Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2000 -00453
! o, DEVELOPMENT SERVICES DATE ISSUED: 01/10/2001
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110DC -00700
SITE ADDRESS: 11205 SW SUMMERFIELD DR
SUBDIVISION: WILLOW BROOK FARM ZONING: R -25
BLOCK: LOT: 016 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: 3N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0.00 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: Fire Suppression System Type I Hood
Owner: Contractor:
CONGREGATE CARE ASSET V, LTD P SANDERSON SAFETY SUPPLY CO.
BY FALCON FINANCIAL 1101 SE 3RD ST
PO BOX 12118898Z3p PORTLAND, OR 97214
S 3Fiono 0503 993275 Phone: 238 -5700
Reg #: LIc 00064969
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Electrical Permit Required
5PCT CTR 11/06/200C $5.77 27200000000 Sprinkler Rough -In
Sprinkler Final
FIRE CTR 11/06/2000 $28.84 27200000000
PRMT CTR 11/06/2000 $72.10 27200000000
Total $106.71
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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.
Pe mi itee
Signature: 67/ .S'-fv G ie -77on/
Issued By:
Call 639 -4175 by 7 p.m. for an inspection the next business day
F . A . 1 1 1 . ' S0 2 1 C '�`� �3t,t�.E,tw�' n/ O 6 t Op
ition
Date received: // (p /Q d Permit rtf V (,t2
163
aa�ri'
= � � 3 Project/appl.no.: Expire date:
City of Tigard _ Date issued: By: Receipt t no.:
mom OW) 639-4171 y: P
Fax: (503) 598 -1960 Case file no.: Payment type:
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Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory s Commercial/industrial ❑ Multi- family 0 'ew construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other: - r - re rµpptesS.'o --
JOB SITE INFORMATION
Job address: * 1 441 JiinirenZAMI1111= Bldg. no.: Suite no.:
Lot. Block: Subdivision: Tax map /tax lot/account no.:
Project name:
Description and location of work on premises /special conditions: . "; :fe f :iffes - — /Skew i" . - rife r / 4 )
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: SNWIMP/ t Id of ullzt -Se -4 -es ( Floodplain ,septiccapacity,solar,etc.)
Mailing address: //? f.J 51,Kir14Q /74PJ /'j 1 & 2 family dwelling:
City: -'fe)c, fd (State: Di ZIP: Valuation of work $ a�SOD
Phone: I I Fax: 1E-mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: 'State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E- mail: Commercial/industrial/multi-family:
CONTRACTOR Valuation of work $ ? S --
Existing bldg. area (sq. ft.)
Business name:
S r e,fo S -ie iy New bldg. area (sq. ft.)
Address: - SO / s'E 7 fA - Number of stories
City: P o / tla w c i I State: Or I ZIP: ° / 72. / y Type of construction
Phone:r63rtr T- 5 I Fax 323/- 6tgg/3I E -mail:
CCB no.: ti c/ q Cl Occupancy group(s): Existing:
New:
City /metro lic. no.: 0000 (./ 7 IS' Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be requited to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: I ZIP:
exempt from licensing, the following reason applies:
I
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $ /0 ' 1
Address: Date received:
City: (State: (ZIP: Amount received $ to to .
Phone: I Fax: 1E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Na all jurisdictions accept credit cards, please call jurisdiction for More information.
attached checklist All provisions of laws and ordinances governing this 0 Visa ❑ MasterCard
work will be complied w' ;a,^Jither specified herein or not. Credit card number I
Expires
Authorized sign // 7 Date: � � - °C ) Name of cardholder as shown oo credit card
$
Print name: MI6 5; t.‘ Av./Ar'" Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6A)0 OM)
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CITI'OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP 2��w -
Date Requested 2 _3 AM BLD
Location // 2-0C S Suir?,or h G -L (( Or Suite MEC
Contact Person C4 1101. s& .C; I44--- hl/Re Ph 9L 3-0.07 3/15 PLM
Contractor Ph L SWR
Tenant/Owner P/oef.S.€ cam ELC
Retaining Wall ELR
Footing Access:
Foundation 4ir\ FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation S
Drywall Nailing dP -l4e�J y< Ccri.A Poe
Firewall
,Eke Sprinkler
Fire Alarm
Susp'd Ceiling > r l '
Roof S C � r /�Q' Le40
Misc: k t
4 tt' _
A •• • iRa PART FAIL
.r;cr.?•' G
Pest & Beam
Under Slab -
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
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 /
Other �/7')
Approach /Sidewalk Date ,� Z 1--
U ( Inspector► H. / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
1 •
MIIIIIWIEAAIAII.^1i 1101 S.E. 3RD AVENUE • PORTLAND, OREGON 97214 • (503) 238 -5700
�IM IWM P 1
I 850 CONGER • EUGENE, OREGON 97402 • (541) 683 -9333
IMiSAFETYCOMPANY 2600 AIRPORT WAY, SOUTH • SEATTLE, WASHINGTON 98134 • (206) 340 -4300
CERTIFICATION - INSTALLATION /INSPECTION
Customer Name 1 . r / • -: { ` 4 z 4.
Address f ... I ::-f > J `
i •
SYSTEM
Model(s) and serial numbers .
/ 'r ' - / %', Sw+ "c�.... r f,�
Number of nozzles and Part No . • ,
Number of detector(s) and degree rating 4
Energy shut -off devices — type and size /
Other accessory equipment provided (pull station, electric switches, etc.) l
COOKING /VENTILATING EQUIPMENT
f/ .
Number of duct(s) and size
Hood size and plenum size / - . 0 fi ,, _ .- <r` # ,
/ 4 w
Cooking Appliances and size of cooking surface. (NOTE: List appliances from left to right and indicate those
being protected.)
1. ' %J i ! T \ 4.
F t �°
2. 5.
3. S 6.
TO BE COMPLETED BY INSTALLER
®'YES ❑ NO
The fire suppression system is installed in accordance TO BE COMPLETED BY CUSTOMER
with the manufacturer's instructions, NFPA Standard
96 and 17 (current issue), and all applicable state and
local codes. Exceptions to other provisions of NFPA 96 ❑ YES ❑ NO
that were observed are noted below. I understand that it is the recommendation of ANSUL
Exceptions: and of the National Fire Protection Association
Standard 96 and 17 that the fire suppression system be
inspected and maintained every 6 months to ensure
continued efficiency and reliability and that failure to
do so may result in failure of the system to operate
properly.
CUSTOMER NAME AND TITLE
❑ YES ❑ NO
All electrical work or work provided by others to SIGNATURE
complete this system installation has been completed. DATE
INSTALLER NAME ., i .1� Vc-� /,.�1►'`, 4" -
SIGNATURE �"j,/ -
DISTRIBUTOR } ' r ,
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ADDRESS f /`'L' i -...02
DATE