Permit 4 I � CITY OF TIGAR BUILDING PERMIT
PERMIT #: BUP2001 -00350
,DEVELOPMENT SERVICES DATE ISSUED: 10/10/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15865 SW 74TH AVE 110 PARCEL: 2S112DC -01400
SUBDIVISION: CREEKVIEW INDUSTRIAL PARK ZONING: I -P
BLOCK: LOT: 004 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: $ 3,950.00
Remarks: Fire Protection. Installation of (50) sprinkler heads.
Owner: Contractor:
PACIFIC AMERICAN PROPERTY EXCH AFP SYSTEMS INC
PACIFIC SANTA FE CORP 19435 SW 129TH
177Ron00 SW UPPER 77B22O��ONES FERRY RD TUALATIN, OR 97062
P p Phe N 5 aa U3 9 968 9 ZTZ4 4 Phone: 503 - 692 -9284
Reg #: LIC 67534
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough -In
PRMT CTR 10/2/01 $81.70 27200100000 Sprinkler Final
5PCT CTR 10/2/01 $6.54 27200100000
PLCK CTR 10/2/01 $32.68 27200100000
Total $120.92
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 9 - 001 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 24x.699 or 1 -N332 -2344.
Pe mi ittee 1
Signature: k' \ tot 1
Issued By: ,� ..G, -_ /1„
Call 639 -4175 by 7 p.m. for an inspection the next business day
Ii
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Date received: lag" ) Permit no.:p /� t" / - 3 )
iI aa._ a
„_ ____
Address: 13125 SW Hall Blvd, 97223 Project /appl.no.. Expire dates
City of Tigard Date issued: By: Receipt no.:
Phone: (503) 639 - 4171 y p
Fax: (503) 598 -1960 All\b‘ Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ New construction ❑ Demolition
❑ Addition /alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
• JOB SITE INFORMATION
Job address: f SR,5 S,L.L 7 1ir _- ('d Bldg. no.: Suite no.:
Lot: 'Block: 'Subdivision: I Tax map /tax lot/account no.:
Project name: 1'? » ». c ( r}v ."Cpyt3.
Description and location of work on premises /special conditions: -
OWNER - FOR SPECIAL INFORMATION, USE CHECKLIST
Name: P _ U 11700 j Q/ZAMA 100 (Floodplain, septic capacity, solar, etc.)
Mailing address: <J 6x/V' FipAA RA 1 & 2 family dwelling:
City: P o t ' State: l ZIP: q 2H Valuation of work $
Phone: f;70.-91 E')- 'Fax: 470.11001 E -mail: No. of bedrooms /baths
Owner's representative: b i c. . % .oJQ Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
' . APPLICANT Garage /carport area (sq. ft.)
Name: Ae f S CJ Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)'
City: W 1 State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E- mail: Commercial /industrial /multi - family:
. CONTRACTOR Valuation of work $ 3950 .
n F. S n Existing bldg. area (sq. ft.)
Business name: I � C7M
Address: I c W I S S L) 1 ai New bldg. area (sq. ft.)
r� I Stated ( 2 I ZIP: 9 )0 V2... Number of stories
City: "
Type of construction
Phone:
(212• 1-84 Fax: (,yt tl b E- mail: »FpSY%'3'tot • *� c cnp an 6 c Ygroup(s): Existing:
CCB no.: 67 5 31-1 New:
City /metro lic. no.: ,3 y$'' Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Nam p, �_ " �,, provisions of ORS 701 and may be required to be licensed in the
Address: h$30 S.W. ltnr. $mss 325 jurisdiction where work is being performed. If the applicant is
City:'(,p , o tateO . ZIP: 9 7ogS exempt from licensing, the following reason applies:
Contact person: Q 1 . „,,,.j, Plan no.:
Phone: �y 5 Z Fax.2 E -mail:
■
ENGINEER
• Name: Contact person: Fees due upon application $ / 2,0 . 9 A-
Address: Date received:
City: State: 'ZIP: Amount received $ i 20. VI "
Phone: Fax: 1E-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 ❑ Visa ❑ MasterCard
work will be complied with, whether specified herein or not. Credit card number: / /
9 -30 �o ( Expires
Authorized signature: Date: Name of cardholder as shown on credit card
Print name: 1 �ikrill Cardholder signature $
+1 Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00/COM)
1
i 1
Fire Protection Permit Check Liist
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: CO
Additional description of work: Q„da fift".d,r. Fvt.c40 tr— n''t
ve
Type of bash (Cornple et � KO C MOlicable�
A.) Sprinkler Wet 'fir Dry
Standpipes
Additional Hazard Group L `
Information Density
Design Area i!sc)
K. Factor S „Ct
Sprinkler Project Valuation: $ 31SO,
B.) Type I - Hood Fire Suppression System
1 Hood Project Valuation $
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑ k A
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal 'IA, B & C): $
Permit fee based on valuation (see chart): $
8% State Surcharge: $
FLS Plan Review 40% of Permit: $
TOTAL: $
is \fists \forms \FPSchecklist.doc 06/07/01
CITY OF4IGARD BUILDING INSPECTION DIVISIO" MST
24 -Hour Inspection Line: 6: 1175 Business Line: 639 -4..1
• BUP cZ00 /, 6o <� �
Date Requested aS,, ' AM PM BLD
Location e / �� g7e 7 it v Suite /7D MEC
Contact Person Ph 6 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Ai
Fi - arm
Susp'd Ceiling
Roof Misc /� 11-e
Misc: C 'Vw
Final
(ab) PART FAIL -
; L '-ING
•
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA 70 Approach /Sidewalk Date 5� /b Inspector / Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.