Permit .,., , •
CITY OF TIG BUILDING PERMIT
PERMIT #: BUP2003 -00213
�> � � DEVELOPMENT SERVICES DA TE ISSUED: 5/29/03
J I I 13125 SW Hall Blvd., T igard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16655 SW 72ND AVE 800 PARCEL: 2S113AC -00101
SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I -P
BLOCK: LOT: 029 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: $ 4,240.00
Remarks: FPS, add (15) new sprinkler heads and relocate (17) 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 4/30/03 $91.30 Sprinkler Final
[TAX] 8% State Tax 4/30/03 $7.30
[FLS] FLS Pln Rv 4/30/03 $36.52
Total $135.12
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: /6
i
Pe rm ittee o
Signature: AAA , A/M t/ �r 4. 'I C - II .39 - by 7 p.m. for an inspection the next business day
16 E ir e ? JZP V t e t in st fiii
• • • C O FOR OFFICE USE ONLY
Building Permit Appl>�ca ioii Received y Building , 3-ao2� 3
7+f -a . ,'-,:.:0 Date/By: ii Permit No.:
City of Tigard Planning Approval Other
y g � Date/By: Permit No.: l ,,�
13125 SW Hall Blvd. Agg 3 v ri Plan Review Other,
Tigard, Oregon 97223 f Date/By: Permit No.:
Phone: 503 - 639 -4171 Fax: 50 i {
�� t 1G ■
' ', ' "', �� • . E " - Post - Review Land Use
� ,I el!! Date/By: Case No.
Internet: www.ci.tigard.or.us ,�,Q D1 ^^4 Contact Juris.: El See Page 2 for Us)
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information
r
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
Er Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling I 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 ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: l lclo55 72''d A1/F1l] LIE Total number of floors
New dwelling area (sq. ft.)
Suite #: $pp 1 iC ! /Apt. #: L Garage /carport area (sq. ft.)
- Project Name: (`,p p'-riz j j (x Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: l Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
• DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
15 OCW ��` N�L�1Z � ��� overhead and profit for the work indicated on this application.
Valuation $ iivi
11
��'� ��4T> Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
[IROPERTY OWNER 1 ❑ TENANT Type of construction
Name: PA -r iisr Occupancy group(s): Existing:
Address: /535D SI;D 5E0w A Pik6v/ 4i S
City/State /Zip: "Poe n.40 D , bi2. 'P7Z ZZl
Phone:(5 L307) 1 Fax:6553 42-9 -7755 NOTICE: All contractors and subcontractors are required to be
"!' licensed with the Oregon Construction Contractors Board under
.. APPLICANT 1 ❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: "Fl P Cc, • jurisdiction where work is being performed. If the applicant is exempt
Contact Name: $le-t. cz PeAeso k, from licensing, the following reason applies:
Address: c 3S (,J 176AP__ S
City/State /Zip: Td6ov_b , OP . 9 722.3
Phont X3)(020 - / SID _ Fax 3 0 — b/ql
BUILDING PERMIT FEES *
E -mail: - Please refer to fee schedule.
CONTRACTOR
Business Name: F12.EST''DP (MTh • Fees due upon application $ 13S,12
Address: c %4 5t,O 7T16/4-gb ST
City/State /Zip: -- .b , 172.. X7Z23 Amount received $
Phone( ) b20-6(li-D I Fax: (50 Date received:
CCB Lic. #: E, 35 ci,E,
Authorized 7 Notice: This permit application expires if a permit is not obtained within
Signature: %��ASI�' Date: 180 days after it has been accepted as complete.
l i ' ► V - o ep- *Fee methodology set by Tri -County Building Industry Service Board.
( (Please print name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03
l �
•
Fire Protection Permit Check List
A.) ❑ New 0 Addition !Alteration ID 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: IS N Et OM hS
r7 r - TE S
Additional description of work:
'
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet ❑ Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $ q LL
B.) Type I - Hood Fire Suppression System
Hood Project Valuation 1 $
•
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes Li
Cut Sheets i.
Fire Alarm Project Valuation:.. $
Project Valuation Subtotal (A, B & C): $ L[Zip,. 00
Permit fee based on valuation (see chart): $ 9).30
8% State Surcharge: $
FLS Plan Review 40% of Permit: $
TOTAL: $
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
•
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Name:PACIFIC REALTY ASSOCIATES Updated: 5:2812003 BSB General � Ea , a il 1-
Address:16655 SW 72ND AVE 000 Jur: I� .. ,
pecifics &
Description: Master #IB P'Y
UP2003 -00210 Project: COTRONIX Areas
(15) FPS, add new sprinkler it l'�
( ) p i 17 sprinkler heads and relocate s ) p h eads. _ ,. l 1 -
i
1 .Activtt for BUP2003 0t2t3 — ),,, r- , c 1 _
' [Menu Code!'
ode Description ' Date1 I 0 . 2 I Date3 Disp I, Done By tote '1 c 0
,0:784 Sprinkler Final . . sc
C783 Sprinkler Rough -In �! �`' I / �, 1
C012 Plans routed to Plans Examiner -° .,�,g,� �,!._ ! • • L —.....■ — ; 1
C008 Permit created 4130!2003 DONE DEB
•
c005 Application received 413012003 DONE DEB '
I C018 Revisions rec'dkouted to PE —. 5123/2003 DONE BB 4 sets.
1 i CO26 Approved plans routed to PT 5/28/2003 DONE BSB
` C090 Ready to issue 5/28/2003 DONE BB
^ CO29 Post - review completed 5/2812003 DONE BB
_ CO24 Plans checked /approved by PE 512812003 DONE BSB
- C100 (F) Issue permit 512912003 DONE DLH --
z
View /Add Activities __ -- _ -_ r'
§tart F —T- Pr ,n , " i .' a NOUel l Group11 i ... ' E Document1 - ... Desktop top " _< CS C 12.31 PM _i
CITY OF TIGARD 24 -Hour
BUILDING InspectiotU • 3 4'75
INSPECTION DIVISION Business Line •-4171
Received Date Requested /6 AM q CS PM BUP
Location l ko ,S T -4 Suite 346 MEC
Contact Person .r.l� Ph ( ) Wes e / -0D- 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ' l , ELC
Ftg Drain Access: /l. �/ d r ELR
Crawl Drain
Slab Inspection Notes: �-� SIT
Post & Beam L�
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
. '= ..pnnIe
Fire • arm
Susp'd Ceiling
Roof
Other:
al
•l PART FAIL
_
J :ING
•ost & Beam
Under Slab
C a l 6111.1 ;1 31111i ff
Rough -In
Water Service
Sanitary Sewer
Rain Drains 1(11P.
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 fl 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
A roach/Sidewalk Date / 1 / Inspector Ext
PP
Other:
Final DO NOT REMOVE thls Inspection record from the Job site.
PASS PART FAIL