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Permit A.. - BUILDING PERMIT CITY OF TIGARD PERMIT #: BUP2004 -00145 In DEVELOPMENT SERVICES DATE ISSUED: 4/27/04 .. - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11365 SW TIGARD ST PARCEL: 1S134DC -00700 SUBDIVISION: ZONING: R -4.5 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: 5 -1 HR : sf N: S: E: W: OCCUPANCY GRP: A2.1 TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 1,132 BASEMENT: sf AREA SEP. RATED: STOR: HT: 0 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: $ 23,720.00 Remarks: Fire sprinkler Owner: Contractor: BAPS TEMPLE AFP SYSTEMS INC PO BOX 41160 19435 SW 129TH SAN JOSE, CA 95160 TUALATIN, OR 97062 Phone: 408 - 453 -6464 Phone: 408 - 453 -6464 Reg #: M€ 692- 13459 FEES 6ln REUIRED INSPECTIONS Description Date Amount Sprinkler Rough -In [BUILD] Permit Fee 4/1/04 $273.70 Sprinkler Rough - [TAX] 8% State Surcharl 4/1/04 $21.90 Sprinkler Final [FLS] FLS Pln Rv 4/1/04 $109.48 Total $405.08 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: ,' P / Perm ittee / `I Signature: ' \ A\ , �I Call 639 -4175 by 7 p.m. for an inspection the next business day r tt C rru el;uuu ►7 LCttl / /; 6Ts y - T I CARD Building Permit Application FOR OFFICE USE ONLY t ,I Received I / A. P S* ��� �� DateB a�� ;� //, PerTm Building t No.: //. —,e0 City of Tigard o� �� Planning Approval Other DateB Permit No : 13125 SW Hall Blvd. 1 1*4 Plan Other Tigard, Oregon 97223 NV' _ ,- VO ' Date : — 2g d - 0 5S Permit No . Phone: 503- 639 -4171 Fax: 5 � . A - A ,0 " . ii Ifs B Post - Review Land Use Internet: www.ci.tigard.or.taki 0 O1� 6711. I Case No. ``NN C Contact ontact �RR� ® See Page 2 for 24 -hour Inspection Request3639 -4175 Name /Method j� Su lemental Information 3.1 - TYPE OF WORK . . - - ' REQUIRED DATA: -='...• o ® New construction ❑ Demolition 1 & 2 FAMILY DWELLING ❑ 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 g Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, matenals, labor, overhead and profit for the work indicated on this application. Q/� ❑ Accessory Building ❑ Multi- Family �J ❑ Master Builder ❑ Other: - Valuation $ ' • . JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths: Job site address: tieri,J, I tt L,AZc (,ST Total number of floors Suite #: 1io51QS Bld /A t. #: New dwelling area (sq. ft.) p Garage /carport area (sq. ft.) �: Project Name: 'g, R_� �, t _A ? A l — 1, (-AL, Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) S W �A�0 k 1 I Ank ?L_ • Other structure area (sq. ft.) - ' :•r ' . REQUIRED -DATA ;. =-' ' z 4' :- ".COMMERCIAL-:- CHECKLIST"; Subdivision: Lot #: ' ` ' Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate , ' - ' ' - ':, DESCRIPTION OF WORK • ' - •' - • the value (rounded to the nearest dollar) of all equipment, materials, labor, 4 overhead and profit for the work indicated on this application. 2 _ Thai ' 05 ` � Valuation $ Z3 M •o.c. Existing building area (sq. ft.) New building area (sq. ft.) l ts9(1 Number of stories Z • • ®'• PROPERTY'OWNER '• ' • `0' TENANT; - ., , ;... .,.,. •- Type of construction �( Name: � ,y S . ' tom, Occupancy group(s): Existing: Address: (V,1 � New: ►143 5�,, t c,Aza z.s. t City/State /Zip: 1 np, pa. Phone: Fax: NOTICE: All contractors and subcontractors are required to be CI APPLICANT :• ❑ CONTACT PERSON' licensed with the Oregon Construction Contractors Board under • C ( provisions of ORS 701 and may be required to be licensed in the Business Name: l a <o 5 f l t'1C • jurisdiction where work is being performed. If the applicant is exempt Contact Name: , t �,1 IgN(�G 1A a L t, S\ .p � from licensing, the following reason applies: Address: i9 --- 12 r l,Jl_ City /State /Zip: j AL. a2. (= i - 1D62 Phone: SDI- CAA -9284 Fax: gb3 („ 2.11$ ' E -mail: : BUMMING - PERMIT . _'.,;., '• • • Please'r'efer to;fee scH ed'tile. = . ", CONTRACTOR_... - G:: Business Name: AJ ? G-(s�T \ LiL . Fees due upon application $ 46S: -- o: Address: 1�1Q3� /:-.),,, I (Iv 1= 41 - City/State /Zip: & A•l.. Z , C�` cc.? Amount received ` , ' $ Phone: Q3- 2 -7g4 I Fax: �I .0 2 - 11go Date received: 4- l -`A CCB Lic. ,- . .1 Authorized Signature: y Date: 3 �I -VA Notice: This permit application expires if a permit is not obtained within � ,n 180 days after it has been accepted as complete. L 1 t \ t �-Sc l *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) i : \Dsts\Permit Forms\BldgPermitApp.doc 01/03 , ' Fire Protection Permit Check List .- . Describe work to be done: A.) ❑ New B.) Modification to sprinkler heads only: ❑ Addition Li 1 -10 heads: No plan review required. ❑ Alteration ❑ 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: Additional description of work: Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler Wet IA Dry at. ' Additional Standpipes 525 Information: Hazard Group • • - • (,tt -I;T (N' Density . t o . Design Area ' • • tSt 1•I K. Factor 5.(0. Sprinkler Project Valuation: $ Z3y12,■ ,ts, B.) Type I - Hood Fire Suppression System . Hood Project Valuation: $ -C.)- Fire Alarm • Submittal shall Battery Calculations , Yes' ❑ . include: Individual Component Yes ❑ Cut Sheets • Fire Alarm Project Valuation: $ D.) Residential Sprinkler (Stand Alone System) - - • Square Footage: Permit Fee: '' O to 2,000 $187.50 . - - 2,001 to 3,600 $232.50 -' , . . .'14 r 3,601 to 7,200 $292.50 7,201 and greater $381.50 . _ Sprinkler Project Square Footage: sq. ft. Project Valuation Subtotal (A, B & C): $ Permit fee based on valuation (see attached chart): $ Permit fee based on square footage (D) (see fees above): $ State Surcharge 8% of Permit Fee: $ FLS Plan Review 40% of Permit Fee: $ TOTAL: $ 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 \forms \FPSchecklist.doc 02/28/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP�UD o6/ (15 Received Date Requested 9 AM PM BUP Location I Co � J Suite l MEC Contact Person Ph ( ) 6`7 a-- 9. / PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall e Sprinkle -- arm Ru Susp'd Ceiling Roof EA `-'- IVA I Other: Aiwa PART FAIL • LU ' NG Posh& 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 Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In �M■ / 4/111■...._41M Low Voltage Fire UPI3ZL 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 JUL -23 -04 12:27PM FROM - Automatic Fire Protection 5036921186 T -817 P.002/003 F -059 Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and test, shall be mace by the contractors representative and witnessed by an owner's representative (hereinafter oefinee as property owner). All defect shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities. owners, and contractor, It is understood that the property owners authorized representative is a legal signatory and fully representative of the property owner and that by the property owner's or property owner's authorized representative's signature, the property owner accepts full respoesibility for the system as installed and agrees that it is in compliance with the applicable approving authorty's requirements and local ordinances. Property Name Date Property Address , �r(� _ , , �lit� •_• c _ TVA ' ( Cl, 0 1 r Accepted by Approving Authorities ( a '_.) • Address Plans Installation conforms to accepted Plans e erYes ❑ No Equipment used is approved ig. Yes ❑ No If no, explain deviations Has the property owner or property owners authorized representative peen instructed as to the location of control valves and care and maintenance of this new equipment? ;Er Yes ❑ No If no, explain Have copies of the following been given to the property owner or property Instruction owner's authorized representative? 1. System Components Instructions Ig Yes ❑ No 2. Care and Maintenance Instructions , Yes ❑ No 3. NFPA 25 X Yes ❑ No Location Supplies Buildings Of System Year Temperature Make I Model of Manufacture Orifice Size Quantity Rating Sprinklers 4 LA - 'If • «12IW = - a 1 . L a S 1N. . ► • - - - -- iggilnil I Pipe and Type of Pipe Fittings Type of Fittings Maximum time to operate Alarm Valve Alarm Device through test connection or Flow Type Map M del Minutes Seconds Indicator (,Q— f 1 r V — f .5" 5- Pn f� I PS _ -1 7'cr -- A -- 0 o ' Dry Valve Q.0.0. Make I Mooel Serial No. Make I Model Serial No. 1 tC at) 1C, , Time to trip Tnp Point Time Water through test Water Air Air Reached Test Alarm • - - rated Properly Dry Pipe connection' Pressure Pressure Pressure Outlet' f� Operating i Min /Sec psi psi l psi Min /Sec No Test w /oQ.O.D I $S' l 3; e* I 1 . S% See._ — with 0.0.0. I If No. explain . "measured from time inspectors test opened (NFPA 12 only requires the 60- second limitation in specific sections) JUL -23 -04 12:27PM FROM- Automatic Fi re Protection 5036921186 T-817 P.003/003 F -059 / ) ,,..46 Operation 0 Pneumatic � - Piping Supervised ❑ Electric Hydraulic Yes III Detecting Media Supervised Yes Does valve operate from the manual trip, remote, or both control Stations? Ne Is there an accessible facility in each circuit for testing? Yes • - Do ❑ No If no, explain e & Preac elug ion ❑ Yes ❑ No I Valves Does each circuit operate I Doe eacn circuit operate valve `Maximum Make Model supervision loss alarm? I tlme [o operate Delug release? release No Min L,Sec Location Make and I Pressure and Floor Male! Semn Residual Pressure Setting Static Pressure (flowing) I Flow Rate Reducing I Valve Test I Inlet (psi) Outlet (psi) I Inlet (psi) I Outlet (psi) Flow (gem) HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for two hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for two hours. Differential dry-pipe valve clappers shall be left open during the test to prevent Test damage, All aboveground piping leakage shall be stopped, Description PNEUMATIC; Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 1 X psi (0.1 bar) in 24 hours, Test pressure ranks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1 % psi (0.1 bar) in 24 hours. All piping nydrostaucally tested at .. •si (` bar) for _hours If no, state reason Dry piping pneumatically tested ❑ Yes ❑ No Equipment operates properly Eg' Yes ❑ No Do you certify as the sprinkler contractor that additives and corrosive chemicals, sodium silicate or denvatives of saaium silicate, brine, or other corrosive chemicals were not used for testing system or stopping leaks? Yes ❑ No Drain ;�adi of gaug c otes near water suppry test connection Tests Test Gual pressure with valve in test connection open wide Underground mains anti lead -in connections to system risers flushed before connection ection made to sprinkler piping Verified by copy of the U Form No. 858 sr Yes ❑ No Other Flusned by installer of underground sprinkler piping ❑ No Yes Explain If powder -driven fasteners are used in concrete, has ,, Yes representative sample testing been satisfactorily ❑ No If no, explain completed? Blank Number Used I Locations Loc Testing © Number Removed Gaskets I Welded Piping I -4 YES ❑ NO If Yes,,, Do you certify as the sprinkler contractor that welding procedures comply with the Requirements of at least AwS 82.1? f` Yes ❑ No Do you certify that the welding was performed by welders qualified in compliance Welding With the requirements of at least AWS 621? Ar Yes ❑ No Do you certify that welding was carried out in compliance with a documented quality Control procedure to insure that all discs are retrieved, that openings In piping are Smooth, that slag and other welding residue are removed, and that the internal Diameters of piping are not penetrated? FO Cutouts Do you certify that you have a control feature to ensure that all cutouts (discs) are Yes ❑ No (Disc;) Retrieved? Hydraulic Nameplate provided ❑ No If Yes Yes 0 No Data no, explain Nameplate Remarks Date left in service with all control valves open ■ 3-69 Name of Sprinkler Contractor �, rJ �o i .4 C j f^ e � � `�` PG !Q�✓ - . sad by: 11 r Signatures —�� .— .4 For': roQ��Y owner (printed amel t aure. I ILL_ 6-k' N Tide Date For sprinkler contractor (pnntea name) Signature E/ Auditional Explanation ana Notes: Title Date