Permit 'CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00187
lyA DEVELOPMENT SERVICES DATE ISSUED: 6/6/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11640 SW PACIFIC HWY PARCEL: 1S136D6 -02400
SUBDIVISION: ZONING: C -G
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: 5N : sf N: S: E: W:
OCCUPANCY GRP: A3 TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 54 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: $ 1,200.00
Remarks: Fire suppression system for kitchen hood installed by other contractor.
Owner: Contractor:
CHAMPION, RONALD V AND METRO SAFETY AND FIRE INC
ROBERTA E 7055 NE GLISAN
11642 SW PACIFIC HIGHWAY PORTLAND, OR 97213
TI onD. q53 34 Phone: 231 -2999
Reg #: LIC 00063651
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler inspection
PRMT CTR 5/14/02 $62.50 27200200000 Sprinkler Final
5PCT CTR 5/14/02 $5.00 27200200000
FIRE CTR 5/14/02 $25.00 27200200000
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Pe rm ittee
Signature: I
Issued : y: r ce " „� ' /
Call 639 , 175 by 7 p.m. for an inspection the next business day
IIIIW , T o P7
e'
A & Building Permit Application
Date received: � ' ;'% v .`,J Permit no.: v�- ..4:' Y
0 ,Till City of Tigard, . ,_>t Project/appl. no.: Ex date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 �
Phone: (503) 639 - 4171 Date issued: � d• I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: a -T: 7- ' r ,- I &2 family: Simple Complex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi- family 0 New construction 0 Demolition
0 Addition/alteration /replacement ' Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: 1 Ib O Sw PRtt FL"' • Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: ,, t &,, ,�) t-1- . —• - .
Description and location of work on premises/special ADO T i.�:. f- / l.1 f� o N C a t "v al C.
- .�., 2 ,r / F.
S... LsSoN
, i .
,,•, (..r-.. /4 ) 0
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: .., .- Z„ • Pi. (Floodplain, septic capacity, solar, etc.)
Mailing ad , ress: , , I " . „ 1 & 2 family dwelling:
ECE �� State ZIP: ' 7 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: Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industrial /multi - family: / ���)
CONTRACTOR Valuation of work $ 1
Business name: Al irra... r 4- r=. T.. c • Existing bldg. area (sq. ft.)
o New bldg. area (sq. ft.)
Address: Z
5`S N �z . C� I. s r • Number of stories
City: P - 1, State: &g. ZIP: -1/13
Fax: 5cs ub•�/6 ;/ Type of construction
Phone:
�y z31•Z4 Occupancy group(s): Existing:
CCB no.: , (
_ New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER 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
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
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 ❑ Visa U Mastercard
work will be compli w' , whether ecified herein or not. Credit card number: / /
_ Expires
Authorized signature: Date: •- ' / 3 - Le °L Name of cardholder as shown on credit card
Print name: ►h1C CA-s 7 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 (6IOOICOta)
APP
Fire Protection Permit Check List
A.) ❑ New ❑ Addition ❑ Alteration ❑ 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 ❑ Dry ❑
Standpipes
Additional Hazard Group
Information 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 Yes ❑
include: Individual Component Yes LI
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A, B & C): $ &DO
Permit fee based on valuation (see chart): $ 6P2. SD
8% State Surcharge: $ S .
FLS Plan Review 40% of Permit: $ acc oa
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.
is \dsts \forms \FPSchecklist.doc 11/21/01
CITY of TIGARD 24 -Hour
Inspection Line: (503) 639 -4175
JILbING MST
INSPECTION DIVISION Business Line: (503) 639 -4171 UP ° — /
Received Date Requested 4 - C AM PM BUP
Location 1/ & Z ie) fi li Suite MEC
Contact Person .e, eA r Ph ( ) 3 1 c9 97 PLM
Contractor 'J Ph ( ) SWR
BUILDING Tenant/Owner ...ILL 1 . Alirii ?i e' ELC
Footing I ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: y ...75 SIT
S a & Beam e4.64 '
Shear Anchors f � n _
Ext Sheath/Shear e V �-/ /, C 4 O i
Int Sheath/Shear If
Framing
Insulation S e,
Drywall Nailing
Firewall
Fire Sprinkler / - -R l \°2 ��� j7.
Fire Alarm v
Susp'd Ceiling
Roof
Other: D `
ma
S� PART FAIL
MBING
P & l abm
U Z " — " _ `� _ n
nder Slab wv� -� a .
Water • S e /� )`' Q
Water Service .1C 1-^ --✓� l k�
Sanitary Sewer
Rain Drains '
Catch Basin / Manhole ( L. P ., 4 �i - � 42)
Storm Drain p ( \
Shower Pan % � ��
Other:
Final I `� . ,_ ���—
PASS PART FAIL 1
MECHANICAL V -- . Za a ? . -- Q O 1 C- �.
Post & Beam L � 3 •�,� _
Rough -In `^/� Z- �� 0 -- — U C7 vvv`t�
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 v 7 LY
C
Approach/Sidewalk Date �/` ; C�
I ( ' Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL