Permit J
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2000 -00013
ii DEVELOPMENT SERVICES DATE ISSUED: 01/25/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134BC -00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 206
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: 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: $ 4,019.00
Remarks: Modification of 22 sprinkler heads to existing system.
Owner: Contractor:
PROVIDENCE HEALTH CARE SYSTEM BASIC FIRE PROTECTION INC
4706 NE GLISAN ST 940 NE LOMBARD ST
PORTLAND, OR 97213 PORTLAND, OR 97211
Phone: 215 -2692 Phone: 285 -1855 O R I G N A L
Reg #: LIC 000486
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough -In
FIRE DEB 01/11/200C $27.40 00- 320955 Sprinkler Final
PRMT KJP 01/25/200C $68.50 00- 321388
5PCT KJP 01/25/200C $5.48 00- 321388
Total $101.38
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 -1987.
•/
. / Pemiitee
Signature V /j
! a'L)
Issued By: - —QQ.A..4,
/
Call 639 -4175 by 7 p.m. for an inspection the next business day
i
Fire Protection Permit Application Plan Check # /- 7 '
CITY OF TIGARD Commercial or Residential Recd By / a ;l1%
13125 SW HALL BLVD. Date Rec'd 1 - f/ - ok1
TIGARD, OR 97223 Print or Type Date to P.E. I -Yi - 7_:'
(503) 639 - 4171, x. 304 Incomplete or illegible applications will not be accepted Date to DST 1- t1- 0 04 7 •
Permit # - 00en 'S
/ / Called ; -'2-. 7 -
Job rime of pevelme rojea Type of System (Complete A or B as applicable)
Address ldress
z , Z S rtJ _u, _ _ T A.) Sprinkler Wet Dry ❑
'
N ame �� I ��5� ,-,..,17-t r i Standpipes 0 (A
I -4�—
Owner Mailing Address Hazard Group
44 i..1 L' S Ftf■ (; Additional
,q ity /State Zip Phone Information Density
r'J) tom-. 9�a-0., ate 2(41:2
Aa gg Design Area
W L14!0 t 1j-, .1. 20 4.
Occupant Mailing Address „ K. Factor •
1'L ( 1 1 42, 7 th Sup o(..c�3 1 I P.
City /State Zip Phone A. Sprinkler Project Valuation $ co
-i lG0 cut-. 91x43 q0 9
Contractor Name '` B.) Fire Alarm 14/A.,
(Sprinkler or l/ IC. r i � P ' 41 O7 J
Alarm Company) Mailing Address Submittal Shall Include Battery Calculations YES ❑
Prior to permit el c(-• J, lam, ( PAa'
issuance, a City /State Zip Phone Individual Component YES ❑
2 Cut Sheets
of all licenses ( '' q1 1 24 6'5 - i v "� -3 B.1) Fire Alarm Project Valuation $
are required if State Const. Cont. Board Lic.# Exp. Date ,..7:5/___.
expired in COT - fec ' - I j _ , 6 Project Valuation Subtotal (A & or B) $ ,1U 1 --
database T
Name Permit fee based on valuation '`, 57-1 �f�R�aJ — 31Viscv5 ki AR-0.4. $ �� y
(see chart on back)
Architect Mailing Address
I '2>b <S L. , $.1U . . .3 E. 00 . ( ( ,-I ✓ e Surcharge $ : ' i
City /State � , Ziip Phone FLS Plan Review 40% of Permit $ _ ,;,_
Pat - A,o ori- H 2N - "7°3'1,, ;
Describe work A.) New 0 Addition 0 Alteration 0 Repair 0 ���-
to be done: TOTAL $ 101,
B.) Modification to sprinkler heads only:
1. 1 -10 heads= No plans required Plans required: Submit three sets of plans, including a vicinity map and
2. 11 += Plan review required the location of the nearest hydrant.
I hereby acknowledge that I have read this application, that the information given is
Number of sprinkler heads: C-2-- correct, that I am the owner or authorized agent of the owner, and that plans submitted
Additional Description of Work: are in compliance with Oregon State laws.
Signature of Owner /Agent Date
A.) In Existing Building New Building ❑ 07-1-idia--- a- 3o -99
Building Contact Person Name Phone
Data B.) Commercial XI Residential ❑ LAr�ar r ��L1 - 29'S= IBS 7
FOR OFFICE USE ONLY:
No. of stories: Plat # Map�rL #:
Sq. Ft:
Notes
Occupancy Cla Type of Construction
l
is \dsts \forms \firesupr.doc 7/2/99
01/24/2000 Fees Associated with Case # BUP2000 -00013
11:03:55 AM
Fee Case Start End Trans. Create Created
Type Type Date Date Case No. Dept. Description Code Revenue Account No. Date By Amount Due
FIRE BUP 01/01/1990 12/31/2005 BUP2000 -00013 [FLS] FLS Pln Rv 245 - 0000 - 433020 01/11/2000 DEB $27.40 $0.00
•PRMT BUP 01/01/1990 12/31/2005 BUP2000 -00013 [BUILD] Permit Fee 245- 0000 - 432000 01/19/2000 RDP $68.50 $68.50 00 ILD
5PCT BUP 01/01/1990 12/31/2005 BUP2000 -00013 [TAX] 8% State Tax 100 - 0000 - 207020 01/19/2000 RDP $5.48 $5.48 TAY-
$101.38 $73.98
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2/16/00 Activities for Case #: BUP2000 -00013
3:08:45 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BUPC005 Application received 1/6/00 DEB RECD No Hold DEB 1/11/00
BUPC008 Permit created 1/11/00 DEB DONE No Hold DEB 1/11/00
BUPC012 Plans routed to Plans Examiner 1/11/00 DEB DONE No Hold DEB 1/11/00
BUPCO24 Plans checked /approved by PE 1/19/00 RDP DONE No Hold RDP 1/19/00
BUPCO26 Approved plans routed to DSTs 1/19/00 RDP DONE No Hold RDP 1/19/00
BUPC783 Sprinkler Rough -In 1/19/00 1/19/00 1/27/00 RB PASS No Hold AKJ 1/27/00
BUPC784 Sprinkler Final 1/19/00 1/19/00 2/9/00 RB PASS No Hold AKJ 2/9/00
BUPCO29 DST post - review completed 1/24/00 BON DONE No Hold BON 1/24/00
BUPC090 Ready to issue 1/24/00 BON DONE No Hold BON 1/24/00
BUPC100 (F) Issue permit 1/25/00 KJP DONE No Hold KJP 1/25/00
BUPC960 Case Finaled 2/9/00 AKJ DONE No Hold AKJ 2/9/00
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Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
Date Requested AM PM__ x 7_ -000 l 30
Location 12q t4 3, 3/ s i� Sui4,21* }
Contact Person NMI/ Ph gq9 j Z 2 , PLM
Contractor Ph SWR
ILDI Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: fr y1 �� ST Slab / ��Jl
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire all
ire S rinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
PART FAIL
�1w� BING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
11�IEG`HANICb
Post & Beam
Rough In •
Gas Line
S - ke Dampers
der
PART FAIL
CTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date 2 Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.