Permit CITY OF T I GA R D BUILDING PERMIT
PERMIT #: BUP2000 -00056
I n DEVELOPMENT SERVICES DATE ISSUED: 2/29/00
r�l II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12005 SW TREEVIEW CT PARCEL: 2S110B6 -06300
SUBDIVISION: REDWOOD VISTA ZONING: R -4.5
BLOCK: LOT: 005 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: $ 2,600.00
Remarks: Installation of residential 13D fire protection system.
Owner: Contractor:
FOUR D CONSTRUCTION GRINNELL FIRE PROTECTION
PO BOX 1577 GRINNELL CORP O � l
BEAVERTON, OR 97075 P OhonN OR 7203
Phone:
Reg #: uc 000632
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough -In
PRMT DEB 2/22/00 $59.25 00- 321803 Sprinkler Final
5PCT DEB 2/22/00 $4.74 00- 321803
FIRE DEB 2/22/00 $23.70 00- 321803
Total $87,69
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.
Permitee
Signature: _ rn ec.„ -l�
Issued By: / )
Call 639 -4175 by 7 p.m. for an inspection the next business day
4
. • Fire Protection Permit Application Plan Check # " /
8 5(
CITY OF TIGARD Commercial or Residential Rec'd By
13125 SW HALL BLVD. Date Rec'd 2 -pz z
TIGARD, OR 97223 Print or Type Date to P.E. .1-...19
(503) 639 -4171, x. 304 Incomplete or illegible applications will not be accepted Date to DST t- I've Re
Permit # 45UPo 9 - oet?,` - p
Called z -L 9 - 0 6
Job Name of Development/Project Type of System (Complete A or B as applicable)
1 41)C.,ks�414,•+ -fo 101 5
Address Address A.) Sprinkler Wet W/ Dry El r� r_s , Sk.. , Trek yTo C +,
Name Standpipes
Cr? K S1 v � fc �" t<7,../ id o
Owner Mailing Address Hazard Group
Additional i3D
City/State Zip Phone Information Density
Name Design Area t
4. , P4,Ilea A,
Occupant Mailing Address K. Factor
H
City/State Zip Phone A.1) Sprinkler Project Valuation $
Contractor Name B.) Fire Alarm G�
(Sprinkler or (,{- i rt n e (-I P /..c.,_ `
Alarm Company) Mailing Address Submittal Shall Include Battery Calculations YES ❑
• Prior to permit - q)._ i N Mot ri tiup �r.
issuance, a City/State Zip Phone 3 ., Individual Component YES ❑
copy I r Cut Sheets
of all licenses P rf -1,,,,d o p 9 q -g B.1) Fire Alarm Project Valuation $
are required if State Const(Cont. Board Lic. Exp. Date
expired in COT / aP Project Valuation Subtotal (A & or B) $ `
database l0 9 - 3 - pi-{)n ' . 6)00
Name Permit fee based on valuation $
Architect Mailing Address (see chart on back) ��
/o Surcharge $ t — 7y
City/State Zip Phone FLS Plan Review 40% of Permit $
Describe work A.) New 0 Addition 0 Alteration 0 Repair 0 TOTAL $
to be done: S 7 6 Ci
B.) Modification to sprinkler heads only: Plans required: Submit three sets of plans, including a vicinity map and
1. 1 -10 heads= No plans required the location of the nearest hydrant.
2. 11 += Plan review required y
I hereby acknowledge that I have read this application, that the information given is
Number of sprinkler heads: correct, that I am the owner or authorized agent of the owner, and that plans submitted
are in compliance with Oregon State laws.
Additional Description of Work:
R.e s;oie, 140 .` 13t) Sys kki Signature of Own /Agent Date
A.) In Existing Building ❑ New Building ❑ /�
al - -1 ) _00
Building o on Name Phone
Data B.) Commercial ❑ Residential t1t1 e 21-1 T>4 !-t /-7 3 - -' - � 2
FOR OFFICE USE ONLY:
No. of stories:
Plat " ,Map/TL#:
Sq. Ft:
Notes
Occupancy Class Type of Construction
is \dsts \forms \firesupr.doc 1 /5/98
iv
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 4.63 134.13
12,001- 13,000 98.50 39.40 4.93 142.83
13,001-14,000 104.50 41.80 5.23 151.53
14,001- 15,000 110.50 44.20 5.53 160.23
15,001- 16,000 116.50 46.60 5.83 168.93
16,001 - 17,000 122.50 49.00 6.13 177.63
17,001- 18,000 128.50 51.40 6.43 186.33
18,001- 19,000 134.50 53.80 6.73 195.73
19,001- 20,000 140.50 56.20 7.03 203.73
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 8.23 238.53
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 8.98 260.28
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
i:\dsts\forms\firesupr.doc 11/5/98
i
1 ek &) P Z 00 0 - 0 0 . (,,
® NEW
PN WS -AW WA BACKFLOW ASSEMBLY TEST REPORT 0 REMOVED
PROPERTY ❑ REPLACEMENT
OWNER: �� - J. % ( 0 -, 4 .' PHONE:
MAILING
ADDRESS: /".(- I � l -' nx j - .-I , >
CITY 7 : , . r. .1 •Y .. •\ n . STATE mil • Z IP
ASSEMBLY ./ --1- ,-> : • ADDRESS: /:% �!� i ,,' Y - - ; r .. - ( 7 - I a : g f ,-) /=t '-
STREET - -'
❑ R.P.B.A. Ip 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
SIZE: I I 11.1 MAKE: / � <i ' MODEL: 4' _- r i
WATER [ / SERIAL
PURVEYOR: C. i' - �'y r 7z �"� i i 'NUMB E R: / `? .•4 i
- ASSEMBLY ..:4\
LOCATION: ;5c ,-: 1 c.F -
REDUCED PRESSURE ASSEMBLY P.V.B.A. / S.V.B.A. INITIAL TEST
MI CHECK ( DOUBLE CHECK AIR CHECK PASSED E
PRESS DROP ( CHECK #1 INLET FAILED ❑
INITIAL RELIEF VALVE B TlOii l / OPENED AT PRESS DROP
.[ OPENED AT ) �"
TEST DATE:
MIN 2 PSID LEAKED ❑ PSIU _
RESULTS BUFFER I PSID PSID S l / / L'--C-'1 A - B = I CHECK #2
MIN) PSI DID NOT FAILED SYSTEM
- RELIEF VALVE (TIGHT 0 Z /:,
PASS ❑ FAIL ❑ 'LEAKED❑ PSID OPEN ❑ ❑ PSI
L COMMENTS
REPAIRS
AND /OR
PARTS
REDUCED PRESSURE ASSEMBLY P V.B.A. /S.V B.A. AFTER REPAIRS
NI CHECK 1 D.C. V.A.
TEST PRESS DROP (A) ` CHECK #1 DATE:
RELIEF I OPENED AT PRESS DROP
AFTER OPENED (B) TIGHT PSID
REPAIRS BUFFER '@1inim I CHECK #2
A- B- .m 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 WITH ALL APPLICABLE
RULES AND REGULAT IS OF THE WATER SYSTEM, AND STATE REGULATIONS
• GAUGE CALI ATI E ?Q Y ETECTOR METER READING
' \' ! of l�Miti CERT
F . T PP"? w}!rl Lbr. Portland. OR P72f11 cm"' -)9`1_90,1q) GAUGE 0
TKSTERS ADDRESS PHONE i'.
�IIt InE?I! ! - It(f ? -mot
:. C OMP AN Y Y E/ / 1 '
RE I IY �� � ` " l Y S ERVICE RESTORED
(REPRESENTATIVE OF OWNER)
l WHTIE - Water System Copy PMK - Customn Copy YELLOW - Tester C opY
CITY OF TIGARD BUILDING INSPECTION ,
24 -Hour Inspection Line: 639 -4175 business Line: 639 -4171 MST
BUP
Date Requested % ( /no AM PM BLD
Location T WO S / ! I a Suite l MEC •
Contact Person Ph ? - PLM
Contractor Ph SWR
< BEtttD1FI 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 -0/ ere.: A we I1G[G –2. – r --
Insulation
Drywall Nailing
F' II
ire Sprinkler
.. ire Alar
Susp Ceiling
Roof
�� PART FAIL
UMBING
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date — / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.