Permit I
A ' CITY OF T I G A R D BUILDING PERMIT
PERMIT #: BUP1999 -00403
4 I I DEVELOPMENT SERVICES DATE ISSUED: 09/15/1999
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S110BB -RED03
SITE ADDRESS: 14111 SW 120TH PL
SUBDIVISION: REDWOOD VISTA ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: 5: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,400.00
Remarks: Add fire sprinkler system.
Owner: Contractor:
FOUR D CONSTRUCTION GRINNELL FIRE PROTECTION
PO BOX 1577 GRINNELL CORP
BEAVERTON, OR 97075 5921 N MARINE DR
Phone: P p Phone N 9 0u 8 V203
Reg #: LIC 000632
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough -In
PRMT GEO 09/10/199c $59.25 99- 318246 Sprinkler Final
5PCT GEO 09/10/199E $4.15 99- 318246
FIRE GEO 09/10/199c $23.70 99- 318246 t r
Total $87.10 ORIGINAL
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 direct questions to OUNC by calling (503) 246 -1987.
S n itee h _� yVv
Signature: � � I�Cl�L7� (� -
Issued By: VI
Call 639 -4175 by 7 p.m. for an inspection the next business day
Fire Protection Permit Application Plan Check# 0 " 2-44 le
CITY OF TI.IGARD Commercial or Residential Recd By
13125 SW HALL BLVD. Date Recd - it , - T7
TIGARD, OR 97223 Print or Type Date to P.E. 9 -/6-9
(5 , 639 -4171, x. 304 Incomplete or illegible applications will not be accepted Date to DST Q ( 3— o f AP
Permit # 16)11 a 'Jfff= tSh3
_ I C Called
Job Name of Development/Project Type of System (Complete A or B as applicable)
i-or ot 3 laisipewee
Address Address h, A Sprinkler e
Jylll Sbil 120 ?L A.) Wt Dry ry ❑
Name Standpipes
FOUr "D CON ST (Z•u.cTlON NO
Owner Mailing Address Hazard Group
1 ?-0. -06 \ cl l Additional 13 p
City/State Zip Phone Information Density
Ti f://4'0'0, Da. C (1015 _540 -°505 i 0 L n
Name Design Area Z S? ll-k VVIE# O
Occupant Mailing Address K. Factor
L A- Z
City/State Zip Phone A.1) Sprinkler Project Valuation $ 7.`A 0 0
Contractor Name B.) Fire Alarm
(Sprinkler or 4w OE CL ca.( 1ro4>Et.Ti an/
Alarm Company) Mailing Address Submittal Shall Include Battery Calculations YES ❑
Prior to permit S12.-1 N • ri pt21 ••t t P.
issuance, a ity/State Zip Phone 6c--5) Individual Component YES 0
co py V o rrt,ar o , OIL- Cut Sheets
of all licenses On 1..1* 7 Fi re Alarm Project Valuation $
are required if State Const Cont. Board Lic.# Exp. Date
exoired in COT
_ 'abase 6324'5 3- J `1 -00 Project Valuation Subtotal (A & or B) $ 2 y, 00
Name Permit fee based on valuation $
s 7,5
(see chart on back)
Architect Mailing Address
5% Surcharge $ ,_I , )
City /State Zip Phone FLS Plan Review 40% of Permit $
a 3 , 1 0
Describe work A.) New 1( Addition 0 Alteration 0 Repair 0 TOTAL $
to be done: $1 , ( U
B.) Modification to sprinkler heads only:
1. 1 -10 heads= No plans required Plans required: Submit three sets of plans, including a vicinity map and
2. 11 += Plan review required the location of the nearest hydrant.
I hereby acknowledge that I have read this application, that the information given is
Number of sprinkler heads: '3 0 correct. that I am the owner or authorized agent of the owner, and that plans submitted
are in compliance with Oregon State laws.
Additional Description of Work
,mss % PON , , Ac.. / 3 O 5--/ 5
Si ature of Owner /Agent Date
A.) In Existing Budding ❑ New Building X 4
Building C o n t a c t rwn Name Phone
Data B.) Commercial ❑ Residential ° rJ h 1, - 2-0 - go b&
FOR OFFICE USE ONLY:
Plat # M ap/ TL#:
No. of stories: 3 ,
Sq. Ft 3 zoo Notes o� / /dj 3'
•
Occupancy Class Type oConstruction
N
is \tiresupr.doc
CITY OF TIGARD BUILDING INSPL DIVISION MST
24 - Hour Inspection Line: 639 -4175 Business Line: 639 - 4171
/� BUP 19 J l 01 0
Date Requested 10/11o0 AM PM BLD
Location I GI III 17 P(, Suite � MEC
Contact Person Ph '2.05 PLM
Contractor Ph SWR
�BC1iLDIN� Tenant/Owner ELC
` RETammg Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing - i°a.c7,
Insulation
Drywall Nailing
Firewajl
Fire Sprinkler
ire
Susp'd Ceiling
Roof
Misc:
ri r• 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 C-/ Q Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
j 1 2 6 L 3
ZU /� /��9G - oCx/o3 NEW
• 1 4% - " .
PNws_AW WA BACKFLOW ASSEMBLY TEST REPORT 0 REMOVED
ED
il PROPERTY ❑ REPLACEMENT
i OWNER: 1_/ ,�. CO �.� I t/G I � e v PHONE:
J
1 MAILING
ADDRESS: / `,fir -( , C " k ' / _ 7 7
CITY G cu vC- -- C Lam- STATE d' • ZIP 9 : C / \
i. ASSEMBLY (
ADDRESS: � /(/ 5 1 Lc+ wZ 1i c t L` 7) c . �-oT3
STREET
❑ R.P.B.A. ❑ D.C.V.A. ❑ R.P.D.A. ❑ D.C.D.4. ❑ P.V.B.A. ❑ S.V.B.A. ❑ A.V.B. ❑ AIR GAP
,. WATER SIZE: I I /1.1 MAKE: /././/,t / / / /,c Hs MODEL: , c' ! :'/1/ ( 1 SERIAL
PURVEYOR: `T'_3 <:d ti, NUMBER: / ' Z ''' 7
ASSEMBLY , j /
LOCATION: ,[` t.5c ;. 1 �a,, - S
i
REDUCED PRESSURE ASSEMBLY P.V.B.A. / S.V.B.A. INITIAL TEST
I' NI CHECK I DOUBLE CHECK s AIR CHECK PASSED ❑
PRESS DROP (A l CHECK #1 INLET FAILED ❑
INITIAL RELIEF VALVE cy O PENED AT: PRESS DROP
OPENED AT (B)ITIGIIT Qfl ( DATE:
TEST
MIN 2 PSID LEAKED ❑ PSIU
RESULTS I 7 / /( 1 �
BUFFER PSID PSID
A - B = I CHECK #2
MIN 3 PSI
RELIEF VALVE ITIGHT ® 7 / DID NOT FAILED SYSTEM
PASS ❑ FAIL ❑ 'LEAKED �D OPEN ❑ ❑ PSI
COMMENTS
REPAIRS
AND / OR
PARTS
REDUCED PRESSURE ASSEMBLY P.V.B.A. /S.V.B.A. AFTER REPAIRS
MI CHECK %' D.C.V.A. -'
TEST PRESS DROP (A) CHECK #1 DATE:
RELIEF I OPENED AT PRESS DROP
AFTER OPENED (B) TIGHT PS ID / /
REPAIRS MIN'°M I
BUFFER CHECK #2
A- e- .mu.a I TIGHT ❑ PSID PSID PSID PASSED ❑
IN COMPLETING AND SUBMITTING THIS TEST REPORT, THE TESTER CERTIFIES THAT THE
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
RULES AND REGULATIONS ,QF THE WATER SYSTEM, AND STATE REGULATIONS.
GAUGE CAL RAT A)' ` METER. READING
{ 1 SIGNATURE Vt
T1�7M ��. , CTL. -
T�T�S NAME PRINTED W GAUGE I
1 7ESIE ml Or, Portland, OR 9 5 0 _ PHONE I
COM P T9fectlpry / / 3 289 yU90
/ / -'r l9 ' /=, C1.r 4' t,- 'SERVICE RESTORED
REPORT RECEIVED BY: (REPRESENTATIVE OF OWNER)
CITY OF TIGARD BUILDING INSPECTION DIVISION MST Ng 9 — 0U 1 .5?
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP 19 ( 4 0 3
Date Requested ��,, - S /S/ 00 AM PM BLD
Location I 9I1 I (�� (w` '� / r Suite MEC
Contact Person I9&A) Ph - 710 - 7 ( 1 6 6 PLM
Contractor Ph SWR
ttJILbIN Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation K I
l FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Drywall on CP0// 4k ,fiZ'v/// n q /a/zitoi Drywall Nailing �S
Fire wall
Fire Sprinkler [4c4 /�`
U / 775C r o x-{ G/4 it
Fire Alarm
Susp'd Ceiling t .---e' 7 • L / se 4/
�
Roof ---
Misc: — %� c--„, : - 1 - - # I
na
PASS PART CO
PLUMBING •12- 7nave q// e9'Gea laaja2,D . Se-ecra
Post & Beam /^
Under Slab 74Z 1 Si* d!L.e 2 e� (e e y `,
Top Out ``''
Water Service ?C), ., ' r �N v�� e/A.r 7 7 / ,2 >P son e),,/ P 1-
Sanitary Sewer
Rain Drains �-
F PASS PART FAIL i SAC Oi.! 4 „. ..- I C / I
C littietS 11 Pos A....... Rough In /e_ CO k r C L� Gas Line
Smoke Dampers
PART FAIL
RICAL
Service A-1. - c v1- O
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final •-/
PASS P ART 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 I se a call for reinspection RE: /(.(k f- [ ] Unable to inspect - no access
ADA _ 7o' /
Approach /Sidewalk Date S
b Inspector 7 jki Ext
Other
Final
L . PASS PART FAIL DO NOT REMOVE this inspection record from the job site.