Permit Y
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00103
_PI A DEVELOPMENT SERVICES DATE ISSUED: 4/5/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110DC -02200
SITE ADDRESS: 15570 SW PACIFIC HWY
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 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: 3N : sf N: S: E: W:
OCCUPANCY GRP: M TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 1,321 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: $ 17,000.00
Remarks: Fire Alarm.
Owner: Contractor:
TIGARD, CENTER LP STONER ELECTRIC
9777 WILSHIRE BLVD #609 2701 SE 14TH AVE
BEVERLY HILL, CA 90212 PORTLAND, OR 97202
Phone:
Phone: FAX- 239 -9521
Reg #: 503-233-363823
FEES REQUIRED INSPECTIONS
Description Date Amount Fire Alarm Insp
[BUILD] Permit Fee 3/12/04 $206.50 Smoke detector insp
[TAX] 8% State Surchari 3/12/04 $16.52 Final Inspection
[FLS] FLS Pln Rv 3/12/04 $82.60
Total $305.62
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 (50 = _ - • 9 or 1- 800 - 332 -2344.
ilai
Iss ed By: ` 44 -
Pe ' ee ,- Awdr Alt
Signature: AM '
f
Call 639 -417 01 7 p.m. for an inspection the next business day
155 ?O .Sw pic« Moo?
FZre_Protection vil e t)
, uildln;; P phcatlon FOR OFFICE USE ONLY
City of Tigard �Q 1 ���
`( R ra /� Permit o. ii O
_ 0 / Q
13125 SW Hall Blvd., Tiga R 97223„.., p BD Plan Revie , / v
Phone: 503.639.4171 Fa Q�. @. 1ld ON ! y. Adritnpo DateB : 3 3 /' 0 4� 12517 Other Permit.
Inspection Line: 503.639. 4 G DI v � Date Ready/By: s , WV" IlliliMMI ® See Page 2 for
Internet: www.ci.tigard.g I L01N Notified/Method: - -D , t Supplemental Information
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
K 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 Commercial /industrial /
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION OC ATION Total number of floors:
Job site address: /S� i f Pte
7D ! � , 7i N+� y r New dwelling area: square feet
City/ State/ZIP: 4 / D'Re g74.73 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: s ch- tA ;l ( , 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: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ / 000. —
S'f*A. // .Sp TftAkier 416441 t91' , tv�i 5751 .. �i
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/Z1P: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: ' li,-i, i t— E t fro c_ BUILDING PERMIT FEES*
Address: 1 9 0 b_�
4 / ' � Please refer to fee schedule
city/ State/ZIP: pA O K r D R
T7-,14.2 Fees due upon application
Phone: ( 5p3) 94,4— G co-0 Fax: (y ) (.,SI — Zrba*
Amount received
CCB lic.: 41. f, a „2.,7 W
Date received:
Authorized signature: 2 4, ' eV & 1t� This /S permit a permit is not obtained
eV ���- ��CCC* r within 180 days after it expires has bee if n accepted as complete.
Print name: lJ 41.1.11 IQ L� �i p�--- Date: �/ * Fee methodology set by Tri- County Building Industry
�' Service Board.
i:\Building\Pcnnits \FPS- PermitApp.doe 12/03 440- 4613T(II /02/COM/WEB)
Fire Protection Permit Check List
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.
El 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: $
C.) Fire Alarm
Submittal shall Battery Calculations Jf ' Yes
include: Individual Component Yes
Cut Sheets
Fire Alarm Project Valuation: $ /7
i
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.
i:\ Building\Forms\FPSchecklist.doc 12/24/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 fL i il c i��+MST
Received /2.0 2 Date Requested `fr� � T AM PM BUP
Location 4' . Suite MEC
() 32_9- 2
Contact Person � Gi�(/l..�X � Ph (� ) ���1/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner � d ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
-
p7"J2.O f/L7 f C/&J.D N 6_ LOW 1/0L74 GE
Susp'd Ceiling
Roof rCcCuti
Oth: D
-
AS - PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer n
Rain Drains
Catch Basin / Manhole
Storm Drain P
S
1\-.)
hower Pan 1
Other:
Final / 1
5
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: ❑ Unable to inspect — no access
Fire Supply Line L fL
ADA D ` � ��0 Ins actor 1����N j3Li1 [ D Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL