Permit , A CITY OF TIGARD BUILDING PERMIT'
PERMIT #: BUP2002 -00049
4• 11 DEVELOPMENT SERVICES DATE ISSUED: 2/21/02
' ` ---4•- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
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: 5N : sf N: S: E: W:
OCCUPANCY GRP: M TOTAL AREA: 0.00 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: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 1,300.00
Remarks: Fire sprinkler head modification
Owner: Contractor:
PPR WASHINGTON SQUARE LLC WYATT FIRE PROTECTION INC.
P.O.BOX 21545 9095 SW BURNHAM
SEATTLE, WA 98111 TIGARD, OR 97233
Phone: 503 - 387 -7538 Phone: 684 -2928 .
Reg #: LIC 64077
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler inspection
PRMT CTR 2/15/02 $62.50 27200200000 Sprinkler Final
5PCT CTR 2/15/02 $5.00 27200200000
FIRE CTR 2/15/02 $25.00 27200200000
Total $92.50
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 -6699 or 1- 800 - 332 -2344.
Perm ittee / /
Signature: ,/�/
Issued By: �d
Call 63 -4175 by 7 p.m. for an inspection the next business day
ir Bl)F ,7odI -voY "7 is 6 L
Allio,
Building Permit Application
� Date received: - ' Permit no.:�1f ?)L �– t-?2, ?
� L + City of Tigard �`'►,! _ ® Project/appl.no.: Expire date:
City ofTigard Address: 13125 SW Hall BIR U, 2�
Phone: (503) 639 - 4171 Date issued: By Receipt no.:
Fax: (503) 598 -1960 FEB 1 s 2002 Case file no.: Payment type:
Land use approval: CITY Of 'g' 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: i O tt /[uj i ?_ �i Bldg. no.: Suite no.:
Lot: • 01 Block: Subdivision: f Tax map /tax lot/account no.:
Project name: .. sr ' - .0 a 1•
Description and location of wor on premises/special conditions: — itzoJA('I 11)12- O 1Akti∎ r
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: Pp2 i J . I : i�� , LLC, ( Floodplain ,septic capacity, solar, etc.)
Mailing address: 0 ,Q , ' • Z3 , - 1 & 2 family dwelling:
In 0.A State:Q1Q, ZIP: a1_ S 1 Valuation of work $ ,
Phone: . Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E-mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi- family:
CONTRACTOR
Valuation of work $ t 3 ° .
Existing bldg. area (sq. ft.)
Business name: g tC IN e? N ' 4E . v New bldg. area (sq. ft.)
Address: •Oct 0 , , '1. ∎i YY1
ZIP: • 2 �3
City: -- fie 01,01_0( j !� Number of stories
Type of construction
Phone: ,••,',41 • 2;12E, M E -mail:
CCB no.: 64-6i Occupancy group(s): Existing:
New:
City /metro lic. no.: 4.i3 3 Notice: All contractors and subcontractors are required to be
ARCI IITECT /DESI licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
' Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied with w t e r - r - - c' : .' erein or not Credit card number: / /
Expires
Authorized signature: / ` / Date: 0 Name of cardholder as shown on credit card
Print name: ( C. ,12-0 • *a $
Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00ICOM)
Fire Protection Permit Check List
A.) ❑ New ❑ Addition ❑ Alteration ❑ Repair
B.) Modification to sprinkler heads only:
Describe work to 1. 1 -10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required. .
Number of sprinkler heads:
Additional description of work:
•
Type System-(Complete °A; c6Z applicable)• '+ '^ 7Y3
A.) Sprinkler Wet Li Dry ❑
Standpipes •
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $ I 300 . on
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: $
:Project Valuation°SubtotalM, Bt& C): -$ \, 3
Permit fee valuation=tsee' $ l02 50
' 8% State •Surcharge: $ v , 00
FLS Plan Review 40% of Permit: $ 2S • CO
TOTAL: $ 92_ . 50
is \dsts \forms \FPSchecklist.doc 06/07/01
a r
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639-4175 r.
DIVISION _ Business Line: (503) 639 -4171 MST
BUP .V ( 19
Received Date Requested Z — 2 , AM PM BUP ° (
Location 94 if • 609- - Suite MEC
Contact Person Ph ( ) 6 8 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT '
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
,�Q , / -.
rinkler `'
arm
Susp'd Ceiling
Roof
Other:
Fi-
PART FAIL
= ING
Post & 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
UG /Slab
Low Voltage
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 nspector Il r , Ext
Other:
Final DO NOT REMOVE this Inspection recor from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour � 1
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP 200 / 4Q s7
Received Date Requested 3 - 2 AM PM P)UP 4CZ - D 0 C?
Location 4. Co/ F e,i) ,4 SC2 , f2D Suite L ' p) ,21'iZ-eiC4 O
Contact Person --/-;"
` .Z. '-', ( ) -...'s8 PLM
Co o • c f - 2 2- 8 l P PS Ph ( ) SWR
'4: UILDI ■ - Tenant/Owner , (2 . i 1 ELC
• . ting
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
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof •�,-`
Other:
I II" ' PART FAIL
. :: �' ING ,�
• Post & Beam / /
Under Slab �i�
Rough -In
Water Service ._____
Sanitary Sewer --�.
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P_a FAIL
Rough -In
Gas Line -
S oke Dampers
final
SS PART FAIL
RICAL
Service
Rough -In
UG /Slab
Low Voltage
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 �I
ADA
Approach/Sidewalk Date V �_____ Inspector q::_al__________ Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
24-Hour e:
Inspection Line: (503) 639 -4175
,1 i. Business Line: (503) 639 -4171 MST
BUP /• dd�
Received Date Requested 3 /L/C z AM PM UP 2: — 0c0
Location $ Z/ SA) 6i 5W 41( Suite MEC
Contact Person ti Ph ( ) PLM
Contractor Ph ( ) SWR
ILDI ■ = Tenant/Owner ELC
oo mg
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
71 PART FAIL
PLUMBING
Post & 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
UG /Slab
•
Low Voltage
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 r .
ADA
Date ate 3/‘ /0 Z Inspector / Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL