Permit C ITY OF TIGARD BUILDING PERMIT
PERMIT #:
° COMMUNITY DEVELOPMENT DATE ISSUED: 9 21 2007 00475
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 110AB -00200
SITE ADDRESS: 14455 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: CANTERBURY SQUARE LOT: 1 -3 JURISDICTION: TIG
PROJECT: SILVER PALACE RESTURANT
Project Description: Replacing old fire suppression system with UL 300 system.
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: 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: $ 4,400.00
Owner: Contractor:
KOLVE, G C FIRE SERVICES PLUS
14389 SW PACIFIC HWY 17675 SW FARMINGTON #118
TIGARD, OR 97224 BEAVERTON, OR 97007
Phone: Contact #: PRI 503 848 - 2345
FAX 503 - 259 -0444
•
Reg #: LIC 162825
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcha 9/6/2007 $6.72
[FLS] FLS Pin Rv 9/6/2007 $33.58
[BUILD] Permit Fee 9/6/2007 $83.95
Total $124.25
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 ules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 10. u may obtain a copy
of these rules or direct questions to OU by calling 503.246.6699 or 1.800.332.2344.
111111111w. -
Issued = iJ�` ii,/ / / Permittee Signature
Call 503.639.4175 by 7:00 a.m. for an inspection that business /y.
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.
•
•
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,,. uildin Permit A lica PtC /Y '
`f Fire Protection System ', { FOR OFFICE USE ONLY
Received pi �
Permit No
, � .: /
II
a 131 of Tigard `4"' 0 6 2007 /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ��
17 . tl 6Q , Date Rea. —1- :
Inspection Line: 503.639.4175 alr
Phone: 503.639.4171 Fax: 50 j ��, E Other Permit:
T I G A R D I Y (Jr ti.J�r i Ii A. e ® See Page 2 for
• ' qt Jugs:
Internet: www.tigard or.go '" r.x- -+ N o t i fi ed/Method: 4,0 /� ._ Supplemental Information
' a 'U. 1../ii X 31'• W _ %M.�
TYPE OF WORK r� Rif 1 1 • t A: 1- AND • • I I Y DWELLING
❑ New construction ❑ Demolition Permit fees' .- . . - - don 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 Commercial /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: faf. , f � New dwelling area: square feet
1 y � Sw lit y
City /State /ZIP: 71— ti nA v n lc q 7 a2 Garage /carport area: square feet
L
Suite/bldg. /apt. no.: Project name: S kteV O(.t 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 app ation.
R t G 1,% ttik I .rP 3 uV 1 tyre 5 i. , .�9✓I -VS�'fWl Valuation ],} (llt'0
w u 1 1 1 V 505 sys „� [ Existing building area: � square feet
3 J / J ' f ' New building area: square feet
X PROPERTY OWNER ❑ TENANT Number of stories:
Name: G C /'K 0 L.. J y Type of construction:
Address: f q-3 Qq S 0 P f }'C ( F ! G y Occupancy groups:
City /State /ZIP: T(C- �J 97 Z y / Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: I^ j Je___ c -P.Irv f 1 v C All contractors and subcontractors are required to be
Contact name: J c , vi j� licensed with the Oregon Construction Contractors Board
Yt^ under ORS 701 and may be required to be licensed in the
Address: 176 7 .1 1 R jurisdiction in which work is being performed. If the
S VN'11I h �� applicant is exempt from licensing, the following reasons
City/State /ZIP: F5 •Q6t V 11^9 ir 9 7 D
apply:
Phone: (973) g�A -13 I Fax:: ( )
E -mail: J
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: 7 ` Se�V1 c>°S P� S
Permit fee:
Address: I l
6 7S � F rW `' State surcharge (8% of permit fee):
City /State /ZIP: P&V toy- �DU FLS plan review (40 % of permit fee):
Phone: 6-03 ) Dig, 43/.4. -.;-- �- I Fax: (G5 ) _0 ( {U f (Due upon application.)
�
CCB lic.: t 6a ,/, c 111
" q _ 1 Total permit fees: /z4. 76
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: [�� $ 1 I Date: within 180 days after it has been accepted as complete.
Let * Fee methodology set by Tri -County Building Industry
Service Board.
1: \BuildingTermits\FPS- PermitApp.doc 03/23 /06 440- 4613T(II /02/COM/WEB)
e r
City of Tigard: Fire Protection Permit Checklist t.
Page 2 -, Supplemental Information
Describe work to be done:
1.) ❑ New 2.) • Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ 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 $ k4eO
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): $ 'j , if-co . c o
Permit fee based on project valuation (see fee schedule): $ Tr3 , 9 S
Permit fee based on square footage (see D above): $
State Surcharge (8% of permit fee): $ (P • �Z
FLS Plan Review (40% of permit fee): $ '� 3 •5�
TOTAL: $ - 2 .
Plan review requires a completed application and 2 sets of plans' at submittal. Plan review fees are required at submittal.
1
"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 \Permits \FPS- PermitApp.doc 2
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: BUP2007- 00-176
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/21/2007
Phone: (503) 639 -4171 V'
Inspection Requests (24 Hrs.): (503) 639 -4175 F'L L—
INSPECTION WORKSHEET FOR DATE: 10/31/2007 TIME: 7 :00AM PAGE: 115
SITE ADDRESS: 14455 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: CANTERBURY SQUARE LOT #: 1 -3 TYPE OF USE:
PROJECT NAME: SILVER PALACE RESTURANT
DESCRIPTION: Replacing old fire suppression system with UL 300 system.
OWNER: KOLVE, G C, PHONE #:
CONTRACTOR: FIRE SERVICES PLUS PHONE #: 503.948 -2315
Inspection Request Scheduled For: Date: 10/31/2007 Z o Pour Time:
Code # Inspection Description Confirm # Contact # Message
9 �0 Suppression trip test 058511 -01 503. 349.7690 N
Corrections /Comments / Instructions:
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I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ` El CALL FOR INSPECTION ❑ ADDITIO AL FS ASSESSED
vw Inspector: Date: t Phone #: 503) 718-