Permit N` BUILDING PERMIT
C ITY OF TIGARD PERMIT #: BUP2005 -00092
��� , DEVELOPMENT SERVICES DATE ISSUED: 3/9/2005
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S101AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 450
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: 2 -1 HR : 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:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: ,,.. IMP SURFACE: PRO CORR: PARKING:
VALUE: 6. 9 . Do
Remarks: Adding (3) new 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
FEES Reg #: LIC 64174
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 3/9/2005 $62.50
[TAX] 8% State Surchari 3/9/2005 $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.
Issued By: - 74 r ,e Z)
Signature: I /1' .Li: d ! ).5- .:.,
Call 639 -4175 by 7:00 p.m. , .r an inspection the next business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
MK
Fire Protection System
Butt/rag g Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: 9 �S 2 PerttutNo'T(N\ ..2t0 . 0g 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review o � �
Phone: 503.639.4171 Fax: 503.598.1960 u"4re Date/By: Other Permit:
Inspection Line: 503.639.4175 P' I I,. Date Ready/By: Jug' ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: T Supplemental Information
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
,ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ I - and 2-family dwelling ► ommerc 'ndustrial
❑ 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: /p-- O l _S Ca e I v `P/ New dwelling area: square feet
City /State/ZIP: Garage/carport area: square feet
Suite/bldg. /apt. no.aL.iSD Project name g '
� ‘ 3 ... / Q Covered porch area: square feet
Cross street/directions to job site: V Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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.
4 - A y &_ _ _1 . Valuation: $ 962 9 •
`. •- n. ) l f`} a �Jn 5 - Existing building area: square feet
J � - - �� - New building area: square feet
❑ PROPERTY OWNER 1E<TENANT Number of stories:
Name: CAL l t,l Lt, ar T $ Type of construction:
Address: /6 'i ( f-1 l � 4 Occupancy groups:
City /State /ZIP: elP , Q_ 9 _ .249- Existing:
Phone: ( ) Fax: ( ) N O-APPLICANT ❑ CONTACT PERSON NOTICE
Business name: ` / , � ({.0,.. � All contractors and subcontractors are required to be
/
Contact name: .� ta,l — licensed with the Oregon Construction Contractors Board
rj A ✓_, under ORS 701 and may be required to be licensed in the
Address: /4-1 Z9 �� jurisdiction in which work is being performed. If the
City /State/ZIP: , 4,-70;)4 applicant is exempt from licensing, the following reasons
�^ /��l / �� y � l yr
apply:
Phone: ( ) (..0 ) --(.1C) Fax: : 6 (cgg. —/C S D
E -mail:
CONTRACTOR
Business name: 1 ^ ,�I� � } � , ` BUILDING PERMIT FEES*
!. :4ddress: _ 7 �r J c� ) �� QJ ✓
a d- 11, � ,J � 47 � Please refer to fee schedule.
(/ , l �l
�t Fee due upon application CQ 7
Amount received
CCB lic.:
Phone:) .� — C /"1 �) Fax: ($6�) (s:; --lQ�
[;''(% " / 7 ai - 1/
Date received:
Authorized signature / '/ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name^ AACCOa Date: 3/ `7 /O'- * Fee methodology set by Tri-County Building Industry
Service Board.
i. \Building/Permits \FPS - PermitApp.doc 12/03 440- 4613T(1I /02/COM/WEB)
CITY OF TIGARD
BUILDING. DIVISION PERMIT #: BUP2005 -00092
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/9/2005
Phone: (503) 639 -4171 ,,
U
Inspection Requests (24 Hrs.);. (503)
INSPECTION WORKSHEET FOR DATE: 3/23/2005 TIME: 7:O8AM PAGE: 58
SITE ADDRESS: 12909 SW 68TH PKWY 450 CLASS OF WORK:
SUBDIVISION: TIGARD OFFICE BUILDING LOT #: TYPE OF USE:
PROJECT NAME: TRINITY UNIVERSAL INSURANCE
DESCRIPTION: Adding (3) new sprinlder heads.
OWNER: PACIFIC REALTY ASSOCIATES. PHONE #:
CONTRACTOR: DELTA FIRE INC PHONE #: 620-4020
Inspection Request Scheduled For: Date: 3/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
999 SprinWer final 002572 -01 503 -307 -2105 N
Corrections /Comments / Instructions:
A Pn C /.
s °7
Af PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: DA 1/1/'] p 1.41-06 le-- Date: 3" 2) — v" Phone #: (503) 718- ��,