Permit • .CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00329
�L �* I4' DEVELOPMENT SERVICES DATE ISSUED: 8/4/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135DD -03301
SITE ADDRESS: 11945 SW PACIFIC HWY 205
SUBDIVISION: HOFFARBER TRACTS NO.1 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: $ 2,200.00
Remarks: Replace existing kitchen fire suppression with new UL -300 liquid fire suppression system.
Owner: Contractor:
TIGARD PROPERTIES INC UNIVERSAL FIRE EQUIPMENT
2106 SE OCHOCO ST 8049 SW CIRRUS DR
MILWAUKIE, OR 97222 BEAVERTON, OR 97008
Phone:
Phone: 641 -8702
Reg #: LIC 86723
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler inspection
[BUILD] Permit Fee 7/12/2004 $72.10 Final Inspection
[TAX] 8% State Surchari 7/12/2004 $5.77
[FLS] FLS Pln Rv 7/12/2004 $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
952-0 • :: : . ough OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
cal • g (503) 246-6. ° ' or 1- 800 - 332 -2344.
Ao ��� / ,
Is ued By: i % ,, 1�� / �
Perm . - e /
Signature: `
all 639 -41 by 7 p.m. for an inspection the next business day
Fire Protection Building Sy Q�E %VED 3 Z/
if Bd Permit A
�1 r aeon FOR OFFICE USE ONLY
Rece ived Pemu No.:
City of Tigard lit A. y 4 Cf 1 gpj� O 9
DateB f a ' � O
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �
Phone: 503.639.4171 Fax: 503 598.1969., �jD �.9 1 i ' `� DateB '�` 0y n � S� Other Permit: \
y Y OF TIGA y tF 2 0'�j
Inspection Line: 503.639.4175 �' F I D ate Ready/By: " ��'/J hiris 0 See Pa e 2 for
G DIVISION r y x 7 /Ju /ow g
Internet: www.ci.tigard.or.us �UILDI No ' 1ethod: Supplemental Information
ol w /a4aty . ,Jae ,
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
X Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling MCommercial /industrial co
❑ Accessory building ❑ Multi- family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ji9 yS' S7� PAC f q � fif rJ 5y 1 '. 1 ., 20.S.' New dwelling area: square feet
City/ State/ZIP: f r ( ! 2Z3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: G,,,ge/`s A 4_64 , Covered porch area: square feet
Cross street/directions to job site: /–J' j/ ig 1 1-1-,..2 F / / Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK e-4.--•--, work indicated on this application.
p Gp i A it, 444, ��(',- 5- S 7 !. 7 Valuation: $ 2_26O a —
°
u L- . / f ri r / F i � r �� .. S Existing building area: square feet
S 5 �� °tit °'1 New building area: square feet
❑ OWNER PROPERTY WNER 0-TENANT Number of stories:
Name: A.1 4 6 u 6 - Type of construction:
Address: Occupancy groups:
City/ State/ZIP: Existing:
g
Phone: (x'33) 6 3c.- 70 z Fax: ( ) New:
❑ APPLICANTONTACT PERSON NOTICE
Business name: an tv.e fs ( r' !pin C7 cA G f All contractors and subcontractors are required to be
Contact name: G em f licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 9' p (f ,Q c, f' S Q • jurisdiction in which work is being performed. If the
` ' applicant is exempt from licensing, the following reasons
[,
City/State/ZIP: �Q e,4a-ef J f c5 • ��CD� �- apply:
Phone: ( 3) 6Y /..g73 2 Fax: : (5:53) 6 `(?-J t(7 �. -
- E -mail:
CONTRACTOR .
Business name: u h ‘)e i"5 Fat_ p n c 'BUILDING PERMIT FEES*
Address: '� Li? s,3 G rr S L' C',
Please refer to fee schedule.
City /State/ZIP: eeig ✓e.l' Qs . 9706
Fees due upon application
Phone: (4 3) (I f _g 7a 7 Fax: ( ) —
CCB tic.: vt 72 3 Amount received
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: /' �, I Date: -I 7.- O y • Fee methodology set by Tri- County Building Industry
7
v Service Board.
i:\Building\Pemtits \FPS- PennitApp.doc 12/ 440- 4613T(11/02/COM/WEB)
•
Fire Protection Permit Check List
Describe work to be done:
1.) New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -1 0 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work: /4 0../<_ 0 t a FT sw p e
H° .c( Re / � c-� w 14 141-'30 o fig. Cct ,res5 �-c..,
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: $ 2200 °"
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El 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): $
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.
is'. Building\Forms\FPSchecklist.doc 12/24/03
CITY OF TIGARD . -
BUILDING DIVISION PERMIT #: B2004 -00328
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/4/2004
Phone: (503) 639 -4171 .,." �� p, 01 i , l� UP
Inspection Requests (24 Hrs.): (503) 639 -4175 .._. `'I L
INSPECTION WORKSHEET FOR DATE: 5/19/2005 TIME: 7:12AM PAGE: 105
SITE ADDRESS: 11945 SW PACIFIC HWY 205 CLASS OF WORK:
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT #: 002 TYPE OF USE:
PROJECT NAME: GAFFER'S FISH & CHIPS
DESCRIPTION: Replace existing kitchen fire suppression with new UL -300 liquid fire suppression system.
OWNER: TIGARD PROPERTIES INC, PHONE #:
CONTRACTOR: UNIVERSAL FIRE EQUIPMENT PHONE #: 641-8702
Inspection Request Scheduled For: Date: 5/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
295 Misc. inspection 007019 -01 503 -641 -8702 Y
Corrections /Comments /Instructions: O�� 1J Pr
( ° ✓C )
i 1 I
ISM . ___II i s. ',- iivit
-.....---------- "°' #
\ (p t....../ l& i
C PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIO AL F ES ASSESSED
rri .---^ Inspector: i
ill. Date: Ci Phone #: (503) 718-