Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #:
#-: -�;1 ISSUED:
DEVELOPMENT SERVICES DATE 110/20 033 -00619
`� � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15985 SW 72ND AVE PARCEL: 2S111 DC -00701
SUBDIVISION: FANNO CREEK TRACTS 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: : sf N: S: E: W:
OCCUPANCY GRP: 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: $ 375.00
Remarks: Add one head and relocate one head
Owner: Contractor:
PACIFIC REALTY FIRESTOP CO
15350 SW SEQUOIA PKWY #300 9384 SW TIGARD ST
PORTLAND, OR 97224 TIGARD, OR 97223
Phone: 503 - 624 -3000
Phone: 620 -6140
Reg #: LIC 63846
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 10/20/03 $62.50 Sprinkler Final
[TAX] 8% State Tax 10/20/03 $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 -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: 1—' i -
1
Permittee
Signature: leg a `
Call 639 -4175 by 7 p.m. for an inspection the next business day
Fire Protection System
Building Permit Application FOR OFFICE O
Received Building USE
Date/B : f .
O' a o 03 /u A Pe No.' � ._ / - o r 0
.
City of Tigard Planning Approval Other /
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 d �iltj�i'I � Date/By: Case Noe
w
Internet ww.ci.rigard.or.us -- Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: _ Supplemental Information
TYPE OF WORK REQUIRED DATA:
6 ( New construction 0 Demolition 1 & 2 FAMILY DWELLING
Addition/alteration/replacement El 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: / sq g 5 S GU - .72 N 4 E • Total number of floors
New dwelling area (sq. ft.)
Suite #: B1 g. /Apt. #: Garage /carport area (sq. ft.)
Project Name: r'j4 -LOA/ / Act Re Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
7 VII 4 JMi /3-F kb, 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,
f DA i Cat n1/ _ - IPEL0N i overhead and profit for the work indicated on this application.
A f 'C /' // ` �� [� a l�'c A
$ .3 1 5 ov
(4Oi2tA)Kl o2 Wl e ,4 170g Valuation
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
0 PROPERTY OWNER I VS TENANT Type of construction
Name: ',4CoN /J4eir- e Occupancy group(s): Existing:
New:
Address: Wigs 4 W- .7 ZN?
City /State /Zip:
NOTICE: All contractors and subcontractors are required to be
Phone: Fax: licensed with the Oregon Construction Contractors Board under
0.APPLICANT _ gi CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: F' E,5Tc/ ('o • jurisdiction where work is being performed. If the applicant is exempt
Contact Name: Jj/z(,t ('E ,250/J from licensing, the following reason applies:
Address: 9384 g 1 /G 4 Yrr '
City /State /Zip: n 6 11 / O . 97773
Phone: (020 - (o 14 o Fax: (,2o - 614 BUILDING PERMIT FEES*
E -mail: Please refer to fee schedule.
CONTRACTOR
Business Name: F' f2 TbF CO • Fees due upon application $
Address:
City /State /Zip: Amount received $
Phone: 1 Fax: Date received:
CCB Lic. #: G3$4 (
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: '' � - . — + 1CU11 / - Date: � ��7�0 3 180 days after it has been accepted as complete.
73 PU Ct b. ?E4i 2 �ON *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03 .
•
Fire Protection Permit Check List
Describe work to be done:
A.) LI New B.) Modification to sprinkler heads only:
❑ Addition IS 1 -10 heads: No plan review required.
tat Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
igvkis 0(0e4-rt 1 kir
Type of System (Comillete A, B, C or D as applicable):
A.) Commercial Sprinkler
Wet ]S Dry ❑
Additional Standpipes
Information: Hazard Group
Density 'iv
Design Area (5
K. Factor . � (e
Sprinkler Project Valuation: $ .Z75oo
B.) Type 1- Hood Fire Suppression System
Hood Project Valuation: 1 $
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
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: 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:\dsts \forms \FPSchecklist.doc 02/28/03