10200 SW GREENBURG ROAD STE 200 rI O
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10200 SW GREENBURG ROAD
-tINCOLN V , SUITE 200
CITY OF TIGARD BUILDING INSPECTION DIVISION 11
24.-Hour Inspection Linc: 6394175 Business Phone: 6394171
�j L ! — AM. I'M MST-
Date Requested: U�
BIJP: ��..
I,ocahon:
Suite: l 131dB: MEC:
Tenant:_^\ �`�5�-- — --- — -- -—
—_. - -�---
Phone: PLM:
Contractor:_ _—
Phone: ELC:—
SIT:
BUILDING B:.L`C:(coni) PLUMBING MECHANICAL CoLEeCTRIC�AL Sewer/Storm
Site Post/Beam Postflicam 1 ost/13cam
FootinRoof
UndFI/Slab Rough•.In Ceiling Water Line
Slab g 1 taming Top('"It Cas bine Rough-In V ultUG pr►nk Sprinkler
Foundation Insulation SaI loor!/Ihtct Reconnectwer Furnace Temp Service MISC.
Bsmt Damp Drywall Stonn
('cilir Rain Drain A/C UG Slab
Masonry I ow Volt
Shcar/Sheath ire S , Crawl/Found ound lr i,gat I'tunp
Approved Approved
CA—pproved�) Approved Approved PP
Appr/Sdwlk o Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL
FINAL FINAL
O Call for reinspection Cl Reinspcction fee of Srequired before next inspection �7 l)nable to inspect
Inspector: ` •-
— --- - Date:- Page---of —
IF
F_ __ TIG�►RL�CITY OF PERMIT
�
DEVELOPMENT SERVICES BUILDING FE
PERMIT #. . . . . . . : BUP97-.00"'
13125 5W Hall Blud.,1'Igard,OR 97223 (503)639.4171 DATE ISSUED; 0 �/;:,4/'37
PARCEL: ].S 135AB-40700
A T TF. ADDRESS. . . : 1020121 SW GRE;ENBURC?r RD #200 T UN T NU:C--F=1
,3LIBDIVIS'TON. . . . : TOWN OF mE'rZGER
BLOCK L.n'i. . . . . . . „ . . . . . : 7
RET SS(..IE:^�- - F"I_C'OR^AREAS,-..-�-.-------- -�i EXTERIOR WALL CONSTRUCTION
CL-ASS OF WORK. :ALT r I RST. . . . : 0 s f N: S,: E: W
TYPE !]F USE. . . -COM SECOND. . . : 1600 S f PROTECT OPEN I N S W
TYPE OF CONST. :2N . . . : 0 s f N: S: F
nCC0PANI':Y GIRP. :B 11 '1 AI. _. i r-,t?I0 f RnOF CONST :CF T F?E RET"? -
OCCUPANCY LOAD: 16 BASEMENT. : 0 Sf AREA SEP. RATED:
STOP. : 0 HT: 0 ft GARnGE. . . : 0 St OC:CU SEP. RATED:
l3E;MT? : ME'ZZ? : REDD SETBACKrj----.-------- RL"G1LIIRED
F I_O0P LOAD. . ., „ : 171 r,s f I_I"F T: 0 f t RGIAT: 171 1 t F I R SF''KL_.:Y SMOV DF'T. . .
DWELLING UNITS. 0 FRNT: 0 ft F?FAF?: 121 ft FIR ppo PLCr)RR: HNDIlNL.,ACC:y
0 BA-I"HS: 0 IMF, SURFACE-
VAL.UE. $ : erjL10
Rr'mar^ks : Tori ant improvement : US WF*9- T DEX - Demo appy-ox 60 lin ft pCArtiti.oni.ng.
Const approx c'O ]. in ft part i.t i nn. Arm ADO casework
FEES
Mj: I VTIV MARK OWNER' S REF' type Amrjr_rnt by date r rcpt
'
SW rREENBURC RD PRMT $ 74. 50 JSD 02/18/97 97--290481
1171u0
rinr.' I>ti:
PriIF_'CC Vl,.. $ 4S. 4'? TS1) 0 ;37 9O4E1
9OITT 150 FIR- $ 29. B0 JSD 18/97 97--,.* 481
;ARD OR 97EE3 .
fi -3,, 7;? ,Tril) O2 1S/`I 1ih4f31
11..IF1l..l F=nCTI'"TC
NE JACKSON SCHOOL ROAD
HT1 .I_511ORO OR '.171;:41 cr'�4F�TOTA1
unn 0 : 1;97,-_9797
r,g tr. . : 0003190
__._..___... _ RFG?IIIF?E'D INSPECTIONS -- - -
s permit is issued srJbTect to the regulations ^ontained in the Fi-am i nq :n,p
hard Municipal Code, State of Ure. Specialty Codes and all other Gyp Boarcj Insp
plicable laws. All work will be done in accordance with Sr.aSp CE'i l ng Tr) p
proved plans, This permit will expire If work is not started —
.Jhin 180 days of issuance, or if work is suspPndPd for sore - -
ar
IN days.
,.nl i t t 2 e `:i i
Call. . Tr inspection - 6.39-4175
%..Ommercial ilPermit AApp1�
�1 . Ijrr1 131:5 SW Hill Blvd 7i,lard, JR 97::1
(5011 639-+1'1 /
Jobsite /address: I C)Coo 3'kV, , OFFICE USE ONLY �•� —_
Ta_nant:�SW&/ 7Q — suite # zQQ_ Planck/Recce.
Valuation: a �0 ---- Permit#
j Map �TL At
Owner: �,,,�D�Q� �C `� wrP�6�� _—.
� Ap�'Qv_�Is Re�u�L��
Address: LD3oo Sw(SA"_LI(e . �LvO
Planning
Engineering
Telephone:
Other
Contractor: ���� 1 f�C�FiC
Address
tl�n(Lo , 02 171,2* Type of constr:_
Telephone: — Vi- 9��— Occupancy Class:
Contractor's License » = .� Sprinkler"? Yes No
(attach copy of current Oregon license)
Sq. FL Of Project:
Contact name & telephone: !- �` sr"1`7H LAO
i,-Z..0 7 44 Story (1 st. 2nd, etc.): - -
Architect 3 Engineer: y��117{-,� J bd.�NG
Proposed Use: " (A('F. 0, '-
Address: N —
Previous use. G _
Note: Plumbing R mechanical plans must
Telephone. � U �O�— _�_ be submitted at time of building permit
application.
l
JOB CESCRIPTION:
i
Applicant ignature & Telephone Number)
aceived by: _�______ Date Received:
,.Cl.1FF3 CCC CST. •C.46
PERMITS Acg. t Description Amount Amt Pd. Balance L`ue
Building Permit IBUILDI
Plumbing Permit (PLUMB)
Mechanical Permit (MECH)
State Tax (TAX)
Bldg. _
Plumb.
Mech.
Plan Check (PLANCK)
Bldg. 4
Plumb.
Mech.
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MTI
Commercial TIF (TIF-C) m� _
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS) _
Office TIF (TIF 0)
Water Quality (WQUAL)
Water Quanity (WQUANT) _
F,re Life Safety (FL.S)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck,'USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: I
I'CCNIPERCCC CS7) 10:96
CITY OF TMEr:Hi)N T:CAS..
DEVELOPMENT SERVICES PERMIT
13125 SW Nall Blvd., Tigard,OR 97223 (503)639.4171 DATA"7-r S . . . . . . : ML�97 00�+
PngCEL: 1 S 1:,'Zn13--00700
3ITf� f D1�Rrcr . . ;'7.. .0 SW GREENLAUP0 RL!
