Permit ,.
A' ' CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00023
471A DEVELOPMENT SERVICES DATE ISSUED: 1/23/04
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S101AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 250
SUBDIVISION: TIGARD OFFICE BUILDING 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: 2N : 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: # (a 93, 0
Remarks: FPS: Addition and relocation of 4 sprinkler heads.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES DELTA FIRE INC
15350 SW SEQUOIA PKWY #300 -WMI 14795 SW 72ND AVE
PORTLAND, OR 97224 PORTLAND, OR 97224
Phone:
Phone: 620 -4020
Reg #: MET 0 000 0 011934
FEES LIC REQUfI4ED INSPECTIONS
Description Date Amount Sprinkler inspection
[BUILD] Permit Fee 1/23/04 $62.50 Sprinkler Final
[TAX] 8% State Surchart 1/23/04 $5.00
Total $67.50
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 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
_____Z:6Y747€,J
Issued By:
Pe it a 9 �� /n /1
Signature: /\�'J � clAci____
Call 639 -4175 by 7 p.m. for an inspection the next business day
®.- Fire Protection System
Building Permit Application
�, j i i City of Tigard RECEIVED Date received: /.2 ye , i / • a t no. . o f . • o , • • B
- = --- Project/appl.no.: Expire date:
City oj Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 JAN 2 3 2004 Date issued: By: Receiptno.:
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commerciaiindustrial 0 Multi- family 0 New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other.
JOB SITE INFORMATION
Job address: a , • ailn _ / l ,AAWPQ _ 1S Bldg. no.: Suite no.:
Lot: Block: Subdivision: ,� ax Tax map /tax lot/account no.:
Project name: lri i / e r✓ l'r 1L�.�� I ie!_
dr
Description and loca ion of work on premise . - cial conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: (Floodplain. septic capacity, solar, etc.)
Mailing address: 1 & 2 family dwelling:
City: State: ZIP: 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.)
��
■,1rtii_'� Covered porch area (sq. ft)
Mailing address: Tr% 0 . A MP I . Deck area (sq. ft.)
Enurrr... • _ ZIP: 49141111.1 Other structure area (sq. ft.)
Phone: Awn, 04w;„ Fax: E -mail: Commercial/Industrial/multi-family:
CONTRACTOR Valuation of work $ (on
�� `, ` Existing bldg. area (sq. ft.)
Address: W `•1 F lAbig� r �_ New bldg. area (sq. ft.)
� ` � E2` � ' Number of stories
�� R= Type of construction
Phone: fon I J Fax: E -mail:
CCB no.: Occupancy group(s): Existing:
_I r New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
rsoemim T���� provisions of ORS 701 and may be required to be licensed in the
Address: Ai, IMIDIVIP1r`r j urisdiction where work is being performed. If the applicant is
ECIMFITM,I XAMIE iti ZIP: i m exempt from licensing, the following reason applies:
Contact person: � �'im Plan no.:
/.t'�T�7
Phon= I. B� �.
ENGINEER
Name: Contact person: Fees due upon application , $ ickA0
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 jutiadictions accept crept cards. please call jmiadictioo for mote information.
attached checklist. All provisions of laws and ordinances governing this O Visa 0 MasterCard
work will be complied i w , Cher s .. i e • herti in or o Credit card number: /
Expires
/
Authorized sign. y ' 1 I I L... x.411 ate: 6 Name of cardholder as aroma on credit card
/ li
Print name: fUr •'Ln g .._ Cardbolda signature S
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,V0 COM)