Permit . .__,.. . •
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00505
I DEVELOPMENT SERVICES DATE ISSUED: 11/12/2004
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S113AA -00200
SITE ADDRESS: 16398 SW 72ND AVE B -08
SUBDIVISION: OREGON BUSINESS PARK I ZONING: I -L
BLOCK: LOT: 002 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: 5N : 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: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,780.00
Remarks: Install (23) sprinkler heads.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES FIRESTOP CO
15350 SW SEQUOIA PKWY #300 -WMI 9384 SW TIGARD ST
PORTLAND, OR 97224 TIGARD, OR 97223
Phone: 503- 624 -6300
Phone: 620 -6140
Reg #: LIC 63846
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUPPLN] Pln Rv 10/22/2004 $106.71 Sprinkler Final
[BUILD] Permit Fee 11/10/2004 $72.10
[TAX] 8% State Surcharl 11/10/2004 $5.77
[FLS] FLS Pin Rv 11/1 0/2004 $28.84
(additional fees not listed here)
Total $106.71
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- 0049-tl ugh OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calli (503) 246 -66 or 1- 800 - 332 -2344.
Iss d By: /
01// I
Permittee .� . k
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
16 ire otectron System
svpJ ni►r
B Permit Application FOR OFFICE USE ONLY
r Received _ ,. Building
Date/B : / / .. O) % i / 1
,.1 ; r :�_ Pe rm it No.: �
city Of Tlgard Planning Approval Other
Date/B Permit No.:
13125 SW Hall Blvd. Plan Review r n Other
Tigard, Oregon 97223 DateB /J - ?�� � Permit No.:
Phone: 503 639 - 4171 ` Fax:, - "' ''Pirell�''I Date�6 Post
car No
Internet: www. ,. ; y °__..
Contact Mal El See Page 2 for
24 -hour Inspection Request: 503 -639 -4175" Name/Method: Su . demental Information
.: .: :TYPE - OF WORK :. . ;>'QU . Df►TA s •
❑ New construction ❑ Demolition 1 & 2. FA LYDWELLING '
I1 Addition/alteration /replacement l ❑ Other:
'CATEGORY'OFCONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling igi Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building 0 Multi - Family
❑ Master Builder ❑ Other: Valuation $
-. :. 3OB S1TE•INFORMATLON • .. No. of bedrooms: No. of baths:
Job site addr /63q' � "� LJ AV•e.1 Lta , Total number of floors
t. #: New dwelling area (sq. ft.)
Suite #:
�p �J Garage/carport area (sq. ft.)
Project Name:6u,KeAw roDuL`�'r 1 bl y Covered porch area (sq. ft.)
Cross street/Directions to job site: Joolvt - 1 ( Deck area (sq. ft.)
Other structure area (sq. ft.)
• REQUIRED DATAi:;
;'COnUMME_ RCIAL - USE.CRECKLIST ' m
Subdivision: 1 Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
' • '' >DESCRIPTIONl.OF. WORK • - .: the value (rounded to the nearest dollar) of all equipment, materials, labor,
i 1n �l L.3 st^ 1 nvlio r overhead and profit for the indicated on this application.
Valuation $ 2:7 6�
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stones
.14PROPERTYOWNER -•. • .:1 T'E iANT „ . Type of construction
Name: PA C j P j - -- Occupancy group(s): Existing:
Address: 1S 7p ,) sIPd i.1D (� 4 U New:
—
City /State /Zip: pt-r.fi , to 9--, NOTICE: All contractors and subcontractors are required to be
P hone O(, ? 4_ow Fax (c. » j4-- --nS-R licensed with the Oregon Construction Contractors Board under
APPLICANT El CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: � (� , jurisdiction where work is being performed. If the applicant is exempt
Contact Name: 13(NLI CP ec ;SC :rY- from licensing, the following reason applies:
Address: po PAY ? 3t)Sy S
City /State / ip:7 p Die, , Q e) Z`r3) -DSLJ S
Phone(5�� (624 -1,l tie Fax: f , I )(owD--1011
E- mail: - BUILDING PERMITTEES•_ . - . -
CONTRACTOR Please refer to fee schedule.'" 1%,..:71
" . •
Business Name: r r P ' C.') _ Fees due upon application $
Address: PQ 7 l y. S
e
City/State /Zip: /t n c ark op A G37 f -ML/S— Amount received $
Phone: j j)k, ( 'c Fax( 3);a-b1 l/ J Date received:
CCB Lic. #: (03394 k •
Authorized -
Signature: i , vi �y1 /� - /� Notice: This permit application expires if a permit is not obtained within
7�
'
� � �� Date: Cam/
180 days after it has been accepted as complete.
` / ZC T f yL *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \BldgPermitApp.doc 01/03
•
• -
Fire Protection Permit Check List
Describe work to be done:
A.) ❑ New B.) Modification to sprinkler heads only:
lita Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration j 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 7r
Additional description of work: ty,t - &Lt tnkLC ke_ixdt5
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Wet ❑ Dry ❑
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $ " 1 - 1 ( 1 3 0
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: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50 •
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Project Valuation Subtotal (A, B & C): $
Permit fee based on valuation (see attached chart): $
Permit fee based on square footage (D) (see fees above): $ o
State Surcharge 8% of Permit Fee: $ sryl
FLS Plan Review 40% of Permit Fee: $ Zs , �S'a
TOTAL: $ t () 1
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.
i:\dsts\forms\FPSchecklist.doc 02/28/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
IN PE i ION DIVISION Business Line: (503) 639 -4171 MST
Re ved `� ' �� Date Requested )/� AM P BUP
Location / ( - ALe AU'"( Suite MEC
Contact Person 55/-e). Ph ( _ ) 3 2aa —O (o 0/ PLM
Contractor Ph ( ) SWR
D ► Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Alarm
III Pik
Susp'd Ceiling
Roof
• I :r: (
e ta
'ART FAIL
'NG
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Siab
Low Voltage
Fire Alarm
Final fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for einspection RE: 0 Unable to inspect — no access
Fire Supply Line (.��, ADA Approach/Sidewalk Date Inspect° Ext
Other:
Final O NOT REMOVE this inspection record from the job site.
PASS PART FAIL