Permit '
` - . 'CITY OF T I GA R D BUILDING PERMIT
PERMIT #: � BUP2004 -00064
�i DEVELOPMENT SERVICES DATE ISSUED: 2/23/04
---' 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
SITE ADDRESS: 15675 SW 72ND AVE PARCEL: 2S112DC -00100
SUBDIVISION: OREGON BUS. PARK 111 ZONING: I -L
BLOCK: LOT: 002 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: icica FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: M 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: $ 1,633.00
Remarks: Demo 4 sprinklers in each of two racks.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES FIRE SYSTEMS WEST INC
15350 SW SEQUOIA PKWY #300 -WMI 600 SE MARITIME AVE #300
PORTLAND, OR 97224 VANCOUVER, WA 98661
Phone:
Phone: 360- 693 -9906
Reg #: LIC 49732
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler inspection
[BUILD] Permit Fee 2/23/04 $62.50 Final Inspection
[TAX] 8% State Surchart 2/23/04 $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.
Issued By: .� / C, a L.li� GC-
Pe mi it tee
Signature: x
CaII 639 -4175 by 7 p.m. for an inspection the next business day
.. -- - Fire Protection System
Building Permit Application
y Date received .1/0;/ Permit no.:.60 0gi
') <.,Til City of Tigard
: _ Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 - 4171 Date issued: By:.?)b 1 Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: • 1 &2 family: Simple Complex:
TYPE OF PERMIT •
0 1 & 2 family dwelling or accessory CommerciaUindustrial 0 Multi - family O New construction Demolition
- Addition/alteration /replacement Tenant improvement Fire sprinkler /alarm O Other:
JOB SITE INFORi11ATION
Job address: 4 5� S t.J .. . hve • . .. Bldg. no.: Suite no.:
Lot: Block: Subdivision:.. Tax map /tax lot/account no.:
Project name: (V t K E c L F. •
Description and location of work on premises/special conditions: )g`'t 6 K AC• K 5 'PR - L67z_ 1�I PIN.(1,
. OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: E(CD(,dity.-'p s , 1,7' 2 ( Floodplain ,septiccapacity,solar,etc.)
M. 1 : • • • - . 42 (,J 1 -I .: f0121 Zoe 1 & 2 family dwelling:
City:1er�Z • p ' J Valuation of work $
Phone!)3 -zoo • S Fax: E -mail: No. of bedrooms/baths
Owner's representative. iii-.1 I __ j, . aeCL Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
• APPLICANT . Garage /carport area (sq. ft.)
Covered porch area (sq. ft.)
Mailing address: . , M ig Gt.111 141 v ' e . - 5 At. Deck area (sq. ft.)
City: i.i ea; v512— EMMA 1212MEMIMII Other structure area (sq. ft.)
Phone36r .' 3 y 6 - Fax: E -mail: Commercial/industrial /multi- family:
. CONTRACTOR Valuation of work $ 1 b 33 , .—
Existing bldg. area (sq. ft.)
Business name: S.,J New bldg. area (sq. ft.)
Address: Number of stories
City: State: ZIP: Type of construction
Phone: Fax: E-mail: Occupancy group(s): Existing:
CCB no.: • 9 New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIHITECf /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: .. Fax: E -mail:
. ENGINEER
Name: Contact person: Fees due upon application • $
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 jurisdictions accept credit cards. please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this 0 Visa 0 MasterCard
work will be complied with, whether specified herein or not. Credit card number Exp; /
Authorized si1Ag ScP
naturd �. .�f. -� Date: 2- / 7 -c4 Name of cardholder as shown on credit card
Print name: JS6".( SAM P' Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 44o -4613 (600/COM)
Fire Protection Permit Check List
A.) ❑ New ❑ Addition Alteration ❑ Repair
B.) Modification to sprinkler h ads only:
Describe work to 1. 1 -10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required.
Number of sprinkler heads: ' ftrsel
Additional description of work: -pz► -, to s PRINIKL -1519-.s IN
Ef}cH - rt.) o A Uc S
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $ ) 6.33,
B.) Type I - Hood Fire Suppression System
Hood Project Valuation $
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A, B & C): $
Permit fee based on valuation (see chart): $
8% State Surcharge: $
FLS Plan Review 40% of Permit: $
TOTAL: $
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 \fortes \FPSchecklist.doc 11/21/01