tlE�I1IVT.CTON. , . . : TI1Whi OF MF'TZGI'R Z.(Thilhlf;: S r,
LOT. . . . . . . . . . . .. . :7
�'L.n9b' Or- WORK. At T t'VAP COOLERS . 1
TYPE OF: L.1 SE. . . . :COM UNIT HEATERS. . : 0 VENT FANS— :. : 0i
'3CCUP(4NC'Y ORP. . :S VENTS W/O r,F'l='I_ : 0 VFN T SYSTEM£:. 0
3TORIEa. . . . . . . . : 0 B01L..ERS/CC11PRESS0RS G100 DC. . . . . . . :. 0
11U0L TYf,Lr,_ _..__ .._......... ...._.. . 0.._3 Lid'. . . : 0 DCIME!?. TNC;Tri;
: /E / ; I 3-15 Hr'. . . . : 2 C:OMML. I NC I N: 0
MIIX 1 NPL1": 0 T I T U 1 '5. 3o i-,r. ,, . : +l+ RE Pn T R UN l '"; ; 0'
r RE' DAMPERS'^. , N Oil -50 !-if''. . . » 0 WOOD STOVES. . : 0
-:rfl< E'F?E c:rr�l_1RF , 1-50+ HP. . , b� rl C� DR''i L"I?r:< , 0
NO,. OF UNI'PS--_.._._.._..__..___ AIR P(MLING UNITS OTHER UNITS;. : 0
11 TI l c o !' 10+700 1.1'm : 0 C("1S 01 T!..ETr. ; r
r'IJRN ) =12710K BTU: 0 (-fm - 0
Rr�m�?il� Tr+ri .>T�': i mE�tc�ur.,mrrrt:
FEE c, _...._w.__._._... ._.
+uf)RI?T'. ESI"f_,t;r:; 8 :;IMf'Sf1i,I I;'ipe <�mn1.int by clam ler c.
10:300 !',W ii12Cf`NINURG RD t"'RY,T 't 32. 00 S 03/00,/07 97--291:5 _'i
)"'F.: 1.00
TIGARD '.)R 972";:7'3 5Pr'T s 1 . (.0 P +73/06/'-_37 97--2291 L
Pimm' #:
L 0T1tI-aUtUI'' _..__ .._._._. _•.,.._._....._,._._..,_.... . .
'',,IIN 3TRY Cf)
00 NE:. COLUMBIA PL._VT)
RTLgND OR 97216
am #:
_ REQU I RED I W'-Pr-T I(-)N".i
= persit is issued subjett to the regulations contained in the '':cin'liny +Jn+, Insp
,rd Municipal Cade, State of Ore. Specialty Codes and W ether Misr. . Inspect i.,.rn _
cabl a laws. al) work wi l'_ be done in accordance with ►'i ri.al I r1 s Fo e t i a n
'••pard plays. This p roit will fxplr° if work is not started
in 18@ days of issuance, or, if wark is 5aspended for torr
IN days.
. , U
I
Call, foi ins,pcactiorl 6313- 4175
Plan Check 0
CITY OF TIGARD Mechanical Permit Application y(1 Recd By
13125 SW HALL BLVD. Commercial and Residential Date P.ecd�i Date to P E
TIGARD, OR 97223 ` Date to DST 3-a-f7
(503) 639-4171, X394 Permit a
Print lir Type �1P��-p�r7C� Called +�—
Incomplete or illegible applications will not be accepted
- Name of DeveloD�nVProiect Description
Table 1A Mechanical Code UT'r PRi�=E AMT
10 C0
lob Streoi Acdress �wleo AI Permit Fee
Address 2,C) w rr ��' -
gldga cty1stau Zip B) Supplemental Permit 3 00
S TI ar --
-- --- Name tor name of businee 1 1 Fumar e to 100 000 13TU 6 00
incl ducts&vents
Owner r 7 50
Marling Address 2) Furnace 100.000 BTU+
3 J incl ducts&vents
Cayr5uta1
Zip Phone 3 1 Floor Furnace 6 00
Gn- ?? .. !ncl vent
-`-_`- rJanie for name of businassl
4 1 Suspended heater,widl heater 600
ror noor mounted heater _—
_
300
Mailing Andress 5 I Vent not incl. n
Occupant , appliance permit
tl�e !1111
600
F�ddre
ro Ip Pnone 6 1 Boder or comp,heat pump,air Gond.�f to 3 HP.absorp unit to t00K BTU_
7) Boder or comp.heat pump,air Gond — 11 00
3-15 HP absorp unit to SCOK BTU
�-�� i r i f+r'v C' 1500
ContractorAddress 8) Boder or comp,heat pump,air GondSIE �uI15-30 HP,absorp un t 5.1 and BTU(Prior to te Zip Pnone 9) Boder or comp,heat pump,air Gond. 22 50�K f_ 30-50 FIR absorp unit 1-1 75 and BTU
ssuance a copy 1 11 of an licenses are Const.Cont.Board Lie.t Exp Dme 10) Boder or comp.heat pump.air cnnd. 37 50
>50 HP;absorp unit 1 75 and BTU
required if � - 4 50expired in C O Tusiness Tax or Metro M Exp Dale 11 ) Air handling unit to
10 000 CFMdata base) 12 ) Air handling unithite1, f �` SL)crrrn10.000 CTM+or Address13.) Non portable 450
evaporate cooler�,p Phone 14.) Vent tan connected300
Engineeriete
to a single duct
t 5) Ventilation system not 4 50
Describe work New O Addition O Alteration t9 Repair O Included in appliance permit
to be done Residential O Nonresidential O 16) Hood served by mechanical exhaust
o 450
Addd`onal Description of work
�U ,-•.
17) Domestic incinerators — r 50
18) Commercial or ndustna" 30 00
Existing use of incinerator _ _
building or property 19 1 Repair units -- 4 50
20) Woodstcve 4 50
Proposed use of
building or property
21) Clothes dryer,etc 4 50
Type of fuel-oil i) natural gas O LPG C) electric G
22) Other units 450
23) Gas piping one to four outlets 2 00
I hereby acknowledge that I have read this application,that the information givens correct.that I am the owner or authorized agent of 24) More than 4-per outlet (each) 50
the owner,that plans submitted are in compliance with Oregon State
laws
Signature of Owner/Agent
---- Date aTY.SUBTOTAL
---� --^ �—_ 'SUBTOTAL
11 rTiI t"ri� �, 5%SURCHARGE
Contact Person Name Phone
�•ic�fn` s 3I' Od,�4. PLAN RE�iEW 25°'o OF SUBTOTAL ?'J
TOTAL
Wpm 'Minimum F errnit,fee is S25+5%surcharge
stUriecht doc (r v 796)
p ITY OF GARD
I� Approved,... .1................. .(
_. Conditionally Ap roved. .................... .( J:
For only the s de ed in: _
PERMIT NO
See Letter t .. ... .[
Att h... ... . ... . . . [ j:
i Job Address o toe
• Date: �7
Bim_—
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S!a ' A 1
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w /■il 1
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N W W W N N N W N N IJ N N N
v1 of O of n tr v" to v!
:moi I j oe cwj 3
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I CIT F TIGP ID IC
t Approved............. .....•... .(
Conditionally Apj ......(
For only the wnr� iz
PERMIT NO.
See Letter to: Foll w �) �r
i
All h.
�— Job Addres Icy a �,u) �� fl�y4\ iC
12
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ITS
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I
CITY OF TIGARID
DEVELOPMENT SERVICES PLUMBING PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PERMIT #. . . . . . . : PL M97
DATE ISSUE-1): 03/03,/97
PARCEL: I9135AB-00700
I-F ADDRESS. .. . : L0200 SW GREr'NSURS RD #200
'BDIVT�,TON__ TOWN (IF MET76EP ZONTINIG: C-..P
OCE;. . . .. . . . . . . .. LOT. . .. . . . . . . .. . . . :7
7
ries or WORV., n- LT (3ARBnGE v'rSPOSnUi. 0 MOBI[-F HOME !PACES,,
;PE OF USE. . . . COM WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . 1,
1-UPANCY GPP, TA FLOOR DRAINS. . . . . . . 0 TI?Aps. . . . . . . . . . . . .. 0
DRIES. . . . . . . . : 0 WATER HEATERS. . . . . : I CATCH BASINS,. . . 0
XTURF,7'r:j - - — - ---- LnUNDPY TRAYS. . . . , 0 9F RnIN DRAINS. . . . . 0
NKS. . . . . . . . . . C 1 URINALS. . 0 GREASE TRAPS. . . . . . . 0
')ATORIES. . . . . . 0 OTHER FIYTIJRES. . . . - 0
1B/SHOWERS....: 0 SEWER LINE (ft) . . . : 0
(qni"ER CLOSETc7i. . 0 WATER L T NF ( f!; ) . - . : 0
r)'!9HWAu.3HFRS. . . . 0 RAIN DRAIN (ft) . . . I Q)
1.7 o m;4 r k -i - T P n-4 n t improvemont Dt-molit. ion of exi-,tirig bac-Pf`1 ()w prevent; ion iltvi
w4 ) ? rf°qoir,p ,-n inspection.
llomer . FE.E
1,,IORRIS SEG36F, 8, S-TMPSON V r)F.? amantL,,,, date pt
100,00 SW GREENBURG RD PRMT fi, 27. 00 S 03/03/97
E 100 -1 03/03/97 97- 1-3 1 1, 71'7
CORD OR 972*123
,,, 1#:
)Titr.artar-
F!IN iTRY CO
NE CnL11MBIA BLVD
'il'LAND nP 972'18
-one It: 3s1. O'L23 4 _6 35 TOTAL
RECILITRED JNSPECTIONS
permit is issued subject to the regulations contained in the Top- rmt [nsp
"ird Muricipa! Code, State of Om Specialty Codes and 611 other RP/Sac:kf low Prev
'Idarrf with Firi�-%] Insq)pr.tion
i cabl P ',aws. Al I work wi 11 be done i n accut
,wov#d plans. This persit will expire if work is not started
,tiin IN days of issuance, or if work is vispended for tore
IFA days,
1.tv
Call for i.n,;j)ectj.on (`,39-4175
.ITY OF TIGARD Plumbing Application 7 �(
3125 SW HALL BLVD. Commercial and Residential ]ate Reca I r.It`1
"IGARD, OR 97223 .,jte'oPE
503) 639-4171 Cite to CST
Print or Type Related SWR s 11-M/r1
Incomplete or illegible applications will not be accepted :ailed
Name )i ceveicomentrProiect FIXTURES (individual) QTY PRICE AMT
Job + Smk 9 00
Address Sr.eet %odress Suite Lavatory 9 00
�C =u Sty rG� 1`3 � u0 or "uD'Shower :.11,10 I I 9 00
Sl Iq a J,tyr5tatef Zip 'shower Onw .'1"--r---0�--t---�
OfZ `� 1 s' 'water Closet 1____I
Name I I 9 00
C snwasner I I -T-
'r� .n>�. I ']00 I I
Owner Matting Address Suue Saroage l]soosai
00
1 900 L�—•--�
V.fVrSlate yip Phore c ocr Crain—�—�
Name F[ L___j_ 9 JO
/_._/e goo —J
Occupant Mailing Address Su,1e Nater Heater
ol _g6o
n/ r 1C'3 1 sundry Room Tray cay,31.1te Zip Phone Unnal
Name then F xtures Sootily)Y 0_1
Contractor Malting Address Suite r. I 1 � lH'orto ssuance Cay.State Z p Phnne aoc❑cant must
provide 311 regcn Const C;lit Board Lie x ExD Cate 900
:ontrac:ors
900 J
cense Plumbing L c s I Exp Gate I .Sewer. t st 100' 30 O7
mformapon
Sewer-each additional 100' 25 00
'or COT COT 3usmess Tax cr ttetro s Exo Cate _
database) I Water service. isl 100' — 30
.00 I
Name ;,ater Service-eacn aaddiona =0025 ±_�_Architect / J Storm,i Ram Dram• st t00' 30
or Mailing Address i Suite Storm 3 Ram Omra -each additional 100' _ 25 00
Mobile Home Space 25 00
Engineer C.tyrState Zip Phone Cimmerctal Bari F'ow Prevention Cevtce or Anti I 25 JO
_ Poilution Device —
M-l!be workNew _ aadihcn alteraticrl 3: RPCau � I a?Ldertlal Sack"cw `)-evention_evrce' S JO
Ce.dile. ^.es,Cenllal C NDn-resiaential Z pr ?y 7r3D or:Vas' `Ict �;nneCleo 10 3 =,xtur? I ]J0
=1!:onal descn Dtton 01 MarkI I _
f 1p)k oenq 1ti/a���GU"'"Tt!' Cato aas�n �— 3 30
✓e r:t�ol,� ileo or=xottrtg.-umom9 a0 00 I —
I Der;hr i
[xist,rg use 'f A -- Sceaadr
y Reduested Inspections a0 00
udd;nq ar orocery 1--� oe hr
— I Ran Crain singe'amuy ,.Yemng 1 I 30 ]0
speed use cl I I Grease Trace
arg or crcoery
QUANTITY TOTAL
u rg movrrg 7r eclac:rg any fixtures' les _ %:o , I ltametnC»ser
es s ack of form) SUBTOTAL I )
e. ,edge:rat '+ave read:his application !hat the nformation
s
'at! 3m•.^.e awrer -r 3uthonzed agent of:he awrer and 51'1 SURCHARGE I 7
-m are •- _cmchance+nth Cregon State Laws.
r arrAgent Cate PLAN REVIEW T5% OF SUBTOTAL
TOTAL p 2S
er rine Phone
1 'Minimum permit fee s 5i; - ,">surc large except?esioential Bacxflow
L.:•111 0\C. _ I Prevention Cevtce vnicn is 515 5'6 surcharge
i'dsts Dimaco ccc 396
EASE COMPLETE AS APPRQPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced i Qty
j Sink
Lavatory —
i
Tub or Tub/Shower Combination i
1 Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain _ 2." --��
�— 3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
'OMMENTS REGARDING ABOVE:
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line:639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling lum
i.
Post/Beam Mach. Shear/Sheath Framing -Mech.
Plbg,Und/Flr/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwik Reins.
Other: _ GG --- -- --- —'
Date: A.M. —P.M. try:—
Address: �..� -21Q L_�
Tenant: _ St MST: _ ---
BLIP: —.--
Con/Own: - - --_-- MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
1 Spector -- v---- Date ZL�
PPROVED ___DISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171
CITY OF TIGARD Fire Protection Permit Application Plan Check#
13125 SW HALL BLVD. Commercial or Residential Recd By
Date Recd
TIGAPD, OR 97223 Date to P E.
(503) 639-4171 Ext. 304 Print or Type Date to DST
complete or illegible applications will not be accepted Permit#
Called
Name of Development/Project Gou 5
Type of System(Complete A or B as applicable)
Job 1.W, ".W ('«trek v' cx2t�,JbrlRrr C,/
Address Address A.) Sprinkler Wet
Z(,r: TI( o Dry
Name Standpipes
n(u"rl5 13G�xcxs 5tr�r �,I _
Owner Mailing Address Hazard Group
Iu �(•(, '.q (,LUEfl)S�tir, Additional
Citylstal zip Phone Information Density
Name Design Area
0 ', \(4T
, K. Factor
Occupant Mailing Address
I ULA,(, ' %l 46 ttk 1Zu z Sprinkler Pro _
City/State zip Phone p ject Valuation $
T t LirW-U 1r L r1 7 LL J 7/.J
COT Business Tax or Metro N Exp. Date B.) Fire Alarm
_ I t-
___t,4q I
Contractor Name Submittal Shall TncTude Battery Calculations YES 0
H c (-r 1J. C.vr-tpArly individual Component YES
�8�prtink rlor Mailing Address -
_ Cut Sheets
Company) City/State zip Phone Fire Alarm Project Valuation $
iU(L '1 ii1,., SSI •dZ-14-
Attach
-1 -Attach Copy State Const.Cont.Board Lic.# Exp.Date Project Valuation Subtotal (A or B) $
Current COT Business Tax of Metro 8 ) Exp.Data A— W 5% Surcharge $ rS
Licenses I• r -- - _. /� 2 5-
Name FL.S Plan Review 40% of Subtotal $
Architect Mailing Address TOTAL $
City/State '.ip Phone PLANS MUST BE SUBMITTED, approved and a permit issued prior
_ to installation. Three sets of plans and site plan (and vicinity map)
Descube work A.)New O Addition o Alteration Repair O required which shows location of nearest hydrant.
to be done I hereby acknowledge that I have read this application,that the information
B.) Basement O HoodNent O Spray Booth C given is correct,that I am the owner or authorized agent of the owner,and
Complete O Partial O Exitway O that plana suhmitted are in compliance with Oregon State laws
Adrldional Description of Work. Signature of Owner/Agent Date
„',.,,., �rf5 a ,J, ,A�
2rP�FE G" t�+�tsn�v tNeT
17K1--A-Lncnt TSY STtM( � S�ppelEJ E �4�tit E�rtnnil )v f
NM=Lt;q(_ AoI)i rt t, _S', Contact Person Name-L_ Phone
A.)In Existing Building A New Building ❑ J f �Iv, /4
r t1 �,`Lo OF .33/
Building .--
Data e•) Commercial p7 Residential C7
FOR OFFICE USE ONLY: _
No.of stories I Plat# MaprfL#:
Sq. Ft — - ' - Ar/
Notes
Occupancy Class Type of Construction
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