Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00443
�
1 DEVELOPMENT SERVICES DATE ISSUED: 10/22/02
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13185 SW PACIFIC HWY B -1 PARCEL: 2S102C6 -00302
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: C -G
BLOCK: � i LOT: 033 JURISDICTION: TIG
FLOOR REISSUE: AREAS sf N: EXTERIOR WALL CONSTRUCTION S
E: OF WORK: AL/1 ` �� FIRST:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: UNK : 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: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,800.00
Remarks: Fire suppression systems for (2) - type I exhaust hoods.
Owner: Contractor:
ALADDIN MOTOR INNS SANDERSON SAFETY SUPPLY CO.
BY BENZENISTE, IRVING 1101 SE 3RD AVE
10155 SW CAPITOL HWY PORTLAND, OR 97214
PORTLAND, OR 97219
Phone: 238 -5700
Phone: 238 -5700
Reg #: MET 00004715
FEES LIC REQUIRED INSPECTIONS
Description Date Amount Sprinkler inspection
[BUILD] Permit Fee 10/8/02 $72.10 Fire Alarm Insp
[TAX] 8% State Tax 10/8/02 $5.77 F Inspection
Final Inspection
[FLS] FLS Pln Rv 10/8/02 $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 -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.
Issued By: e , f ,[.r /42-&.J
Pe rm ittee
Signature: 4 r f n O, (l j� L� /7111 (k.� L
Call 639-4175 by 7 p.m. for an inspection the next business day
,
ou L
Building Permit Application
A Datereceived: %„'! j/Q Z..- Permit no 2gaPZooZ 1) qy3 Q
4,,. ,''"411' City of Tigard l: � !go"
_.. � � 1. - ' Projecdappl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd Tigard, OR �J
Phone: (503) 639 - 4171 ft', 1 Date issued: By Receipt no.:
■ Fax: (503) 5 - 1960 Case file no.: Payment type:
Land use approval: �.�il t ui 11 ' " . ` r 1 &2 family: Simple Complex:
PP c="•1�t T r •
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory • - ommerciallindustrial ❑ Multi- family G ew construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: %t_ 5. r. — t
JOB SITE INFORMATION
Job address: /3 S G , c.7 i / Bldg. no.: - _ Suite no.: 8 --1
Lot: Block: Subdivision: I Tax map /tax lot/account no.:
Project name: � - /vaotv /� te .-7 /
Descri tion and 1 ation of work on premises/s cial conditio • ST4Y i ti / / -w�-
e and
"/� ,,Sf,o — , ' 5 , ` A t oe ��saL Mai) .
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: (Floodplain, septic capacity, solar, etc.)
Mailing address: 1 & 2 family dwelling:
City: ( State: I ZIP: 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.)
Garage/carport area (sq. ft.)
! c1'
Name: ,re l,r cP/ a„r- ... -.-- -
Covered porch area (sq. ft.)
Mailing address: / /Q/ $ 7'G Deck area (sq. ft.)
City: � i . s. I Stater I ZIP: 4, 7,2 / t-/ Other structure area (sq. ft.)
F ax: yyj E -mail: CommerciaUindustriaUmulti- family: o O
Phone: ,,,f S/- 00 �S�- Valuation of work $
CONTRACTOR �
S PiSo .---- A �/ Existing bldg. area (sq. ft.)
Business name: 3 u' � / New bldg. area (sq. ft.)
Address: //c) /
City: ° i h4 I State:: ( ZIP: 97; / C7 Number of stories
Type of construction
s
Phone: A 1E-mail: Occupancy group(s): Existing:
CCB no.: 6 t_/ 9 6 c7 . 2 9 1a } / New:
City /metro lic. no.: OQ L/ �/ / S-- Notice: All contractors and subcontractors are required to be
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: I State: (ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
Name: Contact person: Fees due upon application $ ___/.0 6 - -7 f
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 ❑ MasterCard
work will be complied with ,,,�yi i er specified herein or not. Credit card number: Ezpir/
Authorized signature: / . -Date: /19 7 Name of cardholder as shown on credit card
Print name: /V (• C / 0 i-r^'•�."s Cardholder signature $ Amount
Notice: This permit application expi . ' a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/OOICOM)
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 ❑
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A, B & C): $
Permit fee based on valuation (see chart): $
8% State Surcharge: $
FLS Plan Review 40% of Permit: $
TOTAL: $
is \dsts \forms \FPSchecklist.doc 06/07/01
CITY OF TIGARD . ' 24 -Hour .
• BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION " Business Line: (503) 639 -4171- MST c,L
• • BUP 6,
Received Date Requested l ( 114 AM PM . BUP
Location 31g5
Suite e� — / MEC
Contact Person y Ph ( ) "290 I a PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ,_ ' = i..1.. ELC
Footing
Foundation ELC
Fog Drain Access: pt << f ✓�: 46- z G 7)PC ELR
Crawl Drain
Slab Inspection Notes: ei -� q .. /0 SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear —
Int Sheath/Shear
Framing
Insulation 7 ' , /
Drywall Nailing 1� hoc) D S „T X i/ `'` "1
Firewal 7 j 1-/00.135
e Sprinkl=
Fire arm
Susp'd Ceiling
Roof
rn; PART FAIL
PL ' = ING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
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: El Unable to inspect — no access
Fire Supply Line
ADA D a t e / ///y16 Ins Ext
P P ( Vv'
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
1=111111•11rel A A1AEW,& 1101 S.E. 3RD AVENUE • PORTLAND, OREGON 97214 • (503) 38-5700
IIV P 1' 850 CONGER • EUGENE, OREGON 97402 • (541) 683 -9333 •
IMMOilISAPETY COMP Y 2600 AIRPORT WAY, SOUTH • SEATTLE, WASHINGTON -98134 • (206) 340 -4300
- —* I
CERTIFICATION - .INSTALLATION /INSPECTION
Customer Name !` , .,_3
Address t f (, ,,ii 1.L f
• ' 72_
4 i ` -
/ l
SYSTEM � /`
Model(s) and serial numbers ,�:1fr9 c;.- f 7 (r ` ' i_ /... °-
Number of nozzles and Part No. /),- r ` s �✓lrt p'►— / � /,! �1
Number of detector(s) and degree rating / A � 7 Co
Energy shut -off devices — type and size ,/t °{ - .. • c f �' /.. P
Other accesso - equipment provided - (.pull station, electric switches, etc.) ///
ik -e .• y " a ,l f _ � ' ( , ,i . - fG S Z 1 7r .. ) _.
COOKING /VENTILATING EQUIPMENT
Number of duct(s) and size / .5) - //
Hood size and plenum size / U 9 — -r0 ' ...1 R v 0- ` .r -/ (1 f rl,
Cooking Appliances and size of cooking surface. (NOTE: List appliances from left to right and indicate those
being protected.)
S t
1. r ' i ? 1.- ' !' .r c +F' �- Y Y 1 4 . 4.
2. ( 1 / ‘-',6:S + , ,...i,f-.11 --1. *-. 7 ../ 5.
3. r' ,- _ .. -f - f t L /J P 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.
CUSTOMER NAME AND TITLE
i ES ❑ NO
All electrical work or work provided by others to SIGNATURE
complete this system iinstaall atiion has been completed. DATE 1
�ll
INSTALLER NAME --� ti v.-4 - J �� 1 ‘ j' _,.....- .
SIGNATURE ( - f,,,.). t . E' 5 f r• f (P 1
DISTRIBUTOR ''-.. �• i- r P /f a --- S f ADORES$. / L. f t / / ' = a Y vhf )4 DATE - CJ
1•11111•MeAli1AiertebAil1 1101 S.E. 3RD AVENUE • PORTLAND, OREGON 97214 • (503) 238 -5700 -
imorw IWM I P 1. 850 CONGER • EUGENE, OREGON 97402 • (541) 683 -9333
i SAFETY CO f''A JY 2600 AIRPORT WAY, SOUTH • SEATTLE, WASHINGTON 98134 • (206) 340 -4300
-*
•
CERTIFICATION - -- INSTALLATION /INSPECTION
Customer Name /1/25- 7/f o .0'" / ak 'Q"
Address
/ t A (I i
/ . 5 ,e -
/ rs ,
SYSTEM ���,v
Model(s) and serial numbers �E • t--- 1 +c. ' - 1 424, -
Number of nozzles and Part No. c- l / - �'�Pii . A 1 . - J ta
Number of detector(s) and degree rating /-..?
°
Energy shut -off devices — type and size '<i 4 ..-1 r'I 4_ t gig- 'S cry / (J'?
Other acces ry equipment provi d (pull station, electric switches, lit.) j r !
1 41/ ,. °farms �__ 1.J [e) )% t.., 10 0..)x_
COOKING /VENTILATING EQUIPMENT
Number of duct(s) and size /1P /) , "/ 6
Hood size and plenum size r` •. /ifJ 0 { ; ` �f :Pa .c. �"� — •
/--, �'
Cooking Appliances and size of cooking surface. (NOTE: List appliances from left to right and indicate those
being p.rotected.) t ,,
1 . Cam^• c� y - / { to 4.
2, f 5.
3. 6.
TO BE COMPLETED BY INSTALLER
Er A 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.
CUSTOMER NAME AND TITLE
.Er'YES ❑ NO
All electrical work or work provided by others to SIGNATURE
complete this system installation has been cotpJWed. DATE
INSTALLER NAME 1IT , , ,- -f / ( {
SIGNATURE ! 7" �,... -,�'` 4 e SAS P o . s"`S
DISTRIBUTOR f ,. _ ,� `
r -- �
ADDRE
, / t 7 -�
DATE pi-- �) -- { ; a � / /
,.
t
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 zn erg - 6 0 4 /7
INSPECTION DIVISION Business Line: (503) 639 -4171 dT
BUP
Received Date Requested AM PM BUP 2 ' oo S
Location 1 3 1 < Suite MEC °p — D o S9
Contact Person C/414%1-1:6 Ph ( ) 3 8' 5 7 8) e ra y Z- 7
Contra Ph ) �0 8 4 t ' SWR
/ -rT ;,
CilLDING � Tenant/Owner - ELC
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
'Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof „L
Other:
1660 PART FAIL
• - ' BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PA T FAIL
ECHANICA
Post �t
Rough -In
Gas Line
Smoke Dampers
t I
kgli PART FAIL
y -+;;;' - ICAL
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 / (/
Approach/Sidewalk Date / � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL