Permit .-- . ---‘
BUILDING PERMIT
CITY OF TIGARD PERMIT #: BUP2001 -00180
Av DEVELOPMENT SERVICES DATE ISSUED: 5/17/01
`�'� 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16290 SW 72ND AVE B -02 PARCEL: 2S113AA -00400
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 018 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: 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: 2 SO . DC)
Remarks: Relocate 1 sprinkler head.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES FIRESTOP CO
15350 SW SEQUOIA PKWY #300 -WMI 9384 SW TIGARD ST EXPI! t ED
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 5/17/01 $62.50 27200100000 Sprinkler Final
5PCT CTR 5/17/01 $5.00 27200100000
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Pemiittee
Signature: \\;.4, ,
Issued By: ,
Call 639 -4175 by 7 p.m. for an inspection the next business day
1
Building Permit Application
Datereceived:
t / 'Vey Permit no.itf c vo fr t 60 fro
. 1- , :iy�` City of Tigard
'- Project/appl.no.: Expiredate:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By/ Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1&2 family: Simple Complex:
TYPE OF PERMIT
❑ j & 2 family dwelling or accessory Commercial/industrial ❑ Multi- family ❑ New construction ❑ Demolition
Addition/alteration/replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: - 2' / linejM ' Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: 0 ' iffiwri- C
Description and location of work on premises/special conditions: 1 g 00 41 . ins: •
OWNER FOR SPI•:CIAL INFORMATION, USE CHECKLIST
IIMIWAN/MMINIMMIIMIIIM. (Floodplain, septic capacit), solar, etc.)
M.11 : • r r • . • S i - ' "( e GPO/ 4 irriZrAM 1 & 2 family dwelling:
®' ! b Elm ZIP: ''72Z' Valuation of work $
Phone: ( — ,'3OO Fax: E -mail: No. of bedrooms/baths
Owners representative: Total number of floors E) Pt+ .1R F II
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft)
Cg t " 412JO Covered porch area (sq. ft.)
Mailing address: lat G,D Deck area (sq. ft.)
EMEOPTAMIIMMEMEMESNENEIN Other structure area (sq. ft.)
Phone: (, • _( 1 0 Fax: a2D, , ij E -mail: Commercial/industrial/multi- family: *Mb"' CONTRACTOR Valuation of work $
EMSEMW EPS SDP O , Existing bldg. area (sq. ft.)
Address: i r New bldg. area (sq. ft.)
/G
City: 1 4-20 State: I ZIP: Waal Number of stories
(oZt ( Type of construction
Phone: Fa x: bZ 41 1 E -m ail: X
3 $ Occupancy group(s): Existing:
CCB no.: New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
AItCIIITI CC /DESIGN 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 1 s and ordinances governing this 0 Visa ❑ MasterCard
work will be compl' • , whethe ified herein or not. / Credit card number: Expi /
Authorized signatu _ ate: C/ 7/0 1 Name of cardholder as shown on credit card
Print name: /3/2(1 Cc. b • / ? ?f P 1 'nl 111 Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (M)0/COM)
1
Fire Protection Permit Check List
A.) ❑ New ❑ Addition 11 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:
• Additional description of work:
Type of System (Complete A or B as applicable):
A.) Sprinkler Wet 11 Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $ zsb
• B.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A & B): $
Permit fee based on valuation (see chart): $
8% State Surcharge: $ v
FLS Plan Review 40% of Permit: $ 5 v
TOTAL: $ ( 7 5?-)
i:\dsts \forms\FPSchecklist.doc 10/04/00