Permit 'I ` C ITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2007 -00252
COMMUNITY DEVELOPMENT DATE ISSUED: 5/24/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102 B D - 00600
SITE ADDRESS: 12725 SW PACIFIC HWY ZONING: C - G
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT: 050 JURISDICTION: TIG
PROJECT: NEW YORK NEW YORK
Project Description: Fire suppression
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: 1 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: $ 1,000.00
Owner: Contractor:
FUNK, JAMES H GUARDIAN FIRE PROTECTION
c/o BERGMANN, FLOYD H + MARINE 1012 SW A ST
11600 SW 90TH CORVALLIS, OR 97333
TIGARD, OR 97223
Contact #: PRI 541 - 752 - 2258
Phone: FAX 541 - 752 -4259
Reg #: LIC 100355
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 5/3/2007 $62.50
[TAX] 8% State Surcha 5/3/2007 $5.00
[FLS] FLS Pln Rv 5/3/2007 $25.00
Total $92.50
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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 -0 Y 10100. You may obtain a copy
/
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued = 1 ' / / Permittee Signature:
r
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project. '
Approved plans are required on the job site at the time of each inspection.
1 Z Z ap / .9.1 Mc,. 4-lc, i>.
BuildingPermit Application
li Fire Protection System FOR OFFICE USE ONLY
City of Tigard C EIV ED Received r Z
972
lig `.1 g D eceive �l 3 Q 4 . Permit No.: 7 �! 002_5 a 13125 SW Hall Blvd., Tigard, OR Plan Revte'
C . Phone: 503.639.4171 Fax: 503.598.1M5 Date/By:, �' • 15121. 10 Other Permit: T 1 G A li D Inspection Line: 503.639.4175 3 2� /
e Ul I Date ReadReady/By: 3uri / Supplemental Inf Page 2 for ormadan
Internet: www.tigard - or.gov C ITY ®F Noti acid* vo/ rt. tied/Method: 10-1 5 .) / Su - •
TYPE OF WORK
� �� ®`' GARD (�(aS0�n1 REQUIRED DATA: 1- AND 2- F A AM ' MILi 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
Addition /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 m
omercial/industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11 7rZ; -S • v ' New dwelling area: square feet
� wf
City/State /ZIP: - - r ' 4� j., ®A 97 y >.- Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Al E 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: 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 work indicated on this application.
e�
t Valuation: $ /(90
v CI f ..g. 00 c 7 L� W �, _ _^- ( Existing building area: square feet
,/— �� New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
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: ( ) Fax: : ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: 6. ,,,,,y2 ! 4 .r-rr i
Permit fee:
Address:
/J' 1)... S Gv
City/State /ZIP: Co fe</'a/l /,� S ' 3 State surcharge (8% of permit fee):
FLS plan review (40% of permit fee):
Phone: (6r4 ( ) 7 5,),_ 2 I Fax: (5y1) 7 9 H?- 5 (Due upon application.)
CCB lic.: /0 Q 3 \— Total permit fees:
—
Authorized signature: Amount received: 7� ,
..--1--c-.----- This permit application expires if a permi i s not obtained
Print name: ID f,41-4/ y� � Date: 5 3 -- 07 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\ Permits 'FPS- PennitApp.doc 03 /23/06 440- 4613T(11 /02/COM/WEB)
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City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) El New 2.) Modification to sprinkler heads only:
❑ Addition El 1 -10 heads: No plan review required.
El Alteration ❑ 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: I $ /(00
C.) Fire Alarm •
Submittal shall Battery Calculations ❑ 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.
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $ /OW
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (8% of permit fee): $
FLS Plan Review (40% of permit fee): $
TOTAL: $
Plan review requires a completed application and 2 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 \Pemvts \FPS - PermitApp.doc 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2007 -00252
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/24 /2007
Phone: (503) 639 -4171 f � l
Inspection Requests (24 Hrs.): (503) 639 -4175 � _-
INSPECTION WORKSHEET FOR DATE: 7/10/2007 TIME: 7:00AM PAGE: 76
SITE ADDRESS: 12725 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT #: 050 TYPE OF USE:
PROJECT NAME: NEW YORK NEW YORK
DESCRIPTION: Fire suppression
OWNER: FUNK, JAMES H, PHONE #:
CONTRACTOR: GUARDIAN FIRE PROTECTION PHONE #: 541 - 752 -2258
Inspection Request Scheduled For: Date: 7/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 051656-01 541-752-2258 N
10
Corrections /Comments /Instructions:
( PAS RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL % CALL FOR INSPECTION ❑ ADDITIO AL FEES ASSESSED
Inspector: Date: / i Phone #: (503) 718-
,
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: BUP2007 -00252
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/24/2007 lb
Phone: (503) 639 -4171 g
Inspection Requests (24 Hrs.): (503) 639 -4175 _
INSPECTION WORKSHEET FOR DATE: 7/10/2007 TIME: 7:00AM PAGE: 75
SITE ADDRESS: 12725 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT #: 050 TYPE OF USE:
PROJECT NAME: NEW YORK NEW YORK
DESCRIPTION: Fire suppression
OWNER: FUNK, JAMES H, PHONE #:
CONTRACTOR: GUARDIAN FIRE PROTECTION PHONE #: 541- 752 -2258
Inspection Request Scheduled For: Date: 7/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
9 Suppression trip test 051658 -01 541- 752 -2258 N
Corrections /Comments / Instructions:
•
PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ' LL FOR INSPECTION ❑ ADDITIO AL F .ES ASSESSED
i zip(
Inspector: Date: a _, Phone #: (503) 718-2--‘
al