b C()11 -e 2 °,502.. ko Additional description of work: 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: $ 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): $ 2o0 vu Permit fee based on valuation (see chart): $ ( 8% State Surcharge: $ 6°9- FLS Plan Review 40% of Permit: $ TOTAL: $ (e 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