Permit A CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00320
AwSO47A i1 DEVELOPMENT SERVICES DATE ISSUED: 7/19/02
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15532 SW PACIFIC HWY C -7 PARCEL: 2S110DC -02200
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: 5 -1 HR sf N: S: E: W:
OCCUPANCY GRP: M 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: $ 450.00
Remarks: Raise 3 existing fire sprinklers to higher ceiling elevation.
Owner: Contractor:
TIGARD, CENTER LP FIRESTOP CO
9777 WILSHIRE BLVD #609 9384 SW TIGARD ST
BEVERLY HILL, CA 90212 TIGARD, OR 97223
Phone: Phone: 620 -6140
Reg #: LIC 63846
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Final
PRMT CTR 7/19/02 $62.50 27200200000
5PCT CTR 7/19/02 $5.00 27200200000
Total $67.50
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344. '---
Perm ittee
Signature: O j. A?_ 44 • i
Issued By: )6 L%c :2�
Call 639 -4175 by 7 p.m. for an inspection the next business day
I. .
A r -\ -- , Building Permit Application
„ Datereceivedlcr / a 2-- Permit no.:(3U7 .Dorn c7
3
. -
4 � y City of Tigard //
Project/appl.no.: Expire date:
CiryojTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 - 4171 Date issued: By:t Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: l &2 family: Simple Complex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory • Co mercial/industrial ❑ Multi- family ❑ New construction 0 Demolition
❑ Addition/alteration/replacement Vienant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: ,S Z g — Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: i Ce f :Iv
Descri ,ion and loca ion of ork on premise special conditions: 2/' 2 6
I .., .•L1 e / /N __ :r o
. OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
J (� J (Floodplain, septic capacity, solar, etc.)
Mailing address: i /4 of If u I1 • 60 - 1 & 2 family dwelling:
IIEMMBIZariliZEMIEEMFA ZIP: ' i Z/Z 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.)
APPLICANT Garage/carport area (sq. ft.)
CEIII%5151111r ___if 10N Covered porch area (sq. ft.)
i /� Deck area (s . ft.)
Mailing address: ��•� /�� q
/ Other structure area (sq. ft.)
- � �" J ��� ZIP. �� CommercaUid iU i
nustramulti - faml
Phone: 4p 20 — . ( j Fax: 620 - 0 E -mail: i y: 4s� —
CONTRACTOR Valuation of work $
Business name: P do Existing bldg. area (sq. ft.)
i i ' New bldg. area (sq. ft)
Address: ' 3S d
:1 1 State: O L ZIP: . Number of stories ZEMM
Phone: 4,20 - W , 0 Fax: 1120.4 1, E -mail: Type of construction
CCB no.: ,3 Occupancy group(s): Existing:
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER 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: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $ tol. SD
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 a and ordinances governing this o Visa o MasterCard
work will be complied wi whether • led herein or not. Credit card number: / /
Expires
Authorized signature: n /� 04-1211m) te: 7/17'0 . 2— Name of cardholder as shown on credit card
Print name: / ✓ 7 u t b . / Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440.4613 (6/00/COM)
x ,
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 I $
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: $ 6-2, 5 )
•
i:\dsts \forms \FPScheddist.doc 06/07/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION D'VISION Business Line: (503) 639 -4171 MST
BUP -mod c9
Received Date Requested 1 (.2--6 AM PM UP Z c9 o Z _e6 3 2-0
Location . 5 �� 7j Z / Suite C.. — 7 MEC
Contact Person Ph ( ) 0 /- 515 PLM
Contra • Ph ( ) /5-6 4 ' SWR
4 r DIN ;, Tenant/Owner I T1 4 /e ELC
ELC
Flo) dation 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 49 9
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
ART FAIL
' ! BIND
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 reinspect'o RE: El Unable to inspect — no access
Fire Supply Line
ADA i)
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL