Permit C ITY OF TIGARD BUILDING PERMIT •
PERMIT #: BUP2004 -00231
Agoo& DEVELOPMENT SERVICES DATE ISSUED: 6/10/2004
41" ' I I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11535 SW PACIFIC HWY PARCEL: 1S136AD -04000
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: LOT: 007 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: M TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 116 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: $ 800.00
Remarks: Type 1 hood.
Owner: Contractor:
SMITH, EDITA M GUARDIAN FIRE PROTECTION
833 NW 170TH DR 1012 SW A ST
BEAVERTON, OR 97006 CORVALLIS, OR 97333
Phone: 503- 245 -1864
Phone: 541 - 752 -2258
Reg #: LIC 100355
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 5/19/2004 $62.50
[TAX] 8% State Surchari 5/19/2004 $5.00
[FLS] FLS Pln Rv 5/19/2004 $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.
By: f', /L-� �
Issued B I /
Permittee
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
if S3 c
swMA y ��c,;t
• Fire Protection rSystem
4 Building Permit Application FOR OFFICE USE ONLY
City of Tigard
D ec J / G, O �� 1. � — 3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 46 a 1 Np�'p; ;i I ' Date/B : ' `� ` sf Other Permit:
Inspection Line: 503.639.4175 u'i F'' Date Ready/By: / /uris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Metho. , ; D L Supplemental Information
•
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
J ZIlttirlition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
�(�
❑ 1- and 2- family dwelling Commercial /industrial
Valuation: $
O `"
ID Accessory building CI Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1/ C3 S, tc, P -4e,� 6 / New dwelling area: square feet
City/State/ZIP: / l c �,�� CV �Z Garage/carport area: square feet
Suite/bldg. /apt. no.: 7 Project name: '4/4 / ijy ( O e,.64) , Tr..mi 6:4 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: • Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
s / f , , ! , TZ 4 4_L Valuation: $
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction: VA)
Address: Occupancy groups:
/
City/State/ZIP: Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) I Fax::( )
E -mail:
CO RACTOR
Business name: 6 4,49 2 4w/ �G ci /v�., BUILDING PERMIT FEES*
Address: /0 / ,ci A S
Please refer to fee schedule
City/State/ZIP: �� v 4 S Cht F? ? `J
Fees due upon application
Phone: ( ?/ /) �S).- 225 - 8 .1 Fax: ( /J) 7 Y1- y)- 5 — ,
(DO S5 £x 4 — } a3 —tg(—C941, Amount received
CCB lic.:
Date received:
Authorized signature This permit application expires if a permit is not obtained
within 180 days after It has been accepted as complete.
Print name: Eke, 7 tsc.,....-- I Date: 6 * Fee methodology set by Tri-County Building Industry
Service Board.
i:\ Building \Permits\FPS- PermitApp.doe 12/03 440- 4613T(11/02/COM/WEB)
A
(-
Fire Protection Permit Check List
Describe work to be done:
1.) El New 2.) Modification to sprinkler heads only:
El Addition ❑ 1 -10 heads: No plan review required.
Alteration El 11+ heads: Plan review required.
' ]Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler •
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $ ��
C.) Fire Alarm
Submittal shall Battery Calculations El Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Project Valuation Subtotal (A, B & C): $ Wa) "
Permit fee based on valuation (see attached chart): $
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $
FLS Plan Review 40% of Permit Fee: $
TOTAL: $
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.
i:\ Building\FormsTPSchecklist.doc 12/24/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 - 4175
INSPECTION DIVISION Business Line: (573) 639 -4171 MSP y- 400-3 /
Received Date Re uested ® PM BUP
S73 Location / � 4 % C. Suite MEC
Contact Person 07 4 Zt Ph ( ) PLM
Co
Ph ( ) SWR
. ■RUILDIN±) Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 7' - / h e _ / SIT
Post & Beam G
• Sr Anchors
Ext
Ext Sheath/Shear
Int Sheath/Shear l�
Framing
Insulation \,&�Q /I • r \ - 1 6 V (2) i S �o f
Drywall Nailing —�
Fire wall
Fire Sprinkler •
Fire Alarm
Susp'd Ceiling
Roof
O .: •
PART FAIL
P I ' = ING
• ost & Beam
Under Slab
Rough -In
1' I
Water Service
Sanitary Sewer
0
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: 0 Unable to inspect — no access
Fire Supply Line C J�
ADA � `
Approach/Sidewalk Date Z 7 43 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL