Permit C ITY OF TIGARD BUILDING PERMIT
- V `' --- '� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16550 SW 72ND AVE B -09 PARCEL: 2S113AA -01000
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: OOC 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: $ 1,175.00
Remarks: Relocate (4) sprinkler heads and add (13) roof 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:
Phone: 620 -6140
Reg #: LIC 63846
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 2/21/03 $62.50 Sprinkler Final
[TAX] 8% State Tax 2/21/03 $5.00
[FLS] FLS Pin Rv 2/21/03 $25.00
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 -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: da/11--€ ALI-ge/4
Pe rrn ittee -�—�
Signature: rC� ('42 )-?c.
Call 639 -4175 by 7 p.m. for an inspection the next business day
2 -26 -0 5 6 c--
' A Building Permit Application
. Date received:. d{9 e,3 Permit no.: i 161095..a6 S ,
ii C ity of Tigard
__ - -- Project/appl. no.: A date:
CiryofTigard 1 eCglj Blvd, Tigard, OR 97223 , li _
Date issued: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
La
F E B na us u ,proaa1: twei a i 3 - 6450 1&2 family: Simple Complex:
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory 4 Commercial/industrial 0 Multi-family 0 New construction 0 Demolition
flit Addition/alteration/replacement Tenant improvement Ar..Fire sprinkler /alarm 0 Other.
JOB SITE INFORMATION
Job address: • _ '"j 2. =! • Bldg. no.: "g-D' Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: . A I , . m& 5 5 l 1'x15
D • scription and location of work on premises/ ial conditions: • L • 1 . • A)k.L M_ . EA
• .. �., ':.�_ ? 2n, s i-=• 5
OWNER FOR SPECIAL INFORi♦IATION, USE CIIECI:LIST
Name: t C (• 5 ( Floodplain , septic capacity, solar, etc.)
Mailing address: !S , . . 5 in 1,i e r _ 4 CO 3 1 & 2 family dwelling:
1ty: ' i AII1RI VIA ZIP: • i 2 Valuation of work $
Phone . , - - 0 D IZEMHZE E -mail: — No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: 1 g-rp • ( ) . Covered porch area (sq. ft.)
Mailing address: * 1 / . , • ► Deck area (sq. ft.)
7 ZIP: i Other structure area (sq. ft.)
Phone: I ' , i - . b Fax: ,ZQ, , j i E -mail: -- Commercial/industrial/multi-family:
CONTRACTOR Valuation of work $ I1 - 75—
Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.)
Address: • 3.: 5 _ I ter 4 E" Number of stories
City: i �' t trY��i Type of construction
Phoney, , , • . (- / Fax: , I .401 1 E -mail: — Occupancy group(s): Existing:
CCB no.: , t-( . New:
- etro 'c. no.: 0 Notice: All contractors and subcontractors are required to be
: V t C I I IT ECT/ U E S 1 G N F R licensed with the Oregon Construction Contractors Board under
Mi lir i n provisions of ORS 701 and may be required to be licensed in the
Address
S v a . • • `M r '..5D0 jurisdiction where work is being performed. If the applicant is
a + C 17,2 ' exempt from licensing, the following reason applies:
� Z1P: •
Contact person: Plan no.:
Phone: , -.WjQ 1 Fax p f t- E -mail:
ENGINEER
Name: Contact person: Fees due upon application $ qz, o
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 U Visa O MasterCard
work will be complied . ith, whether s • - ified herein or not. Credit card number: / /
Expires
Authorized signature: // ,,a/ /� O/_ .i / r Name of cardholder as shown on credit card
Print name: ZW.7,FIA i4 s• ' ` cardholder signature $ Amount
V.
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (60.)0'COM)
Fire Protection Permit Check List
A.) ❑ New ❑ Addition ❑ 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 , B or C as applicable) ' °
Al Sprinkler Wet ❑ Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $ i I — 7 - 5 ( "E-
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): $ ( ) 7 S °°
Permit fee based on valuation (see chart): $ ( 0 2.50
8% State Surcharge: $ v. 0 c�
FLS Plan Review 40% of Permit: $ 2:13
TOTAL: $ q 2.
i:\dsts\forms \FPScheddistdoc 06/07/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST pp
L/ BUP - 060 D'� �C
Received / _ Date Requested F — � AM PM BUP
Location L L s sO 2 //7G' Suite L3toes MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) oZ 1 �" SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
•
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
re pri er
Fire arm
Susp'd Ceiling
Roof
Other:
Fig:
- ART FAIL
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/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date VA/03 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL