Permit A. CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP1999 -00302
iat ''I�i DEVELOPMENT B OPMENT r S o SERVICES 639 -4171 DATE ISSUED: 7/27/99
SW
SITE ADDRESS: 11879 SW TREEHILL CT PARCEL: 2S1106A -RED13
SUBDIVISION: REDWOOD VISTA ZONING: R -4.5
BLOCK: LOT: 013 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N - : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,400.00
Remarks: Install new residential 13D system.
Owner: Contractor:
FOUR D CONSTRUCTION GRINNELL FIRE PROTECTION
PO BOX 1577 GRINNELL CORP
, BEAVERTON, OR 97075 2870 NW 29TH AVE
Phone: P9 P hone N T1J-152b gg7210
Reg #: LIC 000632
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Misc. Inspection
PRMT DEB 7/2/99 $38.50 5798 Misc. Inspection
FIRE DEB 7/2/99 $15.40 5798
5PCT DEB 7/2/99 $1.93 5798
Total $55.83 ORIGINAL
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.
S n itee L �' %�� Grp c�tJ
Signature: _.---7/,- -
Issued By: d • !/
Call 639 -4175 by 7 p.m. for an inspection the next business day
7 -2c
Fire Protection Permit Applicatio n �e�,
CITY OF `TIGARD or Residential IGARD -- -9Y
A r
` 1C
13125 SW HALL BLVD. 1 \ ' /o h : 7_,5,_9' y
TIGARD, OR 97223 Print or Type
Incomplete or illegible applications will not be acce ted asr:
(503) 639 -4171, x. 304 P 9 PP —��53
ram a-d h � .�o?
1 4- , l 51?? e.4 c� • :1
Job Name of Development/Project Type of System (Complete A or B as applicable)
Reside-iv-1-'1 Home. N0. 2-
`• Address Address A.) Sprinkler Wet Dry 0
11879 Sk1 `rkeek - ,1l C.:T. �:
Name Standpipes
/eau ,'D L` a-* MCT /O AJ
' Owner Niailing Address Hazard Group
I PO /57 Additional ge.S t e A j( - ;4(
I
6 ity/Stat Zip Phone Density ` 0
Name Design Area Z3 i
Occupant Mailing Address K. Factor
_ 3 -
City /S Zip Phone A.1) Sprinkler Project Valuation $ 2. , q _
Contractor �\ Name ppp B.) Fire Alarm `
(Sprinkler or G t IJNQJ I Ell, P &* 1 ON
Alarm Company) Mailing Address Submittal Shall Include Battery Calculations YES 0
Prior to permit T.810 Al w - ?-q A Ve,_
issuance, a City /State Zip Phone Individual Component YES ❑
copy Cut Sheets
of all licenses 90 0 K 9-7230 22.3- -1525 B.1) Fire Alarm Project Valuation $
are required if State Const. Cont Board Lic.# Exp. Date
expired in COT 63105 3- )A" - O0 Project Valuation Subtotal (A & or B) $ -7 4.
database
Name
(4°..SCo9D atu� Des,9N Permit t fee based on valuation $ 3 8 0 5U
Architect Mailing Address `a (see chart on back)
'F� 71 o Surchar e a y
3 Phone
City/State A:44,N� OR Zip '1 - 9 161 FLS Plan Review 40% of Permit $ 5 .4o
Describe work A.) NewX Addition 0 Alteration 0 Repair 0
TOTAL $ 55e8„3
to be done.
B ) Modification to sprinkler heads only:
1. 1 -10 heads= No plans required Plans required Submit three sets of plans, including a vicinity map and
2 11 += Plan review required the location of the nearest hydrant.
i hereby acknowledge that I have read this application, that the information given is
Number of sprinkler heads. 1 S correct, that I am the owner or authonzed agent of the owner, and that plans submitted
are in compliance with Oregon State laws
Additional Description of Work:
-1 5+-- t 1 Neu, Ites -6eAA 1 j 1 3D sYJ Signature of /Agent Date
A.) In Existing Building 0 New Building , J! / - I- 1 " q 7
Building Contact Person Name Phone
Data B.) Commercial 0 Residential X Z'O ei FR ekj Z y3 - 15 Z,5
FOR OFFICE USE ONLY:
No of stories Z Plat # Map/TL #:
I Sq. Ft' 1
2-3 53 Notes
I Occupancy Class Type of Construction
is \dsts \forms \firesupr.doc 1/19/99
CITY OF TIGARD
BUILDING PERMIT FEES
TOTAL
STATE BUILDING
VALUATION OF PERMIT F.L.S. TAX PERMIT
PROJECT FEES (40 %) . . \ (5 %) . • ` FEES '
1 -1500 25.00 10.00 ', 1.25 - 36.25
1,501-1600 26.50 10.60 1.33 38.43
1,601 -1,700 28.00 11.20 1.40 40.60
1,701 -1,800 29.50 11.80 1.48 42.78
1,801 -1,900 31.00 12.40 1.55 44.95
1,901 -2,000 32.50 13.00 1.63 47.13
2,001 -3,000 38.50 15.40 1.93 55.83
3,001 -4,000 44.50 17.80 2.23 64.53
4,001 -5,000 50.50 20.20 2.53 73.23
5,001 -6,000 56.50 22.60 2.83 81.93
6,001 -7,000 62.50 25.00 3.13 90.63
7,001 -8,000 68.50 27.40. 3.43 ; 99 33 ;
8,001 -9,000 74.50 29.80 3.73 108.03
9,001- 10,000 80.50 32.20 % 4.03 ' . , 116:73 -
10,001- 11,000 86.50 34.60 4.33 125.43
11,001- 12,000 92.50 37.00 i 4.63 • 134.13; : , ,
12,001- 13,000 98.50 39.40 4.93 142.83
13,001- 14,000 104.50 41.80 5.23 151.5,3;
14,001- 15,000 110.50 44.20 5.53 160.23
15,001- 16,000 116.50 46.60 • ' 5.83 ` . • 168.93 x
16,001- 17,000 122.50 49.00 6.1,3 177.63
17,001- 18,000 128.50 51.40 6.43 ' 186.33
18,001- 19,000 134.50 53.80 , 8.73 • 195.73,
19,001- 20,000 140.50 56.20 7.03 2031..73
20,001- 21,000 146.50 58.60 7.33 212.43
21,001- 22,000 152.50 61.00 7.63 221.13
22,001- 23,000 158.50 63.40 7.93 229.83
• 23,001- 24,000 164.50 65.80 • 238.53
24,001- 25,000 170.50 68.20 8.53 247.23
25,001- 26,000 175.00 70.00 8.75 253.75 .
26,001- 27,000 179.50 71.80,.• 8.:9,8, , ' - 260.28 ,+ i i , -
27,001- 28,000 184.00 73.60 9. 20 266.80
28,001- 29,000 188.50 75.40 9.43 273.33
29,001-30,000 193.00 77.20 , 9.65 279.85
30,001- 31,000 197.50 79.00 '9.88 286.38
31,001- 32,000 202.00 80.80 10.10 292.90
32,001- 33,000 206.50 82.60 10.33 • 299.43
33,001- 34,000 211.00 84.40 10.55 , • 305.95
34,001- 35,000 215.50 86.20 10.78 312.48
35,001- 36,000 220.00 88.00 11.00 319.00
36,001- 37,000 224.50 89.80 11.23 325.53
37,001- 38,000 229.00 91.60 11.45 332.05
is \dsts \forms \firesupr.doc 1/19/99
01/10/2000 Activities for Case #: BUP1999 -00302
2:30:03 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BUPA005 Application received 07/02/1999 DEB DONE No Hold DEB 07/14/1999
BUPA010 Permit created 07/14/1999 DEB DONE No Hold DEB 07/14/1999
BUPA030 Plans routed to PE 07/14/1999 DEB DONE No Hold DEB 07/14/1999
BUPA045 Plans appproved by PE 07/14/1999 RDP DONE No Hold RDP 07/14/1999
BUPA050 Apprvd plans routed to DSTs 07/14/1999 RDP DONE No Hold RDP 07/14/1999
BUPA800 Misc. Inspection 07/14/1999 07/14/1999 07/23/1999 TLP FAIL No Hold AKJ 07/25/1999 Sprinkler Rough In
need to talk to sprinkler installer
about position of sprinkler head
above bottom of beam dining
room, no test on system
BUPA800 Misc. Inspection 07/14/1999 07/14/1999 No Hold RDP 07/14/1999 Sprinkler Final
BUPA075 Ready to issue 07/27/1999 GEO PASS No Hold GEO 07/27/1999
BUPA085 (F) Issue building permit 07/27/1999 GEO PASS No Hold GEO 07/27/1999
BUPA762 Sprinkler Rough -In 07/28/1999 RB PART No Hold AKJ 07/28/1999 provide vapor barrier and
freeze protection where
exposed, view at final
BUPA870 Final Inspection 12/30/1999 KS PASS No Hold AKJ 01/02/2000 back flow test report attached
BUPA950 Case Finaled 01/02/2000 AKJ DONE No Hold AKJ 01/02/2000
BUPA763 Sprinkler Final RB No Hold RB 01/10/2000
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business n Lin 63 -4171 91 dd Z
� �
Date Requested 0l
CJ� D (1 / 1
PM BLD
1 l
Location ) � O - ( I Imo/ AAA 1 ( Suite MEC
Contact Person (.1))}/( Ph PLM / Il
Contractor U Ph SWR
IILDIN Tenant/Owner ELC
Retaining Wall ELR
Footing Access: Ar
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear klAj412 , v Framin g V[i n
Insulation
Drywall Nailing
Firewall G
F.Sprinkler�j,l 0
ire Alar -
Susp'd Ceiling
Roof
Misc:
ASS PART FAIL
LU BING
Post & 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
Approach /Sidewalk VI other Date 40 Inspector v (..A. Ex I
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION I y' 71 r ,s
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 1
Date Requested 7 1 �r�/9 9AM PM BLD
Location I ( Y te / I (•thict ( 1 Suite /,� MEC
Contact Person OCt1tt Ph - 72b - 7 ( 1 1 4S .
�' 7 `6, PLM
Contractor Ph SWR
•
ILD Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation I/ I FPS
Ftg Drain [~. SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear i
Framing f iJ S -- [ o4 4 _ - – .f*s2T A - r [��n
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
ART FAIL
P NG
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PAS PARf—NFAIL
_ kIItCHANIC
Pot
Rough In
Gas Line
Smoke Dampers
Fin
ASS ART FAIL
TRICAL
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date .l 2 ^ ? 9 5 Inspector Ext
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
irvv at 7y ib:ii TtRVNIY�, t T P.02/04 F - 118
130903
AatIEW
: P 4 1k -AWWA
BACKFLOW ASSEMBLY TESTREPORT REMOVED i
PROPERTY
❑ REPLACEMENT
��iyr .:;•''..4:'
MAILING PHONE:
..:. •Y:'rL► ;_ DDRESS: C : ,,� ) % ;
• ti'ir 1 '' r.• i 1 ; f j .
':l: `, ' .':. CITY ! , a .••••• .
: I r. ra',f, •, STATE ! ZIP S ?•s -�:�
.;r;t'_ ,.: �` . y.:';� STREET
. ;• s •, R.P. LI D. va IO DA
•
.:.; \` r • , •Y: •. . -...r O B.A. C. ❑ R.P.D.A D.C. ❑ P.V.B.a gs.V.B.a ❑ A.V.B. ❑AIR GAP
, • - r. ,; a �. ' '• w , ^' 'Tar `, r::� • w.
. . ,
+: ;�• _ SIZE: I ..J,.�I•L -7 .L.} MAKE: ' - I, .
... �.- ; .. 'a• MODEL:
WATER
SERIAL
." • ` � ` ' PURVEYOR: / ,' •. - • • ;•' - " A SSEMBLY NUMBER:
LOCATION: ." - .
•
• ... ,..:34,..14)„, - ' - .r a :• �'' :••• f' c.
• • ' : 4 .,s-Yrft� -E• �, ``' '..> • • . ;'• ': REDUCED PRESSURE ASSEMBLY P.V.B. A / S.V.13 A
`• :. .,K _ %, .. . -, •' s: ;.':, OLJ INITIAL TEST
•� �,'! 4 _ q . El CHECK I DULE CHECK AIR CHECK PASSED IS -.; `4 �T s: • - 4, ,. • ^ PRESS DROP —.-1191 CHECK #1 INLET FAILED El ;_ : • • •. jir• ff .'s• -:.h. .': INITIA R6P VALVE '� .
TEsT ��� !^• :; t- O AT
(B) /TIGHT �. OPENED AT• PRESS DROP
:'•��,; i.,�'.q�,,;ef i '" } r c:j: ' RESULTS BU FFER MI PSID I L E A C . 'SW - •
• •• • • • y4 : 0 ,t. :.t,, c A B- _I CHECK %2 P o
a`."' a ,� 1,�� .;' J!'': !• MIN 3 PSI
Y'• ti ' +�+ '' ' M RELIEF VALVE 'TIGHT 3+ 2 DID NOT FAILED
. - • : - ( d . ' '• AL T � PEN CI SYSTEM
f , : :'0 •'. -.` 4.041 ""• :,"' ' -�`r t ' _ PASS ❑ FAIL Q LE PsD O ❑ PSI • : ties •rs .is F ', - COMMENT
, , ' ".4 1 • 4' '.A i�.. .1, REPAIRS
w -'; ' . . # 4 -- , : ar , ' ' AND /OR
.T.r 4 [` )am : .' PARTS
_,- REDUCED PRESSURE ASSEMBLY A
R
•
El CHECK P.V.B.AJS•V.II A AFTER REPAIRS
^. Y 3',�: • . ;.•.::�' ._... • .. TEST rRCaa DROP CA), b,c,tr.A.
CHECK III DATE_
OPENED AT PRESS DROP
. _ .0, ti r a - " _ AFTER OPENED (B) 1 TIGHT ❑ Psio
! REPAIRS WJFFE —I —L—L ,.., . " CH 1tZ ❑
'-‘••••••6-1L. `,...:. �`! 4. ". - - 1Y '
A.B. .m�,rb ITIGHT CI PSID P P'sw — PASSED •
• F; +' :�:• ' .r ' •',., IN MPLE ING AND SURMmINO This TEST REPORT. THE TESTER CERTIFIES THAT THE •
,.,,; ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
•
RULES AND REGULATIONS OF THE WATER SYSTEM. AND STATE REGULATIONS.
GAUGE CALIBL% N DAT.g .. f. ••1 DETECTOR METER READING
ter, ' ' ■.. , �' •.-
. A _ ��
M: (.7-fir � .GAU4E, ..
TESTERS, DDRESS +- '
-. • , • •• -. �/ / • PHONE
COMP Y.41obtR/
REPORT RECEIVED BY (REPRES OF OWNER) L SERVICE RESTORED
WHITE • Wes System Copy PINK • Custom,: Copy YELLOW - Tester Copy
•