Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00543
� i �� DEVELOPMENT SERVICES DATE ISSUED: 12/3/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S113AB -00101
SITE ADDRESS: 16101 SW 72ND AVE BLDG A -200
SUBDIVISION: ZONING: IP
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 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: $ 2,963.00
Remarks: Relocate (23) sprinkler heads & add (8).
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: 503- 624 -6300
Phone: 620 -4020
Reg #: LIC 64174
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 11/16/2004 $72.10 Sprinkler Final
[TAX] 8% State Surcharl 11/16/2004 $5.77
[FLS] FLS Pln Rv 11/16/2004 $28.84
Total $106.71
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: . ,.j . t . 4 1 / C %l ASI( .
CaII 639 -4175 by 7 p.m. for an inspection the next business day
/4/0/ f6' 7 tP
Fir Protection System
Qv�I- c url
Ituilding PermifApplication FOR OFFICE USE ONLY
City of Tigard
A Daced )/, ! _ v / Permit No 4y dU
13125 SW Hall Blvd., Tigard, OR 97223 P1. R 1 , 0 ,'
Phone: 503.639.4171 Fax: 503.598.1960 's ''� Other Permit: ..
iii' Date/B : �'1 %' / j��
Inspection Line: 503.639.4175 '' Date ReadyBy: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: �/( Supplemental Information
TYPE 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.
1:3 I - and 2- family dwelling ® Commercial /industrial Valuation: $
1:1 Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 16101 SW 72nd Ave New dwelling area: square feet
City /State/ZIP: Portland, OR 97224 Garage/carport area: square feet
Suite/bldg. /apt. no.: 200 Project name: QualComm Covered porch area: square feet
t
Cross street/directions to job site: 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.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Relocate 23 sprinkler heads Valuation: $2,963.00
Addition of 8 Sprinkler heads Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ( ® TENANT Number of stories:
Name: QualComm Type of construction:
Address: 16101 SW 72nd Ave Occupancy groups:
City /State /ZIP: Portland, OR 97224 Existing:
Phone: ( ) Fax: ( ) New:
' ® APPLICANT ❑ CONTACT PERSON NOTICE
,
Business name: Delta Fire, Inc. All contractors and subcontractors are required to be
Contact name: John Murphy licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 14795 SW 72nd Ave jurisdiction in which work is being performed. If the
City /State /ZIP: Portland, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 620 -4020 Fax: : (503) 620 -1058
E -mail: johnm @deltafire.com
CONTRACTOR
Business name: Delta Fire, Inc. BUILDING PERMIT FEES*
Address: 14795 SW 72nd Ave
Please refer to fee schedule.
City /State/ZIP: Portland
Fees due upon application )c . 71c
Phone: (503) 620 -4020 Fax: (503) 620 -1058
Amount received
CCB lic.: 64174
Date received:
Authorized signature: 2// This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Jackie McCourtney Date: 11/10/04 * Fee methodology set by Tri-County Building Industry
Service Board.
i\ Building \Permits \FPS- PcrmitApp.doc 12103 440- 4613T(II /02/COM/WEB)
CITY :QF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / '24/ AM PM BUP
Location / r'P / D ( 7 71-L Suite ' a 6 0 MEC
Contact Person J�.c 2� Ph ( ) 6 Z6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ( --0 . ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
F
Fire Alarm
Susp'd Ceiling
Roof / I
rari MI War _
PART FAIL
• = ING "r . �
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -1n
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required b ore next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please 11 for rein • • ection RE: 0 Unable to inspect — no access
Fire Supply Line �� ADA Date _ ,! �� Insp ton NOR Ext
Approach/Sidewalk
Other:
Final DO OT REMOVE this Inspe - Ion record from the job site.
PASS PART FAIL