Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00505
volA DEVELOPMENT SERVICES DATE ISSUED: 12/17/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S113AD -01900
SITE ADDRESS: 16640 SW 72ND AVE B -10
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 009 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 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: $ 14,737.00
Remarks: TI fire sprinklers
Owner: Contractor:
PACIFIC REALTY ASSOCIATES DELTA FIRE INC
15350 SW SEQUOIA PKWY #300 -WMI 14795 SW 72ND AVE
PORTLAND, OR 97224 PORTLAND, OR 97224
r
Phone:
Phone: 620 -4020
Reg #: MET 00001934
FEES LIC REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 11/20/02 $187.30 Sprinkler Final
[TAX] 8% State Tax 11/20/02 $14.98
[FLS] FLS Pln Rv 11/20/02 $74.92
Total $277.20
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 -0f ! - ■ • h OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
callin• 03) 246- 66 or 1- 800 - 332 -2344.
Iss ed By: Cd2.44AM..k .1 0 i ('
Perm' : > •. • A • .
Signature: • %P � R /t .. / l et-
CaII 639 -4175 by 7 p.m. for an inspection the next business day
I P Fire Protection System ?off a 'cot( 7 3
•
wilding Permit Application
� . Date received: 1 — o — O1 Permit no.7e, j ? oo, - o o S. s
miy(` City of Tigard
- . Address: 13125 SW Hall RECEIVED Project/appl. no.: Expire date:
City of Tigard
Phone: (503) 639 -4171 Date issued: J' Receipt no.:
Fax: (503) 598 -1960 NOV 20 2002 Case file no.: Payment type:
Land use approval: CITY OF TIGARD 1 &2 family: Simple Complex:
TiE OF PERNIIT C'
Y
❑ 1 & 2 family dwelling or accessory ommerci industrial 0 Multi - family 0 New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION '
Job address: 1r�1� grf Bldg. no.: Suite no.:
Lot: Block: Subdivision: 'Tax map /tax lot/account no.:
Project name: UQ, r,s .A c�.e.4siii,Q Onaffr A-- �!A'S - �ca.e L ,T_
Description and location of work on premises/special conditions: U
lr OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: (Floodplain, septic capacity, solar, etc.)
Mailing address: 1 & 2 family dwelling:
City: 1 State: 1 ZIP: Valuation of work $
Phone: Fax: 1E-mail: No. of bedrooms/baths
Owners representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
..--.121C-1'
' " 4c;, ::'APPLICANT Garage/carport area (sq. ft.)
Name:
Covered porch area (sq. ft.)
Mailing address: / q 7 5 -- c s 7 . ,. //Q Deck area (sq. ft.)
City: r o fib Sta - S ZIP: 97: V C.p Other structure area (sq. ft.)
Phone -, -LQ 11: • i. Fax: E -mail: Commercial/industriaUmulti- family: --_____,,..
' `• CONTIIACTOR Valuation of work $1%73
l Existing bldg. area (sq. ft.)
Business name: � New bldg. area (sq. ft)
Address: /C-(7 y.s— CS�-t) Z�/� D4(1/ Number of stories
City, - �•jQ1ka State:t� ZIP:: y
Type of construction
Phone —(t0 Fax: E -mail: Occupancy group(s): Existing:
CCB no.: C,0q/ 7 L New:
City /metro lic. no.: 93 Notice: All contractors and subcontractors are required to be
'!;. ARCIIITECI' /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: i /?-7- provisions of ORS 701 and may be required to be licensed in the
Address: 1 / 9�� -(,J 7 /,- jurisdiction where work is being performed. If the applicant is
City' ,� v StateQ [ZIP: 972.) q exempt from licensing, the following reason applies:
Contact person }Za 2� S' , Plan no.:
Phone& Fax: E -mail:
Name: Contact person: Fees due upon application • $ °777.
Address: Date received:
City: State: ZIP: Amount received $
Phone: 'Fax: I 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 ❑ MasterCard
work will be complied wi w ether • • ified herein or not. Credit card number: / /
Expires
Authorized sign. , . L gJifA 4,r•. Date: /('11 Name of cardholder as shown on credit card
$
Print name: _ • C (Q •- IA.c.itsCit- 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 (6 0/COM)
Mir
Fire Protection Permit Check List
A.) ❑ New tia Addition Ca 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: 121
Additional description of work: ztt2,6ate aoo p, -o ac.i . os
TO ACU.OMN‘Op A ' c r Po (2 vJ CL•. t,.) a . $ i t vV O c. Ems. ts3 z .
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet Dry ❑
Standpipes
Additional Hazard Group 6:1
Information Density - l0
Design Area Z2.5
K. Factor 5.62_
Sprinkler Project Valuation: $ / ' / 73 7
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): $ / y 73'7
Permit fee based on valuation (see chart): $ /S7. 3 o
8% State Surcharge: $ /y. 92(
FLS Plan Review 40% of Permit: $ 71 9a-
TOTAL: $ 7 . -
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 \forms \FPSchecklist.doc 11/21/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP - 'S .- 6,,5 --
Received Date Requested /O AM PM BUP
Location / (o (o �D 7 of d Suite a-I /D MEC
Contact Person D (A r� Ph ( ) 3 /d -883( PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner t4'- e._ 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 _
ire S rink) •
Fire Alarm
Susp'd Ceiling (±Z.444_,
efp Roof
Other: r: v �/
�c� fl iDczi-tA e- S u. - i s..
��'ART FAIL
71 111197 17 G V' C °R)7 v
Post & Beam
Under Slab
Rough -In
Water Service � _ ;�A , t_ 41Amp
Sanitary Sewer 1 I
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 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date 2- 1 2 - O 3 • Inspector , • Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour 0-_,-ps) .Berg 2— v o 5b
BUILDING Inspection Line: (503) 639 -4175 s t" 0 ear
INSPECTION DIVISION Business Line: (503) 639 -4171 -°°(117,07\
BUP
Received // ` , / Date Requested ) — AM I PM BUP a --6
Location / 4.9 co IO 7 Suite `U 1 d MEC — 6° Ste
Contact Person L Ph ( ) O — S 31 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner �� ELC
Footing
Foundation ELC j2jec Ftg Drain Access: (...e.;n ELR
Crawl Drain q
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing 'n
Firewall ��jrtivL {1 Z csprmu,zit- - 006,5 Q�/'w&i-
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof 1\[,--d 4c etvs-p v (.AA. fiQ.1 -
Other:
cnYlb' i'Ja - `�S�Y S
PASS 1 FAIL
PLUMB -
Post & Beam
Under Slab
Rough -In 1' jk. 2 004, Z— c c _
Water Service
Sanitary Sewer #. 5'Z
Rain Drains
Catch Basin / Manhole 464 Ac-pvcy-0.04
Storm Drain
Shower Pan
- 1 PART FAIL
ICAL
Post & Beam
Rough -In
Gas Line
S 1.. a Dampers
PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line (. ADA
Approach/Sidewalk Date 2 4 3 Inspector 1 �' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL