Permit CITY OF TI GARD BUILDING PERMIT
P ERMIT #: BUP2005 -00441
4 DEVELOPMENT SERVICES DATE ISSUED: 9/19/2005
'� I- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09309 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Fire suppression.(12,455 sq ft area)
REISSUE: fI, FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FIRST: sf N: S: E: W:
TYPE OF USEKCOM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2N : sf N: S: E: W:
OCCUPANCY GRP: A2 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 439 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:Y
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : Y HNDICP ACC:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 20,741.00
Owner: Contractor:
WASHINGTON SQUARE LLC SIMPLEXGRINNELL LP
BY THE MACERICH COMPANY 6305 SW ROSEWOOD ST
9585 SW WASHINGTON SQUARE RD LAKE OSWEGO, OR 97035
W OR 97223
WAIT Phone: 503 - 683 -9000
FEES Reg #: LIC 149921
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 8/31/2005 $362.45
[TAX] 8% State Surchari 8/31/2005 $29.00
[FLS] FLS Pin Rv 8/31/2005 $144.98
Total $536.43
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: . iz 4 Permittee Signature:' Z e l,
..d
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Fire Pr atect'fotf �yste �� S � .
Building Permit Ann1 't>E nii " � .. FOR OFFICE USE ONLY
_� h li CCC///
City of Tigard Received Ai permit No.:
13125 SW Hall Blvd , Tigard, OR 97223 1% : , , i 1 ` g�(i Plan Review A. I Phone: 503.639.4171 Fax: 503.598.1960 �� e• Date/B : I, yr ,� Other Permit.
Inspection Line 503.639.4175 I Date Ready :. 3 . UPI El See Page 2 for
Internet www.ci tigard.or.us Cll Y OI T IGARD Notified/Method Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
i z New construction ❑ Demolition Permit fees* are based on the value of the work performed. a
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application rt
❑ 1- and 2- family dwelling 'CommerciaUindustrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9 3 o 3 laA5Htocx.ro0 scp u412E_ (o&4 New dwelling area: square feet
City /State /ZIP: T l (7% X4112) / OVZ ° /722"5 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: C - tEESlE(r4-LG pootcT ia-V Covered porch area: square feet r-- t
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.:
indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the '0
DESCRIPTION OF WORK work indicated on this application.
iMSTA.l.1. Pews U( R -t0 FIVZE- SuloPrLESSifa0 Valuation: $
5 YS rem. - Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( )
New:
❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax.:( )
E -mail.
CONTRACTOR
Business name: 51ttA PL (Eirip NN ELI. BUILDING PERMIT FEES*
Address: (930S 5 uJ 12.a$ ,lrjpp S j
Please refer to fee schedule.
City /State /ZIP: LAKE— O S W E -CIO f o pQ_ q 7 eS S Fees due upon application
Phone: (55c,3) ( — 9 0007 Fax: ('Sew) (D7S ''— GS 2-1
Amount received
CCB lic.: I 'i992 -I
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: MIC.Mi F- -Aa Lay Date: 8-- 3 l —1 * Fee methodology set by Tri- County Building Industry
Service Board.
1 \Building\Permas \FPS- PermrtApp doc 12/03 440- 4613T(I 1 /02/COM/WEB)
• NATIONAL ACCOUNT KITCHEN SYSTEM MAINTENANCE REPORT
tgCO/ Fire & I SimplexGrinnell • rg INSTALLATION ❑ MAINTENANCE
Security •
RESTAURANT /IRE SUPPRESSION SYSTEM =
INSTALLATION oFF IF -APP' CAB'E)
SIGNA - • 4 / va1 i ►_1�_
DATE (
L
t ri
Customer Name Gec i..,f • •
•
r
Address ! `)1) (( " \ S 14) ,1 J_ / � , � � , C I • /� �� "! . -
Fi CIO V' 1 Lw L r ; 7
SYSTEM
Model, Size, Serial# _ '.<< • • # of cylinders including master ,
Is system UL300 Compliant? YES ❑ NO EXPLAIN
Number of link(s) and degree rating 7 "�
l 9 C
`Energy shut -off devices - type and size * Cwt' ' Q O UM \JC . Sti
ir s ` � t
Other accessory equipment observed (microswitches, alarms, etc.) �� I C r � - C. 1 L 1 ( ' �
Cylinder(s) Hydrostatic Test Date =PO I
COOKINGNENTILATING EQUIPMENT
Number of duct(s) and size, nozzles and type - (0-‘-1 x 1 0 )
4 - (f) ((o 16)3 t✓ . •
Hood and plenum size, nozzles and type 0 1' c L(- I N) tk' (2 ?S 1 3' - 11U) \ \ 1 ( I
F king Appll ances and size of cooking ac NOTE List appliances ifi from left / 6 �14
to right indicate nozzles used for each).
1. ,...
1 {��' { om' .: r'- 1∎Z0 5. ( � 1.Q i � )2,1P)
- .� - .���/ j ' D u > > >
2. atiria9, (36 02-121/ 1'_lnee (',.1n F�/ Cam �� ,IA/6 4 - 1'i td�'' (; - xZ4) ) 'f- _. N !
3. ID ) r n ►,cc 076;44 *RAC ftj (v i/i L.t 14 7,
4.t Y2-0 HO/ e 416114!) 1304 I NI 8. eha (215 y7.02- (11I p�n ( -j),
TO BE COMPLETED BY TECHNICIAN TO BE COMPLETED BY C T'�OMER I- I N
The fire suppression system is in accordance with the ❑ YES ❑ NO
manufacturer's instructions, NFPA Standard 96 and 17A I have received a copy of this maintenance report and I
(current issue), and all applicable state and local codes. understand it.
Exceptions to the above codes that were observed are
noted below: ❑ YES ❑ NO
Exceptions: I understand that it is a requirement of the National Fire
Protection Association Standard 96 and 17A that the fire
suppression system be maintained semi annually to ensure
continued efficiency and reliability and that failure to do so
may result in failure of the system to operate properly.
Please note that the exhaust system must be cleaned in
accordance with NFPA Standard 96 and is not the CUSTOMER NAME AND TITLE
responsibility of SimplexGrinnell unless otherwise stated
on this form. yy I
. TECHNICIAN NAME _II,� I P fri I If-
SIGNATURE 0-14 4 4/f ! ` / -•••' SIGNATURE
DATE /1 7 r1 c
DATE
(Compliant ❑ Non - Compliant
SG0781
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #:g!P‘z_cx - C1a441
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 I �..
INSPECTION WORKSHEET FOR DATE: it /q / g — TIME: PAGE:
SITE ADDRESS: ? totAt C- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: {-( p f ( SJtpe to-
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
q5;(9 Fl •
Corrections /Comments /Instructions:
ft% . '01,W"
.
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL F.ES ASSESSED
( Inspector: Date: I #: (503) 718-