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Permit CITY OF TIGARD BUILDING PERMIT PERMIT #: BUP2000 -00258 DEVELOPMENT SERVICES DATE ISSUED: 7/5/00 _ - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15705 SW 116TH AVE PARCEL: 2S110CD 07600 SUBDIVISION: KING CITY NO. 2 ZONING: BLOCK: LOT: JURISDICTION: KIN REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: DEM 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: M TOTAL AREA: 0.00 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: $ 8,000.00 Remarks: DEMOLITION OF EXISTING INTERIOR PARTITIONS - NON STRUCTURAL. Owner: Contractor: TOBIAS INVESTMENT CO THE FRANKLIN CORP 300 SE SPOKANE ST A CORP OF WASHINGTON PORTLAND, OR 97202 805 W ORCHARD STE 8 Phone: BPnone 360= 733- /Zu� Reg #: FEES REQUIRED INSPECTIONS Type By Date Amount Receipt Final Inspection PRMT DEB 7/5/00 $105.50 003464 N\-- SPOT DEB 7/5/00 $8.44 003464 `� � Total $113.94 () This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -1987. You may obtain a copy of these rules or dir= f •uestions to OUNC by calling (503) 246 -1987. S m ite Signature: _ ;� igr / / /� / S j G � 77 �� Issued By: 1 •.$ , � Call 639 -4175 by 7 p.m. for an inspection the next business day ICY O_TIGARD Commercial Building Permit Application Plan Check 3125 SW HALL BLVD. Tenant Improvement o e R s# 7 . 1GARD, OR 97,223 to P.E. 503) 6394171 r � (w Date to DST `7� Print or Type (Lit Permit# lxl(�`Y�'/1� ti Related SWR # Incomplete or illegible applications will not be accepted Called Name of Development/Project Existing Building ❑ New Building ❑ Job 64,c4 (3vrL —r Address Street Address Suite Building /.S s. /, //677�m Data Bldg # City /State Zip Existing Use of Building or Property: �y6 /rY 977y %)G 21c��y Name Proposed Use of Building or Property: Property 73 1570 ,s //jvb r/srar/vr GU Owner Mailing Address Suite , � / 797e ( 72-.ec 9f / X oo S.kr. SPUGRAi c57:- No. Of Stories: City /State Zip Phone ($03) / 2' ' 9,OC,: 97200 ZZ3. ZOZ 9 Sq. Ft. Of Project: Name / ,J 7 6 N a� z / 7 Occupant 62.1G e vr4--T Occupancy Class(es) � Name / v/ Contractor 777 - , be--1-14) lid -# Type(s) of Construction Prior to permit Mailing Address Suite 7, _N (07APA/6) issuance, a copy g� lid . O�/lR�O �Q. S?�'• #cj Will this project have a Fire Suppression System? of all licenses Yes kl4 No ❑ are required if City /State Zip 9E12Z.s Phone 36c) Americans with Di abilities Act (ADA) expired in C.O.T..4//,z,,,,yym, W� database - 7". 77 Valuation X 25% = $ - Participation Oregon Const. Cont. Board Lic.# Exp. Date Complete Accessibility Form /2O( 86 Z /Z7 /O/ Project $ �� Name Valuation ZS ,1°C) Architect 4cft1 - (0 /� tf/lEGT Plans Required: See for number of sets to submit Mailing Address Suite /6 Av. ji, a,V /,, e,,5?) City /State Zip Phone ?Z.s. I hereby acknowledge that I have read this application, that the information given is correct, that I am the owner or authorized agent of the owner, and (j of GA'Ai ; G /9• ,y. SysO that plans submitted are in compliance with Oregon State Laws. Engineer Name Signature o r /Agent Date Mailing Address Suite - - , • 00 C nta Z erso Name Phone City /State Zip Phone (6:71/ (•97 !2-� • °J7 ‘577.5-6 FOR OFFICE USE ONLY Indicate type of work: New 0 Addition 0 Demolition O Map/TL# - f Land Use: Accessory Structure 0 Foundation Only 0 Alteration 0 Repair 0 Other O Notes: Description of work: 7 Qrs�70 O/ &:rxAs 7I"& .1' 49� TIF: f —• /VOA/ cr-e v c-r-a �-e___ ` 6� Note: Site Work Permit Application must precede or accompany Building f OS- e/ y Permit Application ` I.\COMNEWTI.DOC (DST) 5/98 I 1 I Date Rec'd: CITY OF TIGARD Rec'd By: COMMERCIAL TENANT IMPROVEMENT APPLICATION /PLANS SUBMITTAL REQUIREMENTS Applicants: Please complete APPLICANT 1. APPLICANT NAME: PHONE #: 2. SITE ADDRESS: FAX # • 1. SITE PLAN (Fully dimensional, drawn to scale) labeled with: ❑ map & tax lot #, ❑ project name, ❑ site address, ❑ site number, ❑ zoning, ❑ applicant name, ❑ phone number. A. North Arrow B. Scale (any standard, architectural or engineering only) C. Street Names 2. See the matrix on back of application for number of plans required based on submittal type (no redlines or tapeons accepted). SIZE REQUIREMENTS: 24" X 36" (ROLLED) ALL DETAILS LISTED BELOW SHALL BE INCORPORATED INTO THE PLANS A. Floor plan(s) B. Wall details C. Reflective ceiling plan D. Seismic bracing detail for suspended ceiling E. Specifications & calculations F. ADA barrier removal worksheet G. Deposit - based on valuation of project - \dsts\forms\comtiapp.doc 10/30/98 . .. , IA/ KING CITY 15300 S.W. 116th Avenue, King City, Oregon 97224 -2693 Im■iiimm Phone: (503) 639 -4082 • FAX (503) 639 -3771 Notice To Contractors Working In King City Due to an intergovernmental agreement with the City of Tigard, many building related permits for projects in King City are issued and inspected by the City of Tigard. If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the appropriate application legibly and submit it to the King City staff. The King City staff will collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create the permit, issue the permit, and perform inspections. Please indicate on the permit application whether you would like the Tigard staff to call you when the permit is ready for issuance or whether you prefer it to be mailed without any notification. Any incomplete or illegible application will be returned to King City staff for correction and no processing will occur until a complete, legible application is received. If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a King City staff person. King City staff will simply sign this form indicating land use approval. Take this signed form to the City of Tigard Development Services Counter located at 13125 SW Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are available at 639 -4171 Ext. 304 should you have any questions concerning submittal requirements. All permit fees will be assessed and collected at the City of Tigard. The City of King. City hereby authorizes applicant to pursue permits at the City of Tigard Building Department for the following project: 6).41 s-at t L_ located at: 15903 St.,3 iii0-61\ p ._,,,,., ..b, King City Representative U '- s I DSTS\XCUNST DOC flE 2c00 c 3.3� •- REFRIGERATION CONTRACTORS INC. Temperature Controlled Systems/General Contractors 5031257 -8668 - FAX 503!255.4581 Sales Office: Mailing: 17246 NE San Rafael PO. Box 661 Portland Or 97230 Gresham Or 97030 September 28, 2000 Rick Bolen, Ext 319 City Of Tigard Development Services 13125 SW Hall Blvd Tigard OR 97223 RE: Letter of Declaration or Refrigeration work at the Grocery Outlet — King City Store As per our discussion the following is my letter of declaration on Refrigeration work at the Grocery Outlet — King City Store located at 15705 SW 116 Ave, King City OR. Scott R Worthington, due here by declare by way of this letter that I have met or exceeded the requirements set forth for the pressure testing of the refrigeration piping as set forth in Chapter 11 of the Mechanical Code. For our testing process we used nitrogen and tested the piping, both low and high, at 400 lbs. PSIG for a minimum cf 24 hours. The refrigerant used within this system is R -404A (Pentafiuoroethane,,1, 1 1,Trifluoroethane, 1, 1, 1 2 — Tetraflucroethanel • On 8/18/00 — The Underground piping for System A -4 & A-5 were tested and inspected the pressure in the piping was 400 lbs and was maintained within the piping until the additional overhead piping was connected to the portion of piping On 911800 — The overhead piping, the refrigeration unit. discharge piping and the eases for System A -1 a & b. was pressurized to 400 lbs with dry nitrogen. After this system passed our tests, we called for and had an inspection done by your office, having passed both inspections we then removed the nitrogen and evacuated the system and charged the unit with 65 lbs R -404A and started system. On 911800 — The overhead piping, the refrigeration unit, discharge piping and the cases for System A -2 was pressurized to 400 lbs with dry nitrogen. After this system passed our tests we called for and had an inspection done by your office, having passed both inspections we then removed the nitrogen and evacuated the system and charged the unit with 100 lbs R -404A and started system On 911800 — The overhead piping, the refrigeration unit, discharge piping and the cases for System A -3 was pressurized to 400 lbs with dry nitrogen. After this system passed our tests we called for and nad an inspection dore by your office, having passed both inspections we then removed the nitrogen and evacuated the system and charged the unit with 100 lbs R -404A and started system On 9/19100 — The overhead piping, the refrigeration unit, discharge piping and the cases for System A-4 was pressurized to 400 lbs with dry nitrogen. After this system passed our tests, we called for and had an inspection done by your office, having passed both inspections we then removed the nitrogen and evacuated the system and charged the unit with 140 lbs R -404A and started system ;_ . 1. - On 9/19/00 — The overhead piping, the refrigeration unit and discharge piping for System A -5 was pressurized to 400 Ibs with dry nitrogen. After this system passed our tests, we called for and had an inspection done by your office, having passed both inspections we then lowered the nitrogen pressure in the system to 125 lbs as the line -up of cases was deleted for the time being and may still be added at a future date. The unit will be left with the nitrogen holding charge, the unit is not wired electrically and cannot be accidentally started, however the unit is labeled with the holding chare and the date it was pressurized By my signature below I am stating that the information given above is true and factual 1L September 28, 2000 _ Scott R Worthington Date Project Manager Refrigeration Contractors, Inc. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 '1 Z — O / BUP Date Requested // AM' PM BLD Location / 70 S� ' k.l 11 :' Suite MEC Contact Person Ph PLM Contractor Ph SWR Tenant/Owner ZIC - ELC Retaining Wall ELR Footing Acces . Foundation `' _ /� FPS Ftg Drain t( }�hQ� A - SGN Crawl Drain Ins ion s Slab 17 SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear /� �1 /ten ^7 Framing 4244 oho — D arr D � ) Insulation Drywall Nailing 13u , AM r'v V' Fire wall ,- ,/ ‘731,0 , ID '36 / FP Fire Sprinkler 1 Fire Alarm Susp'd Ceiling Roof Misc: ��Finar) ' PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date (2/(( Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION I'i(bur Inspection Line: 639 -4175 Business Li e: 6 =-4171 MST /� Date Requested 6 1/ 1-1 / £ lo PM BLD Location I X70 } ii' , ''- A14 Suite • r - &Ad 3.3( Contact Person it Ph 2i 7 — "4 a PLM Contractor Ph SWR BUILDING Tenant/Owner a ro w_f:, 6 2 -1,2. ELC Retaining Wall -- ELR Footing Access: Foundation FPS C l Drain ✓` � SGN Crawl Drain Inspection Notes: VCJ�, Slab SIT Post & Beam Ext Sheath /Shear 1 Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING (/ Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL host eam Rough In Gas Line Smoke Dampers 44p . ART FAIL ICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA l r, Otheoach /Sidewalk Date l 6 u Inspector Ext 7 Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.