Permit r
A w BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2003 -00392
s `N111 •
DEVELOPMENT SERVICES DATE ISSUED: 7/23/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136DA -00100
SITE ADDRESS: 11308 SW 68TH PKWY 2ND 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: 3N . sf N: S: E: W:
OCCUPANCY GRP: B 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:Y
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 12,800.00
Remarks: fire protection sprinklers.
Owner: Contractor:
BENENSON 68TH PARKWAY BASIC FIRE PROTECTION INC
KEY LLC, THE 8135 NE MARTIN LUTHER KING BLV
BY FIRST AMERICAN TAX VALUATIO PORTLAND, OR 97211
WORCESTER, MA 01615
Phone:
Phone: 503 - 285 -1855
Reg #: LIC 48641 441�
FEES MET REQMEDOINSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 6/24/03 $168.10 Sprinkler Final
[TAX] 8% State Tax 6/24/03 $13.45
[FLS] FLS Pln Rv 6/24/03 $67.24
Total $248.79
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 1-800-33
i
Issued By: 1,lf , /v
Permittee 4
Signature: Zy7 a., 24
Call 639 -4175 by 7 p.m. for an inspection the next business day
r Fire Protection System
Building Permit Application FOR OFFICE USE ONLY
Received' a�'� �/� Building p
Date/By: '7--. Pernut No 0 3 —0 0 3 / 2._
City of Tigard A Planning Approval Other
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review / Other t
OY/
Tigard, Oregon 97223 Date/By} - /7 35P Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -598 -1960 - ;�:�i�`' I'r,- I Post - Review Land Use
r! � I
Internet: www.ci.tigard.or.us Date/By: Case No. Contact Juris.: ® See Page 2 for
24 -hour Inspection Request 503 -639 -4175 Name/Method: Supplemental Information
• TYPE OF WORK REQUIRED DATA: •
❑ 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 21 Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, '
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: II 30 B 5 ti ' nal ,2Mp. Total number of floors
New dwelling area (sq. ft.)
Suite #: Bld.. /Apt. #:: Garage/carport area (sq. ft.)
Project Name: Ce a4p4, j t Y$4 141:4)71;17).N Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
. REQUIRED DATA: "•
COMMERCIAL USE CHECKLIST
Subdivision: I 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,
overhead and profit for the work indicated on this application.
T2ev, sio ei� 1 s: tit s sy, i?-1 ,-
r reek/ ∎14 4 ZIAL.4 woy Valuation $
11 /� Existing building area (sq. ft.) �3 , 75
4JDt- 1S Pt i wq SSA ' AO Sir81 -14 ✓.5 New building area (sq. ft.)
141 dY r ,'4w �l Number of stories
❑ PROPERTY OWNE 1 TENANT , • Type of construction 31V
Name: Prey; I1 �� k $ Occupancy group(s): Existing: 8 -tt pstle-
�e wG > 0 � dv►,�,a. 7 el.� S
Address: 11 $ 5W f4 -ii P1"L✓y
City/State /Zip: -$.1- a, y-, v J - ' 7z.z3
NOTICE: All contractors and subcontractors are required to be
Phone: Sv3- 216 ;4913 Fax: Spy -2.1 6' 7 %37 licensed with the Oregon Construction Contractors Board under
VI APPLICANT , ❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: Bas ;(., r; e-,o_ 'F're:'teil p k, jurisdiction where work is being performed. If the applicant is exempt
Contact Name: u,,,, pa,,...).L. from licensing, the following reason applies:
Address: 0135 MA 44 L Tr $)t/I
City/State /Zip: }or-1 4,,,. la 9'7.{ l
Phone: Eva z85 1 655 Fax: Sv3- z05- (2713
•BU LDIIYG PERMIT FEES* _ _
E -mail: u we 0 64.1.;c- A re . 4.v Mrs Ple refer to fee schedule. .
CONTRACTOR ... .
Business Name: Es ; ` 4: rI_ ?.17 O j- Fees due upon application $
Address: 9/35 A 14►1J= Tv-
City/State /Zip: Por7 ,, VR, Amount received $
$
Phone: 503 -Z 51$% I F 503 - Z B b713 Date received:
CCB Lic. #: 486
Authorized �� Notice: This permit application expires if a permit is not obtained within
Signature: Date: 6.7 - - 0.3 180 days after it has been accepted as complete.
U1 . PA V 7 9^. *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name) /
i:\Dsts\Permit Forms\BldgPetmitApp.doc 01/03 (� ' U 7 9
/
Tic 1 3 . q S
Fire Protection Permit Check List
A.) ❑ New ❑ Addition J 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: 63
Additional description o
MeQ z5 h
Joo-A °- 36 5pri+ryrS
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet ❑ Dry S
Standpipes
Additional Hazard Group L:91,4'
Information Density .)v
Design Area /5ov
K. Factor 5.4
Sprinkler Project Valuation: $ j 800,-
. 'B.) Type I - Hood Fire Suppression System •
Hood Project Valuation 1 $
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑ •
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A, B & C): $ 1z Soo, —
Permit fee based on valuation (see chart)• $ 160. )
8% State Surcharge: $ ) 3.45
FLS Plan Review 40% of Permit: $ 67.2-4 -
TOTAL: $ z48.7'
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 11/21/01