Permit AP ' CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00409
l DEVELOPMENT SERVICES DATE ISSUED: 9/23/2004
- '`j'` :, 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15575 SW SEQUOIA PKWY 140 PARCEL: 2S112DD -01600
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
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: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,000.00
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 8/24/2004 $62.50 Sprinkler Final
[TAX] 8% State Surchari 8/24/2004 $5.00
[FLS] FLS Pln Rv 8/24/2004 $25.00
Total $92.50
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: 2. X
Permitter
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
1ss sw seguor4
� ` �Fire Protection System
Bu; " Permit FOR OF FILE USE ONLY
pp •
A licatio Receive i . Building L . `�
■ Date /B • � I i Permit No.: I ., , P y "C)07
* Planning . p ' val Other
City of Tigard _,.- ' "'' DateJBy:
Permit No.:
13125 SW Hall Blvd. � ' ' Plan Revieyi n f� Other
Tigard, Oregon 97223 Date/By: 7 A l ' /3 Permit No.: •
Phone: 503- 639 -4171 Fax: 503 -598 -1960 •^ ^Ga 1 jai- ,_1 '1�u lltjli� Post - Review Land Use
�
Internet: www.Ci.tigard.or.us -- '
( DateB : Case No.
' Contact See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/ Supplemental Information •
TYPE OF WORK
_ ❑ New construction ❑ Demolition , -, & 2 FAMILY DWELLING , -
❑ 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 ❑ Commercial/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: V 31 cj 5.\N . SetvAol a, Total number of floors
New dwelling area (sq. ft.)
Suite #: 140 Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name: lO Cof3La-'h n-C) at .j tlYl Covered porch area (sq. ft.)
Cross street/Directions to job site: lJ Deck area (sq. ft.)
Other structure area (sq. ft.)
.r. , ' ` -t '"�; }' hREQUIRED-DATA:' . ,•, : -.
`t 6CO `USE 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,
T / � T— overhead and profit for the work indicated on this application.
Valuation $ 1 Z.00O --
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
0: PROPERTY. OWNER •.. I ❑ TENANT ;,tc. : ;:','•' :: ,;::., 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
ID APPLICANT 0 CONTACT PERSON . provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip:
Phone: I Fax: :=Yi,i , :i,..4,-.. it r t � . > ES•. ; - .`, , f.,, ;- ; ; '
E -mail: a 6 ; l ,.' a1�" I ar "col ee.sclr :s.;...;: :....
CONTRACTOR ""�' ,.a t - a w l''' . -,;< •..,... rr :,.., ., . .. .
_
Business Name: V\h *{, - FN rem TVU ( (SYIu um. Fees due upon application $
q()(3 ,
Address: c(,ki\(, -j j cula
City/State/Zip: - ard., o x'1223 Amount received $
•
Phone: (o 2 � $ I Fax: (084 • B. % 51 Date received:
CCB Lic. #: 4 4011
Authorized Z � _ l Notice: This permit application expires if a permit is not obtained within
Signature: � Date: 180 days after It has been accepted as complete.
P al-A-12D go d/i -- .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 List
Describe work to be done:
A.) ❑ New B.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑
, Repair
. Number of sprinkler heads: Z,l
Additional description of work:
Type of System (Complete A, B, C or D as applicable)
A.) Commercial Sprinkle
Wet ' Dry ❑
Additional • Standpipes
Information: - Hazard Group -
Density
Design Area • - '
K. Factor
Sprinkler Project Valuation: $ 2
B.) Type I - Hood•Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations Yes Li
include: Individual Component Yes Li
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.
Project Valuation Subtotal (A, B & C): $ 2. . -
Permit fee based on valuation (see attached chart): $ (02. SO
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of-Permit Fee: $. . ' 5 .00
FLS Plan Review 40% of Permit Fee: $ 25.00
• TOTAL: $ ' 12:0
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 cs ?s'a - ms `.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
Received Date Requested /()- AM PM BUP
Location Suite i' 4 MEC
Contact Person �)1 Ph ( ) L% a�f�8 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner S � 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
Firewal
Fir= Alarm
Susp'd Ceiling
Roof •
Othe •
PART FAIL 1 . / �� AINIF eke
• 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 E Please call fir reinspection RE: _ Unable to inspect — • • access
Fire Supply Line / Ar k
ADA Date ' ' Ins ect ��� �/ A `����j�
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL