Permit CITY O F TIGARD
BUILDING PERMIT
PERMIT #: BUP2003 -00438
�4V�k DEVELOPMENT SERVICES DATE ISSUED: 8/5/03
a,1,L II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 63 -
SITE ADDRESS: 14945 SW SEQUOIA PKWY 110 PARCEL: 2S112AD -01000
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
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REISSUE: ( / pL, FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: p" c `, 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: 33 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: $ 11,860.00
•
Remarks: fire sprinklers
Owner: Contractor:
PACIFIC REALTY ASSOCIATES FIRESTOP CO
15350 SW SEQUOIA PKWY #300 -WMI 9384 SW TIGARD ST
PORTLAND, OR 97224 TIGARD, OR 97223
Phone:
Phone: 620 -6140
Reg #: LIC 63846
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler inspection
[BUILD] Permit Fee 7/22/03 $158.50 Sprinkler Rough -In
[TAX] 8% State Tax 7/22/03 $12.68 Sprinkler Final
•
[FLS] FLS Pln Rv 7/22/03 $63.40
Total $234.58
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: . 0 4A T.(M )
Pe mi ittee yr l pp • -'��" /�
Signature: Y GU %( f 1N ,5 /)wii
C all 639 -4175 by 7 p.m. for an inspection the next business day
l '#9 s Fire sw Si4 0 IAPi C 1CW4
re Protec ion system
Permit OFFICE USE ONLY
' Building Permit Application r Date/By: .' � 2 Building
No.: ?,1)�a Oa3 �5 ,/� '
y: - 1 -�-D,.; - O �jl "� mt -O T D
Planning Approval Other -1
City of Tigard \' �D Date/By: Permit No.: yu 1 0 - [ O 3 ;v
R
13125 SW Hall Blvd. ECEI V Plan Review C Other
Tigard, Oregon 97223 s • Date/By:7-�' .,/0,/17 Permit No.:
Phone: 503 - 639 - 4171 Fax: 503 8 1 "16 " � Post - Review Land Use
J � 2Q , ,.I I Date/By: Case No.
—
Internet: www.ci.tigard.or.us C ontact Juris.: ® See Page 2 for
24 -hour Inspection Request: IGIV 1 Name /Method: T I G Supplemental Information
BUILDING p IV IS10
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
[]' Addition/alteration%replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ I & 2- Family dwelling 12tommercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION `, No. of bedrooms: No. of baths:
Job site address: 141145 So SF, i uci4 P4l - r Total number of floors
New dwelling area (sq. ft.)
Suite #: 1 I D 1 Apt. #: C ) Garage /carport area (sq. ft.) •
Project Name: 5-rezU 136, (bmr n 04j lC.AT1. h i.9, S Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
PACik C- �2P Dra-T Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: Lot #:
_ Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
Valuation $ ll , B Io D
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
0 PROPERTY OWNER I ❑ TENANT Type of construction
Name: pfkc jPtt 5 — Occupancy group(s): Existing:
New:
Address:)53SO ` iA) 3tiUi.nIE} PRk&V t# t
City /State /Zip: Pok_ri i.q.A l2_ R7 2,2_,y
Phone(5�)( Fax :( (p�}�- - ]�l SS NOTICE: All contractors and subcontractors are required to be
SLF licensed with the Oregon Construction Contractors Board under
PPLICANT 0 CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: I9 -� p GD . jurisdiction where work is being performed. If the applicant is exempt
Contact Name: 132,Lic 17, PF74-f. 5 07j from licensing, the following reason applies:
Address: q5eic Lt 5) Tl Ei 4
City/State/Zip: - Tl( --, - pE_, , C 7 21
Phone:( ( t, itja F'ax: (�..D3)/&.O - (o 1 L/l
BUILDING PERMIT FEES *.
E-mail. Please refer to fee schedule.
CONTRACTOR _
Business Name: rieL 7 p p Fees due upon application $ 2aq, 5$
Address: G J ? tt bu) T l t 4fab ' r .
City /State /Zip:T16 D , 0 p - g7223 Amount received $
Phone 6 ? �- (o/ C1) Fax :(6) Zb ( ,/ el( Date received:
CCB Lic. #: 60 3`L/(,
Authorized Notice: This permit application expires if a permit is not obtained within
Signature / Lt1eF • : 12 0.F, 180 days after it has been accepted as complete.
/f
77FFA-U) 4 r'J /z,64 l-- *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03
Fire Protection Permit Check �� Lisst La/
Alteration ID New C�Addition La 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: $ 11, $(aQ
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): $ $( 0 oo
Permit fee based on valuation (see chart): $ (SSA So . •
8% State Surcharge: $ (2 - LoS
FLS Plan Review 40% of Permit: $ (03 - LiD
TOTAL: $ 2
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.
is \dsts \forms \FPSchecklist.doc 11/21/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 09 -4175
INSPECTION DIVISION : Business Line: (503) 639 -4171 MST
BUP 3 - B 3CP I
Received Date Requested S _a ( AM PM BUP 3 0 0 4 / 3 9
Location _ _ - Suite I (0 AE 3 ' ° U`% L I /
Contact Person i Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
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
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
0PART FAIL l
• - ING
_ . .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: 0 Unable to inspect — no access
Fire Supply Line
ADA L� / P // 3
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL