Permit CITY OF TI GARD BUILDING PERMIT
PERMIT #: BUP2004 -00302
4 DEVELOPMENT SERVICES DATE ISSUED: 7/20/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15055 SW SEQUOIA PKWY 120 PARCEL: 2S112DA -00800
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
REISSUE: , e5 FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: 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: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 3,055.00
Remarks: Fire sprinklers
Owner: Contractor:
PACIFIC REALTY ASSOCIATES WYATT FIRE PROTECTION INC.
15350 SW SEQUOIA PKWY #300 -WMI 9095 SW BURNHAM
PORTLAND, OR 97224 TIGARD, OR 97223
Phone:
Phone: 684 -2928
Reg #: LIC 64077
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 6/23/2004 $81.70 Sprinkler Final
[TAX] 8% State Surchari 6/23/2004 $6.54
[FLS] FLS Pin Rv 6/23/2004 $32.68
Total $120.92
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: 7de,t,MI
Permittee } &$
�l\Vwt0�
Signature: ,
Call 639 -4175 by 7 p.m. for an inspection the next business day
iroFC %w s vorik.rrcW Iw
Fire Protection System ,
w roll orrtcc usE ONLY Bu, J " P ' rmit A • I lie tion Receive • Building
� '. -0D34
, ' I Date/8 / i i 1 ' - Permit No. ��
� C Planning A.' wal Other
City of Tigard Date/B : Permit No.:
13125 SW Hall Blvd. r - it 2004 Plan Review / 3' Other
Tigard, Oregon 97223 -'' r Date/B : 4f-0 `t /' Permit No.:
4 '�
Phone: 503- 639 -4171 4 Q "a ,r . " I Post - Review Land Use
6
Contact Case No.
Internet: wwW.ci.tigar gltt NG DIVISION IL �� See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/Method: Su r r lemental Information
•
TYPE OF WORK - - i_ ..REQUIRED DATA: '
❑ ew construction ❑ Demolition , - , , ° 2'FA0LYDWELLING
J Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION . ' Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling 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 E
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: t 493, ��Q Pt ? Y KW Total number of floors
New dwelling area (sq. ft.)
Suite #: 1 Z O ` j ri 0&5 I Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name: I Xe, f c, Gy po ' CAD ' Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
:. lst ;rice;° r , U ..... DATA: • :• :: -. • `.: Q5
.':. t -.-. - - A t'. C O : J C , I AL ' .,••• SE. CHECKLIST - (�
Subdivision: I 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 $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
0: PROPERTY.OWNER .•. ' I. 0 TENANT ..: r - ‘,...'',. P, , =•, ••:,•• Type of construction
Occupancy group(s): Existing:
Name: New:
Address: •
City /State /Zip:
NOTICE: All contractors and subcontractors are required to be
Phone: Fax licensed with the Oregon Construction Contractors Board under
APPLICANT •> • 0 CONTACT PERSON • s provisions of ORS 701 •
and may be required to be licensed in the
Business Name: ({:1,9 G0N' cj't•D)Z) jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address: .
City /State /Zip: .
Fax: :q;� •, -, ,i<. :, 4.:: • - *`' � :'?*
Phone: . . ,41,, • 111 111 1, s RM FE _t ` . • 1
E -mail: 0[i! ' ., ':'. ! eiw• :to jee,sciedule. --;.!•.: •
- . • CONTRACTOR _ : k,., ' , r � „� :a 4 :.:t . .. �F . . ...
Business Name: \ \IX0, - B YP. Q O'b ()N Fees due upon application $
Address: (4O(5 ANN IY N i•1 RM
/State /Zi
y p� figard� o q �zz3 Amount received
Phone: ( ,) go zg l Fax: (z . 449;1 Date received:
CCB Li . #: I li v 11
Authorized , Notice: This permit appllcatloa expires if a permit is not obtained within
Signature: //.7 Date '�7� 180 days after It has been accepted as complete.
/ / *Fee methodology set by Tn - County Building Industry Service Board.
(Please print name)
is \ Dsts\Pcrmit Forms\BldgPermitApp.doc 01/03
Fire Protection Permit.Check Lift, ' •
Describe work to be done:
A.) ❑ New B.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan'review required.
Alteration - heads: Plan review required.
❑ Repair
Number of sprinkler heads:_ 6
Additional description of work:
Te 0 T a ovi vlem-
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: $ 3 OSS --
B.) Type I - Hood Fire Suppression System: -` .
Hood Project Valuation: I $ '.
C.) Fire Alarm _ . -
Submittal shall Battery Calculations Yet ❑ •
include: Individual Component '' . • ..Yes '❑
Cut Sheets . • : • • • •
Fire Alarm Project Valuation: . $• •
D.) Residential Sprinkler (Stand Alone : System) :,.W "�-
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50 • (*try= i - .
3,601 to 7,200 $292.50 =; r' :• ,
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Project Valuation Subtotal (A, B &• C): .$ 3 0S5 •
Permit fee based on valuation (see attached,chart): • .;$'; ' •
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $ 0,b4-
FLS Plan Review 40% of Permit Fee: $ 32 . kpg
TOTAL: $ 120 . g Z
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 "5" technicians.
is \dsts \forms\FPSchecklist.doc 02/28/03
CITY OF TIGARD 24 -Hour
• BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP J0d 7 ,6
Received Date Request d 0 AM PM BUP
Location `.c0 Suite fe)'b MEC
Contact Person --- 1)A0 s Ph ( ) 6R'ti PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner /a_e" * 7., ELC
Footing
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 � ∎VA∎ v� �� Sy I/1.11.41 .
Fire , � L`_J' '� ��/ ��� ������
or azoo Fire Alarm ! � /► W
Susp'd Ceiling
Roof P •
Other: 7100f
in
PASS PART
PLUMBING
Post & Beam
Under Slab
Rough-In
Service
Sanitary Sewer
Rain Drains —
Catch Basin / Manhole
Storm Drain altArAW4r7
Shower Pan !'
Other: •
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL ' 1 1 ; r
Service
Rough -In y ; op
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
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL