Permit y; BUILDING PERMIT
C ITY OF T I G A R D PERMIT #: BUP2002 -00541
�u� ?�II� - 13125 DEVELOPMENT H BMEN DATE ISSUED: 1/7/03
(503) 639 -4171
PARCEL: 1 S134BC -00401
SITE ADDRESS: 12442 S W SCHOLLS FERRY RD * * ** ,
SUBDIVISION: ZONING: C -N
BLOCK: LOT: 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: 5N 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,104.00
Remarks: Modification of (21) fire sprinkler heads for tenant improvement.
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
Phone:
Phone: 503 - 285 -1855
Reg #: 69D -1779 48641 ����
FEES MET REQRI Q3 SPECTIONS
Description Date Amount Sprinkler Rough -In
•
[BUILD] Permit Fee 12/20/02 $72.10 Sprinkler Final
[TAX] 8% State Tax 12/20/02 $5.77
[FLS] FLS Pin Rv 12/20/02 $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.
Z�- - s�C_
Issued By: / , (.0
Permittee ' ,,�� �
Signature: a��,
Call 639 -4175 by 7 p.m. for an inspection the next business day
v
A •
as;^- Building Per •
Date received: / /0 AA Permit no.: lee
;:' "i► w; City of Tigard
Project/appl. no.: xp dt
City of Tigard Address: 13125 SW Hall Blvd, TIg±O �7 i!I I'2 ( ae: � \
Phone: (503) 639-4171 uV L ��� ++ Date issued: B Receipt no.:
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
ij
Land use approval: BUILDING DIVISION 1 &2 family: Simple Complex: QX)
TYPE OF PERMIT
0 I & 2 family dwelling or accessory ❑ CommerciaUindustrial ❑ Multi-family 0 New construction ❑ Demolition
® Addition /alteration/replacement A Tenant improvement li Fire sprinkler/alarm ❑ Other:
JOB SITE INFORMATION
Job address: a 44A 5, ( A). SC Hoz c S FE RV RD Bldg. no.: Suite no.: 20 2
Lot: Block: (Subdivision: I Tax map /tax lot/account no.:
Project name: pjzo111 CE /4 6ALLTH S LiSTEitA SCHo.(.S FERRY /M,O.13, �\
Description and location of work on premises/special conditions: 1�C oC( /'IN) /{DD HEA D5 TER TENANT "s
/W T0 VE MENT
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: ?RoVl DENCC NEAI,TH SYSTGWI (Floodplain,septic capacity,solar, etc.)
Mailing address: 1 7o 6 N. E, GL. ( S/4 N ST, 1& 2 family dwelling: d
City: ?oRrt q Nl) (State: O'R. (ZIP: g 7a 1 3 Valuation of work $
Phoneo3) I S - 653 5 'Fax: 215-6672 I E -mail: No. of bedrooms/baths
Owner's representative: WAR REM Si /141 Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
Garage/carport area (sq. ft.)
Name: "DA ) G 7 ( s NAM /BNS I c F! RE PR7TEC770N.) Covered porch area (sq. ft.)
Deck area (sq. ft.)
Mailing address: 1
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi-family: 0
CONTRACTOR Valuation of work $ oZ 1 o4 "
Existing bldg. area (sq. ft.)
Business name: T3A5 K.. F i R C "PRo'ECT) 0 IQ New bldg. area (sq. ft.)
Address: 7I 3 S NE 1 1 Tr 131V7, Number of stories
City: " RTLA N D I State: OR. I ZIP: 9 7 Z i t
Type of construction
Phone: 3,it 5 - $ s I Fax:A$S_67(3 I E -mail: DAN e $HStc f 1RE • t( "'bccupancy group(s): Existing:
CCB no.: 4 $6 ( New:
City /metro lic. no.: 304 Notice: All contractors and subcontractors are required to be
- ARCHITECT /DESIGNER. licensed with the Oregon Construction Contractors Board under
Name: 3•Ot. R JURGENS & ASSaC iATES ZAJC.. provisions of ORS 701 and may be required to be licensed in the
Address: 'Mg ( 5455 Nw GREENBR (ER Pktf, surr6 ZG jurisdiction where work is being performed. If the applicant is
City: 730
JERT0A) I State: OR R I ZIP: q 7 a a& - exempt from licensing, the following reason applies:
Contact person: DA11I 0 JOHNSON Plan no.:
Phone: 6.9o i'7 77 Fax: 6cto -o9 /5 E -mail:
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: IZIP: Amount received $
Phone: I Fax: I 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 whether s ecified herein or not. Credit card number: ex
Expires p
Authorized signature: Date: ////3/02.. Name of cardholder as shown on credit card
Print name: A t) G R i S 1.1 AAA\ 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/OO/COM)
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 or B as applicable):
A.) Sprinkler Wet Z11 Dry ❑
Standpipes
Additional Hazard Group L G NT •
Information Density ex 1 5T.
Design Area
K. Factor
Sprinkler Project Valuation: $ ( 0 4, °=
• B.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A & B): $
Permit fee based on valuation (see chart): $
8% State Surcharge: $
FLS Plan Review 40% of Permit: $
TOTAL: $
•
is \dsts \forms \FPSchecklist.doc 10/04/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
&M
INSPECTION DIVISION Business Line: (503) 639 -4171 ST
Received Date Request t ‘ 3 AM PM BUP
Location 42- Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
= I LDINC; Tenant/Owner ELC
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firew.
ire S.'.. -
ire Alarm
Susp'd Ceiling
Roof
0.
in- •
• SS PART FAIL (11:;i715-1\
• ' BING
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: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date y?-676 Inspector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL