The URL can be used to link to this page

Permit i. BUILDING PERMIT CITY TIGARD PERMIT #: BUP2003 -00672 Ai* lvtirilik DEVELOPMENT SERVICES DATE ISSUED: 1/14/04 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 sr PARCEL: 1S135AB-00100 SITE ADDRESS: 1 /0.3.5e) Sot/ L I N COLI�I SUBDIVISION: TOWN OF METZGER ZONING: R -4.5 BLOCK: LOT: 005 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: 2 -1 HR : sf N: S: E: W: OCCUPANCY GRP: El 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: $ 70,376.00 Remarks: Fire sprinkler for new school. Owner: Contractor: WASHINGTON CLACKAMAS CO DELTA FIRE INC SCHOOL DIST 23J 14795 SW 72ND AVE 6960 SW SANDBURG STREET PORTLAND, OR 97224 TIGARD, OR 97223 Phone: Phone: 620 -4020 Reg #: MET 6 0000 0 0 4 1934 FEES LIC REQUIRED INSPECTIONS Description Date Amount Sprinkler Rough -In [BUILD] Permit Fee 12/4/03 $585.67 Sprinkler Rough -In [TAX] 8% State Surchari 12/4/03 $46.85 Sprinkler Rough -In Sprinkler Rough -In [FLS] FLS Pin Rv 12/4/03 $234.27 Sprinkler Final Total $866.79 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 , .-6699 or 1- 800 - 332 -2344. °C I Permit . - I. • Signature: $ I I / �; :i // (/ Call 639 -4175 by 7 p.m. for an inspection the next business day IOZS'S Sw qv 4 Fire Frotection System prrtovefl 1_1z - ot .pse ,, ' � Pr A Building Permit Application Date received: 42/0-3 Permit no &N o3- �, 'r�=, ;' City of Tigard RECEIVED 067oZ. P roject / appl. no.: Expire date: Cit�y�oj�Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 ., Phone: (503) 639 -4171 DEC 4 2003 Date issued: B I Receipt no.: Fax: (503) 598 -1960 • Case file no.: Payment type: J CITY OF TIGARD 1 &2 family: Simple Complex: J Land use approval: BUILDING ui t/ISION TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi -famil ew construction 0 Demolition ❑ Addition/alteration/replacement 0 Tenant improvement (fire slffr arm 0 Other. JOB SITE INFORMATION i N. r�� m• Job address: �� -- - -•— Bldg. no.: Suite no.: Lot: Block: Subdivision: Tax map /tax lot/account no.: Project name: �_, A d / (_N I- l kA4. L- IF Description and location of work on premises/special conditio OWNER FOR SPECIAL INFORMATION, USE CHECKLIST Name: 77 — 9L,} -77e1 J ,0L j , (Floodplain,septic capacity, solar, etc.) Mailing address: 1 & 2 family dwelling: City: State: ZIP: Valuation of work $ Phone: Fax: E -mail: No. of bedrooms/baths Owner's representative: Total number of floors Phone: Fax: E -mail: New dwelling area (sq. ft.) APPLICANT Garage/carport area (sq. ft.) ` Covered porch area (sq. ft) Mailing address: 'i�•o �i�� i Deck area (sq. f .) �tr . /. ►!amin Eras Zip ... y7 . Other structure area (sq. ft.) Phone• / • M Mi E -mail: Commercial/Industrial/multi-family: CONTRACTOR Valuation of work $ 7(/ 3 7 Existing bldg. area (sq. ft.) Q ft /E. New bldg. area (sq. ft.) Address: `a�j�hrJ� ( Number . stories ds',�Z�n�MIMI eTV A - Type of construction Phone- f s V 2.0 Fax: E -mail: CCB no.: / 1(tra Occupancy group(s): Existing: City /metro lic. no.: / New: �►ii Notice: All contractors and subcontractors are required to be ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under Elmo e�� & provisions of ORS 701 and may be required to be licensed in the Address: e�� fw_amre. jurisdiction where work is being performed. If the applicant is �� — exempt from licensing, the following reason applies: Contact person: 471� 1 'Ian no.: • Phone: 0 s (1 ) Fax: E -mail: ENGINEER Name: Contact person: Fees due upon application • $ QCQ - 7 Address: . Date received: 42,/ City: State: ZIP: Amount received $ ?dc. • 9 l b r Phone: Fax: E -mail: • Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jutisdictions accept aedit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this ❑ Visa U MasterCard work will be complied w' heeh- \ cifre�d�hee herein or not. Credit card number Expires Authorized sign.L L! - -L—• /�irL(Date: /1 ` 2 1 J Name of cardholder as shown on credit card Print name: .l � 1 / " ik■-. 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. 440.4613 (6001COM) SPS, G 7 y . d 4 5 - a 4 a, 79 ° 7 ....,... W afro -00 C,72- I 003$`0. Strica„, , . CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR A BOVEGROUND PIPING PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. . PROPERTY NAME Date 7/1/04 METZGER ELEMENTARY - PROPERTY ADDRESS 10255 SW 90TH AVE ACCEPTED BY APPROVING AUTHORITY('S) NAMES • - City of Tigard ' ADDRESS 13125 SW Hall Blvd • PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS N YES ❑ NO EQUIPMENT USED IS APPROVED N YES ❑ NO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION N YES ❑ NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS N YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS N YES ❑ NO 3. NFPA 25 N YES ❑ NO LOCATION SUPPLIES BUILDING: OF SYSTEM YEAR OF K FACTOR TEMPERATURE MAKE MODEL MANUFACTURE QUANTITY RATING Reliable G 165F Reliable GFR 165F SPRINKLERS Reliable GFR 165F Reliable F3 212F PIPE AND Type of Pipe: Schd. 40 and Sch 10 FITTINGS Type of Fittings: Cast iron 125# and Grooved ■ MAXIMUM TIME TO OPERATE ALARM DEVICE THRU TEST CONNECTION ALARM VALVE TYPE MAKE MODEL MIN. SEC. OR FLOW Water Flow Switch Potter Electric - VSR -F 0 41 INDICATOR - • DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP TRIP POINT TIME WATER ALARM THRU TEST WATER PRESSURE AIR PRESSURE AIR REACHED OPERATED CONNECTION' PRESSURE TEST OUTLET* PROPERLY DRY PIPE MIN. SEC. PSI PSI PSI MIN. SEC. YES NO OPERATING Without ❑ ❑ TEST Q.O.D. With ❑ - ❑ Q.O.D. IF NO, EXPLAIN: *MEASURED FROM TIME INSPECTOR'S TEST CONNECTION OPENED. (OVER) OPERATION - - - -- -- -- - - -- - - -- -- - ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC * • PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED ❑ YES ❑ NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE CONTROL STATIONS • YES ❑ NO a IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO, EXPLAIN DELUGE & PREACTION ❑ YES ❑ NO VALVES DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM? VALVE RELEASE? OPERATE RELEASE YES NO YES NO MIN. SEC. ❑ ❑ ❑ ❑ HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static pressure In excess of 150 psi TEST • (10.2 bars) for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2_ HRS. IF NO, STATE REASON: DRY PIPING PNEUMATICALLY TESTED ❑ YES ❑ NO EQUIPMENT OPERATES PROPERLY ' ❑ YES ❑ NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OF SODIUM SIUCATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? TESTS ® YES ❑ NO DRAIN I READING OF GAI AT NEAR WATER SUPPLY TEST I CONNECTION OPEN WIDE DE WITH: PS ST TEST CONNECTION: UNDERGROUND MAIN AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING OTHER EXPLAIN VERIFIED BY COPY OF THE U FORM NO. 858 AYES ❑ NO FLUSHED BY INSTALLER OF UNDER- GROUND SPRINKLER PIPING AYES ❑ NO BLANK NUMBER USED LOCATIONS: NUMBER REMOVED TESTING 0 GASKETS WELDED PIPING ® YES ❑ NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? 0 YES ❑ NO DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? 0 YES ❑ NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? 0 YES ❑ NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL (DISCS) CUTOUTS (DISCS) ARE RETRIEVED? ® YES ❑ NO HYDRAULIC NAME PLATE PROVIDED IF NO, EXPLAIN: DATA NAMEPLATE 0 YES ❑ NO DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: /if 4 REMARKS - / • NAME OF SPRINKLER CONTRACTOR: • TESTS WITNESSED BY • FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES I I FOR SPR ' RAiONTRACTOR (SIGNED) TITLE DATE /64- I -� I ( ..PP-t r41- e.e'c%— Cr ny - me._ I Y I s ; . .. -, r•� ' a- I TITIE. ( t ( DAT f/, 01-- �=il1r 1 TIT P FO' - PONSIi��T GI 4 , • P , . Y E (SIGNED) I TITLE A I DAT�/ /� ADDITIONAL EXPLANATION AND NOTES (BACK) • • CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST 47.ao -60 6 �� Received Date Requested 7 7 AM PM BUP Location / 4 '?-t' 1 1 Suite MEC Contact Person Ph ( ) a O? — gss� PLM Contractor Ph ( ) SWR liv u_ BUILDING Tenant/Ownere/iC bliZ,V1A . ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall ,ur p I ,- Fire • larm Susp'd Ceiling Roof Other: attil PART FAIL • MBING 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 UG/Slab Low Voltage Fire Alarm Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line Approach/Sidewalk Date /� /� Inspector � ' " Z Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING _ • Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP 4'7bC)(1 Q'S� pd Received Date Re uested 7 ✓ ( AM ✓ PM BBUPd oo — 000 3 ar Location b 3 Suite Contact Person R-6YI Ph ( ) 0 9 — FSS7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC ELC• Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation 0 Drywall Nailing Firewall �� M11 Fire Sprinkler Fire Alarm Susp'd Ceiling Roof 14.00G O I _ , c7C f at 4 461 M PART FAIL I 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 4 II r Rough -In r �? IW . /i ` .. ,ia∎ Low lt Voltage 1 WJ1I(4IEiga -1 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: D 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