Permit CITY OF T I GA R D BUILDING PERMIT
PERMIT #: BUP2002 -00039
s , �l�; DEVELOPMENT SERVICES DATE ISSUED: 2/12/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110CD -07600
SITE ADDRESS: 15785 SW 116TH AVE
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
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: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: IP /SD D • DO
Remarks: Installation of 6 fire sprinklers.
Owner: Contractor:
TOBIAS INVESTMENT CO LARSON FIRE PROTECTION
300 SE SPOKANE ST 16410 S HIRAM AVE.
PORTLAND, OR 97202 OREGON CITY, OR 97045
Phone: Phone: 503 - 655 -5456
Reg #: LIC 118596
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler inspection
PRMT CTR 2/12/02 $62.50 27200200000 Sprinkler Final
5PCT CTR 2/12/02 $5.00 27200200000
Total $67.50
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Pe rm ittee
Signature:
n
Issued By: (a e — 1
Call 639 -4175 by 7 p.m. for an inspection the next business day
t w Building Permit Application
A - Date received: / 7 -' 6 Z Permit no.:,�7 —(XV3
‹Ty� City of Tigard
-.. Project/appl. no.: Expire date:
City o(Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 - 4171 Date issued: By Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ i ulti - family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement 7 4 ire sprinkler /alarm LI Other:
JOB SITE INFORMATION
Job address: 1 s li • - T4 q 0 4 I [ r. ', 0110M
Lot: Block: Subdivision: ' ap /tax lot/account no.: NAMI
Project name:
Description and location of work on premises /special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
(Flood plain, septic capacity, solar, etc.)
Mailing address: 1 & 2 family dwelling:
City: State: ZIP: Valuation of work $
Phone: Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.)
Name: Orv1 a < , PO Covered porch area (sq. ft.)
Mailing address: ,- z ; . 2,
.� Deck area (sq. ft.)
City: /, _ 61 - ECM ZIP: 0 - 1)-1- , Other structure area (sq. ft.)
Phone: - 60) �� E -mail: CommerciallindustriaUmulti- family: r
CONTRACTOR Valuation of work $ /goo. 06
Business name: ,,,,,.., 1.e. 10 • { m /, , Existing bldg. area (sq. ft.)
Address: In New bldg. area (sq. ft.)
, i
•
Number of stories
1317211.., / ZIP:
Phone: E-mail: Type of construction
1 - - %_ Occupancy group(s): Existing:
CCB no.: iE'sa. New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
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 ❑ Visa ❑ MasterCard
work will be complied with, whether specifi herein or not. Credit card number: Expires
Authorized signature: L_ - -A . Date: .)- ` l t- �- Name of cardholder as shown on credit card
Print name: am p r . Cardholder signature $ Amount
J
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6ro0/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):
A.) Sprinkler Wet ❑ Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $
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): $ �!
Permit fee based on valuation (see chart): $ 6a, 5�
8% State Surcharge: $ 6
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
CITY OFT 24-Hour ns Inspection Line: 503 639 -a175
BUILDING I� ( ) OO t- O S
INSPECTION DIVISION Business Line: (503) 639 -4171 - t 0 _ 0 0 3S
Received Date Requested SXT AM / PM
/ S' 7i / .3 Z
Location / �p Sui � r� 0 �— 006
Contact Person Ph ( ) PLM
Contractor Ph ( ) puILDI Tenant/Owner 1 C ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear /f. O 13 _.
Framing �.
Insulation I Q L ,c ./ � � � _ 000.34
5 — 0 /'
Drywall Nailing
Firewall rote V cr‘
ire Sprin I: <
Fire arm 61/- /L4C411j1- Y� -+�-C JC_/1 d . oy"
Susp'd Ceiling `�
Roof (/) . J
PASS PART A
PLUMBING /� / /
Post & Beam `' �' l/tl a !--& / t
Under Slab .(^• S �-�!
Rough -In •
Water Service
Sanitary Sewer
Rain Drains / —
Catch Basin / Manhole / . a 0
Storm Drain
Shower Pan
Other:
Final
PAS T FAIL
CHANT L
Post & Beam
Rough -In
Gas Line
Spa* Dampers
Cjiii
PASS PART FAI
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 Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA D ate 2 / Ins ector Est /
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIG ' - ' 24 -Hour • .
BUILDING p ( )
Ins ection Line: 503 639 -4175 19dP6'
v� �7 �Ol - 60 3 g
INSPECTION DIVISION Business Line: (503) 639 -4171 )/
/ 4:rr_• - oo/.6a3
Received Date Requested . 1 c/o — �I'. AM PM l 45 2, coo 3,
�
Location / 5-7 S _ //# ' Suite 02156J - 6fl 3" C -2.-
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
UILDI Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access:
ELR
Crawl Drain
Slab Inspection Notes: �,J� > pe �..4, SIT
Post & Beam •
Shear Anchors S da-.4 •
Ext Sheath/Shear
Int Sheath/Shear ei'Y 6/ _ L�J� J ?5-4 0)2-s•-•--tc!) — er
Framing U
Insulation
Drywall Nailing . // -- ,, ,w, II
Fi reveal l A L"l� �a O -- 60 O D 9 C `ri (�) — a �r e ,,-g_.; Fire Alarm m 4
Susp'd Ceiling S )'7 �O b / 6 O 3 6 Z _,A) -. cr'c.__
PART FAIL ��i
MBING �a e i — !6 C 3 54 t ; vyl 45 .,,c--)
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan A,,- 4- J . Q -_ 6 [_ a-"-e54
Other:
Final ...a-/ / VC) 6 L) -- i 3 S LL� / rt PAS ART FAIL ' /
CHANIC %r' V t/ J 5 L'''11. Post & Beam r' 3 0 1 � t �� l ' v_ Rough In S
Gas Line a ' � - - - . L _ _
Smoke Dampers •
PART FAIL /' , 4--e_gLi2-_e_ CTRICAL C - z. fit-- ��' �`r��
Service
Rough -In ` L
UG/Slab
Low Voltage O GC- C
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 ?/ > - 2------ Inspector v �-- Ext�
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL