Permit li CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP1999 -00543
AIlAr DEVEL SERVICES (503) 639-4171
DATE ISSUED: 12/30/1999
- 13125 SW
SITE ADDRESS: 12001 SW TREEVIEW CT PARCEL: 2S11066 06400
SUBDIVISION: REDWOOD VISTA ZONING: R -4.5
BLOCK: LOT: 006 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: $ 2,755.00
Remarks: Residential 13D fire sprinkler system.
Owner: Contractor:
J T. ROTH, JR GRINNELL FIRE PROTECTION
12600 SW 72ND GRINNELL CORP
SUITE 200 5921 N MARINE DR
o
TIknD OR 97223 P 0 Phone N Z8- 908u
Reg #: SIC 000632
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough -In
PRMT GEO 12/23/199E $59.25 99- 320603 Sprinkler Final
5PCT GEO 12/23/199E $4.74 99- 320603
FIRE GEO 12/23/199E $23.70 99- 320603 •
Total $87.69 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.
c
Pemtitee /
Signature: [Y� G� I ( e`Gc ok. — p4
Issued By: J c/ / ��i� " /WI_
Call 639 -4175 by 7 p.m. for an inspection the next business day
Fire Protection Permit Application Plan Ch:a /. - /ie.
CITY OF TIGARD Commercial or Residential edd : • _ • -
13125 SW HALL BLVD. Date Redd /A --A - --, /
T \RD, OR 97223 Print or Type Date to P.E/ -a3 S
(b...,) 639 -4171, x. 304 Incomplete or illegible applications will not be accepted Date to DST G 1 414 ° 1•
115r/ 99- ,r # aq�� �T
Job Nam of Deve t/P
menroject Type of System (Complete A or B as applicable)
ge \u \)IS - I -- "—
Address Address A.) Sprinkler Wet Dry 0
l "?..1n I S \...J rt a lt. U,.,, LT_
� X--OT 00 ‘057-61 e-r-/ ha)
Standpipes
No
Owner Ma�ili Add S Hazard Group
/- z 7a / Additional 13 t,
ity/Sta 749 Zip 9 Phone Information Density
Name Design Area .. S P K gegj
Occupant Mailing Address K Factor
4. .--
City /State Zip I Phone A.1) Sprinkler Project Valuation $ a 7 S-5
Contractor Name �^ B.) Fire Alarm
(SPrinkler 6 6 n1NQ .- l t t pee.
Alarm Company) Mailing Address Submittal Shall Include Battery Calculations YES 0
Prior to permit 5c yesil 0 • 1/1 yte Dr.
issuance. a City/State Zip Phone (sa3) Cut Sheets
.J l
Component YES ❑
copy
of all licenses Po /UR 47aio3 ) B.1) Fire Alarm Project Valuation $
are required if State Const Cant Board Lice* Exp. Date _
"ed in C Project Valuation Subtotal (A & or B) $
tabors (p3 "x0 S 3 — 14 - 0 0 �O -�' S S
r Name
Permit fee based on valuation $ c-
Architect Mailing Address (see chart on back) ✓ `l. as
5% Surcharge $ Lf , '71t-
City/State Zip I Phone
FLS Plan Review 40% of Permit $
Descnbe work A.) New o/ Addition 0 Alteration 0 Repair 0 �'
to be done: TOTAL $ $ 7 4,1
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. 114= Plan review required / the location of the nearest hydrant
I hereby acknowledge that I have read this appucatxxi. that the wnfomtabah given IS
Number of sprinkler heads: =rect. that I am the owner or authonzed agent of the owner. and that plans submslted
are in compliance with Oregon State laws.
Additional Descnpuon of Work:
Res; 1 .. 1 4 -:Q 13 C• Sys-lei-4'1 Signature of OwnerlAgent Date
A.) In Existing Building ❑ New Building [ 1 . "'�� 99 ,
Building Contact Pe on Name Phone
Data B.) Commercial ❑ Residential t$ We N L'
D "5O Al I s'a 3 - - 8q -1O$'
FOR OFFICE USE ONLY:
No. of stories:
Plat ft Mapfak
Sq. Ft
‘ i O 3 ? Notes
Occupancy Class Typed Construction
5N i 1,
i `,firesupr.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 7 l q-0,0Sy?
Date Requested
ZIOD AM l` PM BLD
Location I zoo/ i ✓Ne.P u l Suite G MEC
Contact Person 6 Ph g(C' 50 2 / PLM
Contractor Ph SWR
r1�CJILDING� Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam 'T
Ext Sheath /Shear - J
Int Sheath /Shear • �_ \ •�
Framing (�(J
Insulation
Drywall Nailing
Fire wall
<ire Sprin �—
gy I2 Z, 'Nv� -.� � --yam —Q
Fire Alarm
Susp'd Ceiling c � --�— `N (/ U �
Roof
Misc:
Fin
PAST PART FAIL
PLUMBING
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 [ I 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: [ j Unable to inspect - no access
ADA
Approach/Sidewalk / ,
Other Date ( ( Inspector v �-�, . Ex� t
Final
PASS PART FAIL DO NOT REMOVE this inspection record frow the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP /` 9- do Su3
Date Requested (— J3 —CO AM PM BLD
Location l Z CO t —►-n V C32 Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing i ��/�: �i/�r��1v�/ T�S� - �Z5Pv.c - T
Insulation
Drywall Nailing c • v— i Ar Aro
Firewall
Sprinkler I" Sc.)hA -T �r�i'2�•vll�.���c S� ��A�UL 57
Susp'd Ceiling 3 A.6/ 4V0/ lo7 ,ry
Roof
Misc:
PASS PART
PLUMBING
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 Date /� p
Other /7 — l 7 Ins ec Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
I ea _ .',u_ ,99Y-t 143 l�l.a
. [3 NEW
PN WS -AW WA BACKFLOW ASSEMBLY TEST REPORT ❑ REMOVED
PROPERTY r ❑ REPLACEMENT
OWNER: �� R- el 4 PHONE:
MAILING
ADDRESS: / / f - - 0 'S(.) 7_2 ,.
CITY 7 ; f , .• _I� STATE ZIP ,7i C
f ASSEMBLY • _
, -. ADDRESS: / 7 !) G'/ II �' L•' 1 v.-e -cv . - ,.: L -- /
STREET _ t . . r id
_
t Y
: ❑R.P.B.A. ❑ D.C.V.A. ❑ R.P.D.A. ❑ D.C.D,A. ❑ P.V.B.A. ❑ S.V.B.A. ❑ A.V.B. ❑ AIR GAP
L SIZE: I I 1 I. - V I tl MAKE: (. / - MODEL: 7 (" .. .? , .
1 WATER %-' --- n SERIAL
i. PURVEYOR: !--, 4- ' r) ( / t' t ., mot" ' NUMBER: l .1 "! a c''!: S
LOCATION: -, -. .r,,._ v „
t REDUCED PRESSURE ASSEMBLY P.V.B.A. / S.V.B.A INITIAL TEST
f NI CHECK CHECK ( DOUBLE CHECK AIR PASSED R
PRESS DROP (A l CHECK #1 INLET FAILED
INITIAL OPENED VALVE (B �,. / OPENED AT. PRESS DROP DATE:
TEST MIN 2 PSID PSID
r' ' RESULTS BUFFER 'LEAKED ❑ PSID PSID s /f !` !'1
F A - B= I CHECK #2
MIN J PSI Q _ ,- ,7 DID NOT FAILED SYSTEM
4 • RELIEF VALVE (TIGHT PsD OPEN ❑ ❑ PSI
PASS ❑ FAIL ❑ ILEAKED❑
COMMENTS
REPAIRS
AND /OR
PARTS
REDUCED PRESSURE ASSEMBLY P.V.B A. /S.V.B.A. AFTER REPAIRS
NI CHECK D.C.V.A.
TEST
PRESS DROP
(A)I CHECK 111 DATE:
• RELIEF I OPENED AT PRESS DROP
AFTER OPENED (B) TIGHT ❑ PSID
REPAIRS BUFFER '@1°® ( CHECK #2
A - B■ mme,ra I TIGHT ❑ PSID PSID PSID PASSED ❑
IN COMPLETING AND SUBMITTING THIS TEST REPORT - THE TESTER CERTIFIES THAT THE
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WM-I ALL APPLICABLE
RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS.
GAUGE CALIJR (,1Q DA -3/ i ? METER READING
t .. -1,-<- -
TESTEIGNATU�IE - / _ . CERJq .
1 / 1 -1 /. rS„� ( C �"✓•4 ` (- l ,,
TESTERS NAME PRINTED i I _ iAUGF,, II TT
TESTER , ADDRESS // PHONE R
4 COMPANY NINE,/
E
/
REPO BE / E . ` .,�f 2, 7 ( , La" SERVICE RESTORED
(REPRESENTATIVE OF OWNER) •
WHITE.. Water S.nMm (:nnv PINK - Customer ('env YELLOW - Triter Cnov
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP 9qq'5cis_
Date Requested ( AM < PM BLD
Location 1.2-60 I TrketuI (fL Suite MEC
Contact Person C14 J J3/1 Ph '7,0 -3 8 Co S PLM
Contractor - Ph SWR
1�IN Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing - i _ /-1rTv4C -1,_ Ar_ l ��
Insulation
Drywall Nailing
Firewall
( ire Sprinkler
ire Alarm
Susp'd Ceiling
Roof
Mi .
'_►" PART FAIL
• II 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 Date
/-- Q 0 Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job sate.