Permit ^', BUILDING PERMIT
C ITY OF T I GA R D PERMIT #: BUP2005 -00070
14 , DEVELOPMENT SERVICES DATE ISSUED: 2/23/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136DA -00100
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL
SUBDIVISION: ZONING: MUE
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: : sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0 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: # a 4 /0(o . 00
Remarks: Relocate (4) sprinkler heads & add (4).
Owner: Contractor:
BENENSON 68TH PARKWAY BASIC FIRE PROTECTION INC
KEY LLC, THE 8135 NE MARTIN LUTHER KING BLV
�B/Y FIRST AMERICAN TAX VALUATIO PORTLAND, OR 97211
PhoneESTER, MA 01615
Phone: 503 - 285 -1855
FEES Reg #: LIC 48641
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcharl 2/23/2005 $5.77
[BUILD] Permit Fee 2/23/2005 $72.10
[FLS] FLS Pln Rv 2/23/2005 $28.84
Total $106.71
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:
Permittee
Signature: c -�,
Call 639 -4175 by 7 p.m. for an inspection the next business day
Fire Protection System
Buiidinj Permit A ONLY
OFFICE USE ON
City of Tigard p I vE D Received Permit No.: -/,1 /t 6
1312 Hall Tigard, Plan Review Blvd., Ti ard, OR 97223 Date/B : ,_ D� 3 - `►� VL. _ a (fir/
Phone: 503.639.4171 Fax: 503.598.196( Eg 2 3 2005 I `D i l l Date/By: Other Permit:
Line: 503.639.4175 . ,' ' Date Ready/By: Jnris 0 See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: S \(r Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
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.
❑ i- and 2- family dwelling ® Commercial /industrial Valuation: $
El 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: 11308 SW 68 PARKWAY, New dwelling area: square feet
City /State /ZIP: TIGARD, OREGON 97223 Garage/carport area: square feet
Suite/bldg. /apt. no.: LUNCH Project name: SIS LOWER LEVEL Covered porch area: square feet
ROOM
Cross street/directions to job site: 68 BETWEEN 99W AND ATLANTA STREET 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.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
RELOCATE 4 EXISTING SPRINKLER HEADS WHILE ADDING 4 FOR LUNCH Valuation: $$2,406.00
ROOM REMODEL Existing building area: square feet
New building area: square feet
Number of stories:
❑ PROPERTY OWNER ® TENANT
Type of construction:
Name: PROVIDENCE TIGARD BUSINESS CENTER
Address: 11308 SW 68 PARKWAY Occupancy groups:
City /State /ZIP: TIGARD OREGON 97223 Existing:
Phone: ( ) Fax:( ) New: B
® APPLICANT ❑ CONTACT PERSON NOTICE
All contractors and subcontractors are required to be
Business name: BASIC FIRE PROTECTION, INC. licensed with the Oregon Construction Contractors Board
Contact name: TODD CRIVELLONE under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed. If the
Address: 8135 NE MLK Jr. BLVD applicant is exempt from licensing, the following reasons
City /State/ZIP: PORTLAND, OREGON 97211 apply:
Phone: (503) 285 -1855 Fax: : (503) 285-0713
E-mail:
CONTRACTOR
Business name: BASIC FIRE PROTECTION, INC. BUILDING PERMIT FEES*
Address: 8135 NE MLK Jr. BLVD Please refer to fee schedule.
City /State /ZIP: PORTLAND, OREGON 97211 Fees due upon application $106.71
Phone: (503) 285 -1855 Fax: (503) 285 -0713 Amount received
CCB lic.: 48641 Date received:
This permit application expires if a permit is not obtained
Authorized signature: / within 180 days after it has been accepted as complete.
� /0,15" * Fee methodology set by Tri County Building Industry
Print name: TODD CRIVELLONE Date: 03f13f94' Service Board.
i:\ Building \Permits \FPS- PemutApp.doc 12/03 440.4613T(11 2/COM/WEB)
CITY OF TIGARD
BUILbING bIVISION PERMIT #: BUP2005 -00070
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/23/2005
Phone: (503) 639 -4171 , �.a��0 1 1 11 ,
-._191- Inspection Requests (24 Hrs.): (503) 639 -4175 ' .� s:_..
INSPECTION WORKSHEET FOR DATE: 5!6/2005 TIME: 7 :10AM PAGE: 79
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE
DESCRIPTION: Relocate (4) sprinkler heads & add (4).
OWNER: BENENSON 68TH PARKWAY, PHONE #:
CONTRACTOR: BASIC FIRE PROTECTION INC PHONE #: 503-285 -1855
Inspection Request Scheduled For: Date: 5/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 006244 -02 503 - 849 -7891 N
Corrections /Comments/ Instructions:
)/ J r 7 Fk1 )i tz_(tp_ (p
D , .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONA FEE ASSESSED
Inspector: �l Date.ON 1 Phone #: (503) 718 -