Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2001 -00315
,;fly DEVELOPMENT SERVICES DATE ISSUED: 9/11/01
--'� �� I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16112 SW 72ND AVE B -18 PARCEL: 2S113AA -00500
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: OOA 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: B TOTAL AREA: 0.00 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: $ 1,100.00
Remarks: Add heads in new corridor and new heads at new wall to bottom of structure.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES FIRESTOP CO
15350 SW SEQUOIA PKWY #300 -WMI 9384 SW TIGARD ST
PORTLAND, OR 97224 TIGARD, OR 97223
Phone: Phone: 620 -6140
Reg #: LIC 63846
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough -In
PRMT CTR 8/30/01 $62.50 27200100000 Sprinkler Final
5PCT CTR 8/30/01 $5.00 27200100000
PLCK CTR 8/30/01 $25.00 27200100000
Total $92.50
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Permittee
Signature: 677, 2 ab_ ad //j;9
Issued By: 41 on/74
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application
,, Date received: V a) Permit no.• UFO/ -0.031
r• - iyi City of Tigard
° ° - Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 -4171 ' ��
a' .. �� Date issued: By: 1 Receipt no.:
Fax: (503) 598 -1960 v r Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPF OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ - ulti- fancily ❑ New construction ❑ Demolition
O'Addition/41. • , replacement (9 Tenant improvement 1' ire sprinkler - arm ❑ Other:
.1011 SITE INFORMATION
Job address: , _ Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: -_,- , 7 _ • -- '.
Des ri • don and location of work on premises/ . - ial conditio : ' v P si ► +' ` 1 ' id
:. I. k '_ . A
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
>. hrf3 (Floodplain, septic capacity, solar, etc.)
Mailing address: LSI V Z4 ri p r i4 ` 0 1 & 2 family dwelling:
ENR State: 0' ZIP: 12 ' Valuation of work $
Phone: , • 6 c 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.)
Name: Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commerciallindustriallmulti- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
Business name: ' . I a,
Address: CA 3 : 4 S 1tv Ti . 4.7..Q • New bldg. area (sq. ft.)
Number of stories
Ear - ,L MMIXIM ZIP: 11213 Type of construction
Phone: , • , . ; / • 0 Fax:: 2r- -14 E-mail: Occupancy group(s): Existing:
CCB no.: , ; . , New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCM I [u l /D I :S I G N I: R licensed with the Oregon Construction Contractors Board under
Enws pimmitz provisions of ORS 701 and may be required to be licensed in the
Address: s;� • �„ (�r,,i��1Z 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 ❑ Visa Cl MasterCard
work will be complied ' , whether . i • • m erein or notion credit card number: / /
Expires
Authorized sig � a 2 , 1 ' 0 ./ , D v m Name of cardholder as shown on credit card
Print name: L %: �J`I)�ti (� �� , /I 1 Cardholder signature $ Amount
Notice: This permit application e .ires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6A0/COM)
n S
Fire Protection Permit Check List
A.) ❑ New ❑ Addition lElAlteration ❑ 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: 14
Additional description of work:
Type of System (Complet , B or C as applicable):
A.) Sprinkler Wet L ' Dry ❑
Standpipes
Additional Hazard Group (,tgw"'i'
Information Density 10
Design Area 4/4
K. Factor 5 to
Sprinkler Project Valuation: $ Mao
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): $ c52
Permit fee based on valuation (see chart): $
8% State Surcharge: $ 6,06)
• FLS Plan Review 40% of Permit: $ ( 945',670
TOTAL: $ 612_,56
is \dsts\forms \FPScheddist.doc 06/07/01
CITY OF TIGARD BUILDING INSPECTION DIVISION MST ' .
24 -Hour Inspection Line: 639 -4175. Business Line: 639 -4171
BUP �C /
Date Re quested /D �3 AM PM BLD
Location l 1J 7 i!'1 G� �� -(J`2� Suite 18 MEC
Contact Person ,/.� ! Ph 6 2 - D c , / tiO PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall -� / / /
Fire Sprinkler 4-/ ( 5 `� / G C/,4;
�
Fire Alarm
5C / J C, `(Y V''4"L
Susp'd Ceiling //
Roof
Misc: L /iT /(
Vii; 1 ��
` FAIL
P IN
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE •
Backfill/Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line /Va ADA 61,2
A pproach /Sidewalk Date l !/ I Inspector I Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.