Permit C ITY` OF TIGARD • BUILDING PERMIT
.
PERMIT #: BUP2007 -00343
COMMUNITY DEVELOPMENT DATE ISSUED: 6/29/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
• PARCEL: 1S134BC-00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 1 STF ZONING: C - N
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: 1ST. FLOOR MPG
Project Description: Relocate (1) head and plug (1) to meet code.
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: B TOTAL AREA: 0 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: $ 1,063.00
Owner: Contractor:
SISTERS OF PROVIDENCE IN OR BASIC FIRE PROTECTION INC
BY STEVE FOSTER 8135 NE MARTIN LUTHER KING BLV
PO BOX 13993 PORTLAND, OR 97211
PORTLAND, OR 97213
Contact #: PRI 503 285 - 1855
Phone:
FAX 503 - 285 -0713
Reg #: LIC 48641
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 6/29/2007 $62.50
[TAX] 8% State Surcha 6/29/2007 $5.00
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 -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: �J Permittee Signature: Z
....cdtLy. 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.
Fire Protection System RECEWED
Building Permit Application FOR OFFICE USE ONLY
JUN 2 9 2007
City of Tigard R D e a te e d / 01% 6 ^ , �L y permit No.: ' 2
° 13125 SW Hall Blvd., Tigard, OR 9720f OF TIG D Plan Revi w / t
' 2 Phone: 503.639.4171 Fax: 503.59EUED`NG+ DIVISION Date/B : Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By: el See Page 2 for
Internet: www.tigard or.gov Notified/Method: EN 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
Fs Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- 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: / a yy/ 3c✓ -Sc. 400 4 it-07y Roca New dwelling area: square feet
City/State /ZIP: 7; „„/ , dk q—f a a 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: /5i 0C1 Ix /'"v G PM 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.
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.
rice $ it i ler .
/ Valuation: $ 4 063 ° x
eee (o �f� / 4ec q. ,44 / — #4 tie, Cdot Q Existing building area: square feet
New building area: square feet
(PROPERTY OWNER ❑ TENANT Number of stories:
Name: /4011 .Sc SoJ /s /e "P . c � c. ( P /etc Type of construction:
Address: 42. tell .. SW Sc !, o d (s �-�i y tau a� /n Occupancy groups:
City/State /ZIP: 7p A O2 9.7 ?„2 3 Existing:
Phone: ( ) / Fax: ( ) New:
ca-APPLICANT ❑ CONTACT PERSON NOTICE
Business name: eaz % C , I / � f e Pro-f e f ; trot All contractors and subcontractors are required to be
Contact name: ��� c L ld licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 8 S ILF ,yIG lc. S4. 4L tJ 0 jurisdiction in which work is being performed. If the
�„f applicant is exempt from licensing, the following reasons
City/State/ZIP: 35 . / _ . �O -Wo a. `T 7oZ / / apply:
Phone: (SOS) An_ (' s,$- Fax: : (503) Z( - o-; /3
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: /S ic Fil14-- Permit fee: q.2, Sv
Address:
State surcharge (8% of permit fee):
City/State/ZIP: FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.: tin q/ / �
Total permit fees:
Authorized signature: / Amount received:
///��� / This permit application expires if a permit is not obtained
Print name: /O 0 1/ eg4 µ em p, Date: 6 /..7q /p 7 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I: \Building \Permits \FPS- PermitApp.doe 03/23/06 440-4613T(Il /02/COM/WEB)
Y + r
City of Tigard: Fire Protection Permit Checklist
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: $
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): $
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: $
C: \ken\STANDARD\DETAILS\PERMITS \City of Tigard FPS - PermitApp.doc 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP 007 -003 3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/29/2047
Phone: (503) 639 -4171 pig I
Inspection Requests (24 Hrs.): (503) 639 -4175 I -
INSPECTION WORKSHEET FOR DATE: 10/11/200 TIME: 7 :01AM PAGE: 83
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 1STF CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: 1ST. FLOOR MPG
DESCRIPTION: Relocate (1) head and plug (1) to meet code.
OWNER: SISTERS OF PROVIDENCE IN OR, PHONE #:
CONTRACTOR: BASIC FIRE PROTECTION INC PHONE #: 503. 285-1855
Inspection Request Scheduled For: Date: 10/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
999 Sprinkie.r final 057361 -01 503- 518.3965 N
Corrections /Comments/ Instructions:
,
1
PAss ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
16/1 1 / �
1
Inspector: Date: Phone #: (503) 718 - l
CITY OF TIGA9�® � 6u/goz co 3' 3
'UILDING DIVISION '� PERMIT # r *a •_.
13125 SW Hall Blvd., Tigard, OR 97223 0 A TE IS - D: 7/24/2(x0/
Phone: (503) 639 -4171 /� "l i
Inspection Requests (24 Hrs.): (503) 639 -4175 _`:` -=: ifi
INSPECTION WORKSHEET FOR DATE: 10/10/2007 TIME: 7 :01AM PAGE: 45
•
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE
DESCRIPTION: TI - Tech /Draw area remodel.
OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 503 - 215 -6282
CONTRACTOR: IN LINE COMMERCIAL CONSTRUCTION PHONE #: 503 -642 -511 i
•
Inspection Request Scheduled For: Date: 10/10/2007 31$fiL/' Po Time: i
_
Code # Inspection Description Confirm # Contact # Me .age e
230 Final inspection 057292-01 503.619-3965 Y
fi _ r
Corre ions /Comments /Instructions: „. D r -
l/C
f p 01 L ' • 0 .-- 0 7 -, C, \A lAi‘Vkv‘6\,) .
10 41 6. ice 20 01 o 0343 C, , t,r, s. 5 Q___-
•
•
C. a \ - / ( i k A ' A c. i - '
i
v PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
v6 i Inspector: Date: ( Phone #: (503) 71 S- Z� 2%i
CITY OF TIGARD . .
BUILDING DIVISION PERMIT #: BUP2007 -00343
13125 SW Hall Blvd., Tigard, OR 97223 ISSUED: 6/29/2007
Phone: (503) 639 -4171
I
Inspection Requests (24 Hrs.): (503) 639 -4175 I1-.
INSPECTION WORKSHEET FOR DATE: 9/21/2007 A E: 7:00AM PAGE: 42
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 1STF CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: 1ST. FLOOR MPG •
DESCRIPTION: Relocate (1) head and plug (1) to meet code.
OWNER: SISTERS OF PROVIDENCE IN OR, PHONE #:
CONTRACTOR: BASIC FIRE PROTECTION INC PHONE #: 503285 -1855
Inspection Request Scheduled For: Date: 9/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
995 Misc. inspection 056054 -01 503-519-3170 N
CL SO ) j �%...ot-c. (-0- Yomv■ 'Corrections /Comrlgents/ Instructions:
j/PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: VL V'- Date: 1 4 1 6 1 P hone #: (503) 718- I'l 7)1