Permit �■ CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2001 -00122
j1/ DEVELOPMENT SERVICES DATE ISSUED: 4/12/01
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136CD -01601
SITE ADDRESS: 11670 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
REISSUE: (}� FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: r / FIRST: sf N: S: E: W:
TYPE OF USE :' COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 3N : sf N: S: E: W:
OCCUPANCY GRP: B 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 1,490.00
Remarks: Install fire suppression system in Type I exhaust hood. Upgrade to existing hood
Owner: Contractor:
DOUGHTY, J PAUL AND LILLI SANDERSON SAFETY SUPPLY CO.
10150 SW CANYON RD 1101 SE 3RD ST
BEAVERTON, OR 97005 PORTLAND, OR 97214
Phone: Phone: 238 -5700
Reg #: LIC 64969
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough -In
PRMT CTR 4/6/01 $62.50 27200100000 Sprinkler Final
5PCT CTR 4/6/01 $5.00 27200100000
FIRE CTR 4/6/01 $25.00 27200100000
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 -1987.
Pe
Wna tu
Signature: , �L
Issued : y: ' . ■ ■ T a'`
Call 639 -4175 by 7 p.m. for an inspection the next business day
r t i i l p i i2w ................
.. Building Permit Applic ®'
a� ^ ��V Datereceived: /% // Permitno.:/ & Paoo / - /a;
I City of Tigard REC \
.. Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 9 Q
Phone: (503) 6394171 NA M MT Date issued: By:. Receipt no.:
Fax: (503) 598-1960 7 / oEV E Case file no.: Payment type:
N�� :
Land use approval: Cp�iM� 1& 2 family: Simple p Complex:
TYPE OF PERMIT `k.
CI LA 2 family dwelling or accessory CI Commercial/industrial ❑ Multi - family ❑ New construction fl Demolition
Addition/alteration/replacement ❑ Tenant improvement U Fire sprinkler/alarm 8'C�er: f-7 xe 5; 1
JOB SITE INFORMATION
Job address: `/ 6 70 SG- 2 A c i r e t/ . Bldg. no.: Suite no.: 1
Lot: I Block: Subdivision: / I Tax map /tax lot/account no.: r
Project name: z 2,.., Cabo° V
Description and location of work n premises/special conditions: s 7e. i i ' t ° p p / e s - v -- sysiear.—
/ 7 � •� s� / 0D 300
a
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST I
Name: , 27' 4 .400s- (Floodplain, septic capacity, solar, etc.)
Mailing address: 1 & 2 family dwelling: , �
City: I State: I ZIP: Valuation of work $
Phone: I Fax: I 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.)
Name: PA, -c1,-,t 1 1 o •n.boix.vvr` Covered porch area (sq. ft.) C
Mailing address: 1 0) C 3 r `& Deck area (sq. ft.)
I
City: d , 1,„.._„,_.‘ State: 0 ZIP: q 7)-1 t/ Other structure area (sq. ft.)
Phone: j 3 y- S Fax: 7 T' - .t i E- mail: Commercial/industrial /multi- family:
CONTRACTOR Valuation of work $ /, y f O
Business name: 5; .2 4 �T V Existing bldg. area (sq. ft.)
r0 / fC 1�� New bldg. area (sq. ft.)
Address: r Number of stories
City: 7 i f/o...- I State:Or I ZIP: 977/I
Type of construction
Phone: „2 3r. f7n7 I Fax: 7-3 ir- 0/931E-mail:
CCB no.:
64/6 Occupancy group(s): Existing:
New:
City /metro lic. no.: 0 0 E C:' y7 /S Notice: All contractors and subcontractors are required to be
ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Board un ler
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:
i State: I ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $ '2 s : 31 —
Address: Date received:
City: (State: IZIP: Amount received $
Phone: I Fax: I 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 ❑ MasterCard
work will be complied wi er specified herein or not. Credit card number: Ex
Expires
P
Authorized signature: Date: `� ` (< - U Of Name of cardholder as shown on credit card
$
Print name: t'Wo -e I To �N� v.._ Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 446613 (6 COM)
&
6
CITY OF T4GARD BUILDING INSPECTION DIVISION ' ~
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP ?e, 0( - 0 / Z-Z-
Date Requested 7- AM PM BLD
Location / f (p 7 ) MEG
Contact Person n ! - 3 // 3 PLM
Contractor S t ,4-/'A, -e ----' - --PT • � .�, - SWR
BUILDING Owner _ 4 ELC
Retaining Wall 0 0 ELR
Footing
Foundation Access: �� tt`. tC l FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: - 0 6 � l
Slab ` � SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
s
Dry wal I n Nailing IP
Dwall
Firewall fa ' 41
is S rinkl �,P/J. . //��
! `• •
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Fi
AS PART FAIL
BING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspectio Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA A
Approach /Sidewalk Date 0 £ ( 0'
Inspect
Other Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
� II EW I 1101 S7E. 3RD AVENUE • PORTLAND, OREGON 97214 • (503) 238 -5700
_ r1 850 CONGER • EUGENE, OREGON 97402 • (541) 683 -9333
NN SAFETY COMPANY 2600 AIRPORT WAY, SOUTH • SEATTLE, WASHINGTON 98134 • (206) 340 -4300
CERTIFICATION - INSTALLATION /INSPECTION
Customer Name i 77 - 7 Y'
Address i - 7(
SYSTEM
Model(s) and serial numbers
Number of nozzles and Part No.
Number of detector(s) and degree rating
Energy shut -off devices — type and size
Other acceskory equipment provided (pull station, electric switches, etc.)
COOKING /VENTILATING EQUIPMENT
Number of duct(s) and size
Hood size and plenum size
Cooking Appliances and size of cooking surface. (NOTE: List appliances from left to right and indicate those
being protected.)
1 . L ' r 'f � 4.
.- J .
2. l'" 5.
3. 6.
TO BE COMPLETED BY INSTALLER
❑ YES ❑ NO
The fire suppression system is installed in accordance TO BE COMPLETED BY CUSTOMER
with the manufacturer's instructions, NFPA Standard
96 and 17 (current issue), and all applicable state and
local codes. Exceptions to other provisions of NFPA 96 ❑ YES ❑ NO
that were observed are noted below. I understand that it is the recommendation of ANSUL
Exceptions: and of the National Fire Protection Association
Standard 96 and 17 that the fire suppression system be
inspected and maintained every 6 months to ensure
continued efficiency and reliability and that failure to
do so may result in failure of the system to operate
properly.
I. CUSTOMER NAME AND TITLE
r
112'" YES ❑ NO
All electrical work or work provided by others to SIGNATURE
complete this system installation has been completed. DATE
INSTALLER NAME �,,,,..�•- A
SIGNATURE /'fir 4 T e 5S ! ,, iec
DISTRIBUTOR f
ADDRESS ' f
/ j,
DAT '�^—