Permit •
•
.._..:_:.
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00248
l � i�;� DEVELOPMENT SERVICES DATE ISSUED: 6/21/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S113AD -01800
SITE ADDRESS: 16650 SW 72ND AVE B -12
SUBDIVISION: OREGON BUSINESS PARK I ZONING: I -L
BLOCK: LOT: 011 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: $ 1,728.00
Remarks: Alteration of (15) fire sprinkler heads for TI
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
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 5/27/2004 $62.50 Sprinkler Final
[TAX] 8% State Surchar1 5/27/2004 $5.00
[FLS] FLS Pln Rv 5/27/2004 $25.00
Total $92.50
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
calli n 03) 246 -. • 99 or 1- 800 - 23
Issu d B _• I, . - Ca .
:
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Permittee
Signature: � r , li C �jc �L/1L,'
Call 639 -4175 by 7 p.m. for an in a ction the next business day
/40 CrO o r' 4.L"1
Fire Protection System.
s&-'
, Building P ermit Application FOR OFFICE USE ONLY
City of Tigard D R a` e /B ved _ /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 kotid �' '` DateB : 6 - • - J'.f A Other Permit:
Inspection Line: 503.639.4{, E CE'VED 3.:-_,14 F Date Ready/By: lure See Page 2 for
S
Internet: www.ci.tigard.or. Notified/Method: Supplemental information
MAY . BiO'oRK REQUIRED DATA: 1- AND 2- FAMILY DWELLING s
❑ New construction • Demolition Permit fees* are based on the value of the work performed.
�� �� Indicate the value (rounded to the nearest dollar) of all op
E. ddition/alteration/repla 3 r�1�� 'waltz Other: equipment, materials, labor, overhead, and the profit for the d
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: C
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 LOCQ ‘-. 7 6 7. 1 ,\J � New dwelling area: square feet
City/State/Z � 97 11. - `"/ I Garage/carport area: square feet
s •
n C J • Suite/bldg. /apt. n. ,!t i , Project name: A d �� .. _ Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECICLIST /
Subdivision: I 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.
A N 's Id 1 ft ( I - I r Valuation: $ / 7 a g
(Ts S Existing building area: square feet
LIZ
New building area: square feet
❑ PROPERTY OWNER I e g TENANT Number of stories:
Name: Type of construction:
Address: 1 3 7 ()__ Occupancy groups:
City/ State/ZIP: 4f l�� eye 7 2„,9 3 Existing:
�� J
Phone: ( ) LFax: ( ) New:
%APPLICANT ❑ CONTACT PERSON NOTICE
Business name: _ f All contractors and subcontractors are required to be
Contact name: n licensed with the Oregon Construction Contractors Board
'I / under ORS 701 and maybe required to be licensed in the
Address: Q e �• jurisdiction in which work is being performed. If the
City/State/ZIP: - ) t- �"7 d � � f [
apply:
is exempt from licensing, the following reasons
l pPy:
d pi Phone• ( .44 . � e, — r . r Fax:: ('1 _ • __;16 MAN
E -mail:
CONTRACTOR
Business name: (1c1... ' � ` � ,] /}� BUILDING PERMIT FEES*
Address: /447
1 S ( W C 7c,tt V \L
y � (j Please refer to fee sch e e
City/State/ZIP: +�-k /� 7 � � /
(o ``��� �� ��C./14.0 J i ^ � Fees due upon application 1 9 �
Phone: ) r Fax: d ) ....e., ^ � 4 ( - 7
Amount received
CCB lic.: ` .
Date received:
Authorized signature: 1 �� This permit application expires if a permit is not obtained
j54C (� within 180 days after it has been accepted as complete.
Print name: . `�"a I „/) �t Date: s(�� / * Fee methdology set by Tri-County Building Industry
l 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.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration X11+ heads: Plan review required.
❑ Repair f s -
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Wet ❑ Dry
Additional Standpipes
•
Information: Hazard Group
Density •
Design Area •
K. Factor
Sprinkler Project Valuation: $ 1'7 2- 8
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: $
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: $ 01. SQ
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
CITY OF TIGARD 24 -Hour
BUILDING • Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP -ODa
Received Date Requested 7 � J 4 P AM PM BUP
Location c ` ' d Suite MEC
Contact Person Ph ( ) Z. 1 6 6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire
• )
ire arm m, j
Susp'd Ceiling --
Roof
Other:
• PART FAIL
• = ING
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 -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In ■11101 • I 1 � �.. 1
Low Vot Voltage
ANIMIEGIEMil
Fire Alarm NOW
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL