Permit OF BUILDING PERMIT
CITY TIGARD
PERMIT #: BUP2004 -00284
� 6 DEVELOPMENT SERVICES DATE ISSUED: 6/28/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112DD -01600
SITE ADDRESS: 15575 SW SEQUOIA PKWY 160
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: $ 2,500.00
Remarks: Alteration of (22) heads for TI.
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 6/17/2004 $72.10 Sprinkler Final
[TAX] 8% State Surchari 6/17/2004 $5.77
[FLS] FLS Pln Rv 6/17/2004 $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.
Issued By:
Permittee
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
i \
1555- 0 seta .
lire rotecion System
GAO" FOR OFFICE USE ONLY
Bilk ��g Permit �J 1,110/611 Received 0� Building / lk Date/B : i J J Permit No.: I�. I, / "ea-
P Planning A' .rova Other
City of Tigard 100 Date/By: Permit No.: •
13125 SW Hall Blvd. Plan Revie Other
Tigard, Oregon 97223 i IGNR D Date/B : . ' Z� Q < L Permit No.: •
Phone: 503-639 - 4171 Fax: Y 03ARI , Q '1 J 15 �� �" 'bli � Id'" Da Post r �d Use
l o� 7o Case No.
Internet: www.ci.tigard.o t se Contact 0.. :07 • . - ---,.. C4 See Pep 2 for
24 - hour Inspection Request: 503 - 639 - 4175 Name/Method: / / Supplemental Information
E OF WORK, ,,,;.,> .... A. , , „, .,
... - TYPE - .. . .... -- ':: � . � :�� `' �REQUIltED�ATA:' ; -:: •. �.
❑ New construction ❑ Demolition ,,, 8/2'FADIILYDWELI ING . .
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 - a-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 •2 , No. of bedrooms: No. of baths:
Job site address: 15515 •i1\1,Cet4voi R pKNIy. Total number of floors
New dwelling area (sq. ft.)
Suite #: 6 0 Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name: (4,1ZIS , imu ' Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
,. :,,,,- k. r , .r -' 1RED•DA :- r. a:' `',.•:
y .. f , � .,
• `� � lvi ,� 'USE'CHECKI:IST.. :`'
.: , r� � ���0�1I1VIER�
>��_�'. �o . �.. ...... �' r 4 .
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
- '.- DESCRIPTION OF WORK • ` . - :, 1....,-. :r - .. ' the value (rounded to the nearest dollar) of all equipment, materials, labor,
�- Q T � �ti�YDVeM�.NT— overhead and profit for the work indicated on this application.
Valuation $ 0 SDv
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
•''D: PROP TY: :OWNER .:', : `1 ❑ - TENANT :.,. , i ,:.r ;? .r; ae5i;,: Type of construction
Occupancy group(s): Existing:
Name: 1 1G�t,�,�� SY New: A ddress: LSD _ o l A
City/State /Zip: cJ ` T
NOTICE: All contractors and subcontractors are required to be
Phone: �j, licensed with the Oregon Construction Contractors Board under
(] APPLICANT :- = 0 CONTACTPERSON::�u 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 / afplies:
Address:
City /State /Zip:
Phone: j Fax: ; , ' r- �a;v�t �� i^ w-b �i:l F °�f `
E -mail: i 3� i il'.t :•', "�'L, ' [` e e,ic u e:' K. . , f :
fr :' CONTRACTOR . !�N.f- ,.� , •,ra ; .. 1*a P,..440:.:4.6::/,-.X. ak •r., :r.$r '1''
Business Name: \ <L t - V1rei \Me Oki c Fees due upon application $
Address: (kc4 ' N-l-IRM $
City/State /Zip: C'Xt' (W- qi 7Z' Amount received
Phone: (5 t 3 .-A-7 I Fax: (903) I(24 • et b5� Date received:
CCB Lic. #� ' 401 7
Authorized ___ / Notice: This permit application expires if a permit is not obtained within
^ /
Signature: Date: 6 iZ /0 ” 180 days after It has been accepted as complete.
�.1 Cl- kAl1ex) 2.0 Hie-- r 111 •Fee methodology set by Tn - County Building Industry Service Board.
(Please print name)
is \ Dsts\Permit Forms\BIdgPermitApp.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: Z7�
Additional description of work:
-wU m u1 r
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: $ 2 / ScO
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: _ $
D.) Residential Sprinkler (Stand Alone System): : , -F' . .
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
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): $ 2 60O
Permit fee based on valuation (see attached chart): $
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $ Cj ,11
FLS Plan Review 40% of Permit Fee: $ -G.(2 4-
TOTAL: $ jt O. J
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 \tortes \FPSchecklist.doc 02/28/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 P MST 1 ry
o O P BOO -(d 2l
Received Date Reque ed O � I AM / PM `( BUP
Location • ) �� 7S J Suite /6 d MEC
Contact Person Ph ( ) (p Frei— 7.9 Z PLM
Contractor _ Ph ) SWR
BUILDING Tenant/Owner 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
Firewall _
' - .�` , lip Ai r
Susp'd Ceiling -
Roof
Ot :
anal •
PASS PART FAIL
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 444
Gas Line
Smoke Dampers \ /
Final
PASS PART FAIL
— �� 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
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL