Permit : C
A -- BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2002 -00455
6 ,ir e DEVELOPMENT SERVICES DATE ISSUED: 10/23/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S114A0 01500
SITE ADDRESS: 17005 SW 92ND AVENUE
SUBDIVISION: ZONING: R -12
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: 0.00 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: $ 1,500.00
Remarks: Restroom with concession stand - installation of Type I hood fire suppression.
Owner: Contractor:
TIGARD, CITY OF SANDERSON SAFETY SUPPLY CO.
13125 SW HALL 1101 SE 3RD AVE
TIGARD, OR 97223 PORTLAND, OR 97214 •
Phone: 238 -5700
Phone: 238 -5700
Reg #: MET 8 0 44 00 6 0 4 4715
FEES LIC REQUIRED INSPECTIONS
Description Date Amount Sprinkler Final
[BUILD] Permit Fee 10/16/02 $62.50
[TAX] 8% State Tax 10/16/02 $5.00
[FLS] FLS Pin Rv 10/16/02 $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
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: 44,12 - /..:."& ,
Pe mi ittee
Signature: ,pa a , A--
CaII 639 -4175 by 7 p.m. for an inspection the next business day
:ti ` D ZI o z • . ' ii Building PermitApplication . • P a55` ;.„.,
i � '" - *° ;,:��� � • �� Of Tlgai'(1 _ Date received: /p//5 Permit no bt� w
'1"t . .
City o Ti and
Address: '13125 Blvd, Tigard, OR 97223 ProJecdappl.no.: ,sedate:
ty f g Phone: (503) 639 - 4171 , . . Date issued: ; I By . i Receipt no.:
• Fax: (503) 598 -1960 ••-. • . - - Case file no.: Payment type:
Land use approval: - • ' 1 &2'family: Simple Complex:
.,a; TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory Ca Co mmercial/industrial' . Cl Multi - family _ construction ❑ Demolition
❑ Addition /alteration/replacement . - • D Tenant improvement.. ' 0•Fire,sprinkler /alarm O Other: �. �P , S� — #ie ��c� •
JOB SITE INFORMATION . - ` -
Job address ' .7.0o. : 5 .,. `- - . . . 4 ... Y -' Bldg. no.:• v Suite no.:
Lot: ° Block:- : ` , Subdivision: - -. `: - ' ' -:. • • ' • ' , . Tax map/tax • lot/account no.:
Project name: • - .. 0 K..., ,K . - - • - , . .
Descri•tion and location of work'on premise pecial condi 'ons: __. ' d L/ 71 " O -
a
OWNER . FOR SPECIAL INFORMATION, USE CHECKLIST
- ( Floodplain, septic capacity, solar, etc.)
Mailing address: • • - 1 & 2.fandly dwelling:
City: . ' - State: '' " ZIP: ' • ' - Valuation of work : $
Phone: Fax: . E-mail: - • No. of
Owner's representative: . . : - . Total . number of floors -
• Phone: ` Fax: ' - E-mail: New dwelling area (sq. ft.) •
- APPLICANT Garage/carport area (sq. ft.) !w
liffilligrinillifflififfillillMillill Covered porch area (sq. ft.)
Mailing address: /' .0/. . :F- .,� - ' . Deck area (sq. ft.)
1133111re alEMIIII® State: 0 / - ZIP: 7,, G� Other structure area (sq. ft.)
Phone: .,3 , - O Fax:.31(- 6ci43 E-mail: . . . , Commerclal/iindustrlal /multi - family: / 0 .
!
CONTRACTOR , - Valuation of work' $ 7 )0 0
Business name: .y - e . - Existing bldg. area (sq. ft )
Address: C.-- New. bldg. area (sq. ft.)
/ Number of stories
Et El • rjrim!simial
��� ZIP: '� -
T ype of construct
Phone: .2 V c>o0 Fax:2 V-6443 E-mail:
CCB no.: . L/ ( Occupancy group(s): Existing:
New:
City /metro lie. no.: C) p Q G 7/ - 5-- Notice: - All contractors and subcontractors are required to be
. ARCIIITECFIDESIGNER . licensed with the Oregon Construction Contractors Board under
Name: ' provisions of ORS 701 and may be required to be licensed in the
Address:• - jurisdiction where work is being performed. If the applicant is
Ci State: ZIP: exempt from licensing, the following reason applies:
ty : •
Contact person: - Plan no.: . .
Phone: Fax: E-mail: • ' -
• ENGINEER '` : " .. ,. F
Name: - Contact person:` ' .. Fees due upon application $ - . • S
Address: Date received: '
City: State: ZIP:. Amount received $
Phone: Fax: E-mail: - Please refer to fee schedule.
I hereby certify I have read and examined this application and the , Not all jurisdictions accept credit cards, please call Jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this . 0 Visa U MasterCard
work will be complied wi , w ether specified herein or not. ' Credit card number. /
Date:
(0 - C�)- -- Expires
Authorized signature: ,N-�' - -- Name of cardholder as shown on credit card
Print name: it/rc L_f Eo vv"-&s-- $
Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 44O -46t3 (&VOCOM)
REVISIO. 4 Q• IT WI PM GREENHECX SUPPLIED PARTS - INSTALLED
CHANGE ro sHrP LOOSE DIET COLLARS - OH , a QTY AN B DESCRIPTION
2002. 456440 0 419336 1W NOZZLE (1 FLOW)
456439 1 419335 1N NOZZLE (1 FLOW)
456443 2 419339 230 NOZZLE (2 FLOWS)
PROPRIETARY INFORMATILPR NOTICE 456444 0 419340 245 NOZZLE (2 FLOWS)
456445 0 419341 260 NOZZLE (2 FLOW)
r 15.00 15.00 30.00- THIS DOCUMENT IS AND CONTAINS CONFIDENTIAL 456448 0 419342 290 NOZZLE C2 FLOWS).
--- 500 TRADE SECRET INFORMATION OF THE COMPANY 456441 0 419337 2W NOZZLE (2 FLOWS)
275 - AND RENAINS THE PROPERTY OF THE COMPANY
AND IS TO BE RETURNED UPON REQUEST. 456442 0 419338 3N NOZZLE (3 FLOWS)
•••• ■ � _ - NEITHER IT NCR THE INFORMATION IT CONTAINS 457296 1 415671 HIGH TEMP. PULLEY ELBOW
• • • • • CL. CL.16.9 -- - - 10 - 1+ - 4 MAY BE REPRODUCED DR DISCLOSED TO PERSONS -.. 2 417369 SERIES DETECTOR
• 0 • NOT HAVING A NEED TO KNOV CONSISTENT VI7H
• °° ; RELEASE THE PURPOSE DF LOAN OE THE DOCUMENT 651055 0 BRACKET, DETECTOR MTG.
• • • • • • • • 651 190 1 1.25' CONDUIT
• • • • • • • ' vITHOUT %MITTEN PERMISSION. 707423 0 VERY. SUPT. ANGLE RED TANK
• •• ••
• • • • : 451168 168 1 77286 EVERGREEN .500 CONDUIT SEAL
• • • pIPE t Ca(DUIT 451167 3 77284 EVERGREEN .375 QUICKSEAL
•••••• 11Y ATSIIL bIS1RZtulte -
• • ,' 456447 2 418569 SWIVEL ADAPTER
• i
• • • • 451162 0 CHROME ELBOW
•• ••
451163 0 CHROME CLOSE NIPPLE
• • • • • g DUCT COUAR(S) SHIPPED LOOSE
• • • • • • ANSUL DISTRI OR TO PIPE 452527 341n CHROME SLEEPING
• • 'L10.2 ° ° • • PL -38.4 DUCT NOZZLE (S) IN COLLAR Cs) AND
462046 0 429853 REG. RELEASE SHIPPING ASS1.L
• • • ADJUST DETECTORS IF NECESSARY. 461296 0 429850 REG. ACTUATOR SHIPPING ASSN.
• • I 3.0 GAL TANK SHIPPING
• • r • • • • • 4.61297 0 429878 3.0 GAL. WIG. BR KT SHIP AS
• • •o• 60.00 '
461298 0 429864 1.5 GAL. TANK SHIP ASSM.
bit` - +r • � az.31 _
• s.•n 34 16.973 ._. — ..Ja
• 3-t")
PL -L.. L-267 ' � —Z oo CITY OF TIGARD
d o 10. -1is Approved
IE 0801 �' M iL Conditionally Approv ( )• TEEm d .. k For only the w�(a� as describein: r B,G. /� 7 Z -I
PERMIT NO. ,` �(,av� 23 0 ` See Letter to: ( )'
NoZ2 F -- ® 5.00 ' ® � Folio ch
Atta _ ` ,
L. `�`�f L / A, , •
4 8_000 Date: Job A. ' t ae: '
-
2 o I7/, 1 '�' GREENHECK SUPPLIED PARTS
` I --- 11.38 ANSUL • • 1, • 11" SUPPLIED PARTS SHIPPED TO ANSUL DISTRIBUTOR
A /7ov2 6 - 31 ~ 4231 _ _ 4T _ Y ' ANSUL Dto • IP_TION GH OTY_ ANSUL . DESCRIPTION
/ 462048 1 429853 REG. RELEASE SHIPPING ASSM.
�µ D. l I S 1 - 7 I Q 1 419337 2W NOZZLE (2 FLOW)
1 `� `7 1 79372 3.0 GAL. ANSULEX • 461296 0 429850 REG. ACTUATOR SHIPPING ASSN.
2+.00 2..00 t 2 2.
1 Z S �e 1 2 FUSIBLE UN ( K SIZE TED) 461295 1 429862 3.0 GAL TANK SHIPPING ASSM. r--- 0 - . 00 f ✓J� 0 5 ���� 1 i '" �Il - ` 1 24916 TEST UNK 461297 0 429878 3.0 GAL M. BRKT SHIP ASSM.
- -
0 15850 101 -10 CARBON DIOXIDE CART. 1 461298 0 429864 1.5 GAL TANK SHIP ASSM.
N(0v)G6` 1 5373 LT -3D-R NITROGEN CART. 456783 1 55607 I 1/2" MECHANICAL GAS VALVE
X7
` _ J �_ — 0 15851 101 -30 CARBON DIOXIDE CART. 451 177 1 4835 REMOTE PULL STATION
i ) ���Oc,3y�� 1 GAS VALVE (FIELD DETERMINED) 680775 2 15821 WIRE ROPE (50 FEET)
��e`�(` 457296 td 41%71 HIGH TEMP. PILEEY ELBOW
I ,—
1 � \� yes
.nlvn DioniL RESPr1NSI IB mE5
T1`� �— .COORDINATION OF JOB INSTALLATION WITH
381730 1 423873 SPOT ELECTRICAL SWITCH
i I I c I JOB CONTRACTOR
'GASVALVE HOOKUP TO AUTOMAN (CHANCEOUT
S SIZE & TYPE OF VALVE AS NECESSARY)
I I I •REMOTE PULL STATION HOOKUP TO AUTOMAN
I I
*CHARGING. TESTING, AHO CERTIFICATION OF COOK PAW PROJECT
'PIPING AND NOZZLES FROM FACTORY STUBOUTS. FLOW woo. is CHEW - 5.000 WAX: CHEW
(FOR CHAIN. SALAMANDER & UPRIGHT BROILERS. T rn0•tc>2.� LZNCflI.'3.00
Co k �� E t4c PIZZA CO T1 PPO G SKILLETS. BRAISING PANS � - � MN
I � _, -_
do PIZZA CO1-NEYOR NS) / oucT O r / , - - -
� �A • MODIFY A PPLIANCE DROPS iF SHELVES ON THE
O L7 50 �'(� � . . APPLIANCE INTERFERE WITH NOZZLE DISCHARGE ANSUL R 102 (UL300)
�� n q 'SUPPLY PIPING BEFT�WOEOEQN MULTIPLE HOODS. POINTS FIRE PROTECT/ON „ ^1j FOR � `�� K � � �� • PRO PE R ORIENTATION OF 1 1 U I .T IPI_ R E HOODS 55059501 — - ES 5443
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST 60; BUP
Received Date Requested / Z/6 AM PM BUP
Location / / ` i Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: . SIT
Post & Beam 1,A t 'A..
Shear Anchors
Ext Sheath /Shear 611 ' Alt- C ��L¢°/ teldafe.
Int Sheath /Shear j
Framing
Insulation Arlirlailr:1140M/ - , , Lit Drywall Nailing IsrA
F
/
ire wall /4./r) , � �
Fire Sprinkler �
Fire Alarm •
Susp'd Ceiling
Roof
Other: ,l.' i.�� >�. j; ;'"
-' -
�7 " PART FAIL
PLUMBING 4.1 4 !. D
Post & Beam ''
Under Slab
Rough -In
Water Service ,
Sanitary Sewer s
Rain Drain
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
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date � nspector t' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL