Permit t P-
A � CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00063
i� DEVELOPMENT SERVICES DATE ISSUED: 5/15/03
��' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11477 SW PACIFIC HWY PARCEL: 1S136AD -04300
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: . LOT: 002 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: A3 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: $ 2,750.00
Remarks: Fire suppression for Type I Hood
Owner: Contractor:
BANNING, MARK A + PATRICIA E TRS UNITED FIRE AND SAFETY
3895 TAMARACK LN 4611 NE MARTIN LUTHER KING JR
LAKE OSWEGO, OR 97035 PORTLAND, OR 97211
Phone:
Phone: 503 - 249 -0771
Reg #: MET 00003093
FEES LIC REQBII� INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 2/11/03 $72.10 Sprinkler Final
rm
[TAX] 8% State Tax 2/11/03 $5.77
[FLS] FLS Pln Rv 2/11/03 $28.84
Total $106.71 .
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
calli9g - (503) 246 -6699 or 1- 800 - 332 -2344.
� f� - ao Issued By: c ` sue , t
� tee- ) `
Permit — / •
Signature: s it0_P , 9. r „T ✓`
Call 639 -4175 by 7 p.m. for an inspection the next business day
Fire Protection System '2- - 2 L/_ v 3 C, c
• Building Permit Application Received FOR OFFIC Building USE O
�_
Date/By: -/ i -D 3 4) Permit No.�U Vc900 3 - 0c)063
1.
City of Tigard Planning Approval Other
y Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review e ! 4 ■ - C o • Other No.: -'�
Tigard, Oregon 97223
D a te/By: Permit N 0
0
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 O� �i''M� if ( Post - Re Land Use lil
��
Internet: www.ci.tigard.or.us Asir 11 Date/By: Case No. Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: , Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
❑ Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION' Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: 11 Li-77 $w Poet r I c, 041.4 Total number of floors
New dwelling area (sq. ft.)
Suite #: I Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: 'BAN N ► l.1 G S Re S'f"Q.0 vs a. itt Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: I Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate^_
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
Ftr� K
S p p r{ SS,or∎ IlnSfiatu F o0
Valuation $ (9 " Sty 2
Existing building area (sq. ft.)
New building area (sq. ft.) j
Number of stories l
❑ PROPERTY OWNER I ❑ TENANT Type of construction ji i i
Name: " A-n VII n 4 S e ge-S ettA.1/'amt- Occupancy group(s): Existing: 11i
Address: 11 1411 Std egafr .i E c, tA ` ■ 11
City/State /Zip: ji t; tvi2..O D se_
.t
/ NOTICE: All contractors and subcontractors are required to be
Phone: Sty 3 ZH cf --7.4 Fax: � 0 3 2wy -L 1s0 licensed with the Oregon Construction Contractors Board under
❑ APPLICANT ❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: (; jurisdiction where work is being performed. If the applicant is exempt E
Contact Name: from licensing, the following reason applies:
. :::,
Address:
City/State /Zip:
Phone: I Fax:
BUILDING PERMIT FEES*
E -mail: Please refer to fee schedule.
CONTRACTOR
Business Name: U v „; f: d f r.e alv„c( 5A4.ET`, Fees due upon application $
Address: 4( 11 xis. L Llc 3 r (a d
City/State /Zip: P 4. t& D2 x72 Amount received $
-;
Phone: 5j3 24' 077/ I Fax: .5/;. 3 214 q OS-7 2— Date received:
CCB Lic. #: ( 5
Authorized //� "I t Notice: This permit application expires if a permit is not obtained within
Signature: 1 ,2 Date: "//4-6 180 days after it has been accepted as complete.
'F! // ' 7l *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03 ' ' � oZ �v
Tk 5
FLS .P15.154/
Fire Protection Permit Check List
A.) ❑ New ❑ Addition ❑ Alteration LI Repair
B.) Modification to sprinkler heads only:
Describe work to 1. 1 -10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required.
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet Li Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation I $ A160
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑ •
Cut Sheets
Fire Alarm Project Valuation: $
•
Project Valuation Subtotal (A, B & C): $ ? '5
Permit fee based on valuation (see chart): $ / iO
8% State Surcharge: $ 5. 77
FLS Plan Review 40% of Permit: $ ,v1.0
TOTAL: $ /0.11
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.
is \dsts \forms\FPSchecklist.doc 11/21/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) gin MST
INSPECTION DIVISION Business Line: - 003)=639 1LT1
'' , l —v BUP 3 — D CO 6. 3
Received Date Requested PM BUP
Location TI t" Suite MEC
Contact Person Ph ( ) 0 2 — 0 7 1 1 1 PLM
Contra Ph ( ) SWR
UILD Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 3 • O m • SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
C
ift/
Fi
ASS) PART FAIL
MBING
Post & Beam
Under Slab
Water S
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 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
ADA
Approach/Sidewalk Date I nspector �/� Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL