Permit . , .
A 'CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2000 -00057
* * * *Veillj DEVELOPMENT SERVICES DATE ISSUED: 2/29/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110BB -06700
SITE ADDRESS: 14000 SW 120TH PL
SUBDIVISION: REDWOOD VISTA ZONING: R -4.5
BLOCK: LOT: 009 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 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: $ 2,200.00
Remarks: Installation of residential 13D fire protection system.
Owner: Contractor:
FOUR D CONSTRUCTION GRINNELL FIRE PROTECTION
PO BOX 1577 GRINNELL CORP
BEAVERTON, OR 97075 5921 N MARINE DR
Phone: P 0 Phone N2 94Ju8u 03
Reg #: uC 000632 ORIGINAL
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough -In
PRMT KJP 2/29/00 $59.25 00- 321804 Sprinkler Final
5PCT KJP 2/29/00 $4.74 00- 321804
FIRE KJP 2/29/00 $23.70 00- 321804
Total $87.69
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 -1987.
Permitee
Signature:
Issued By: A< 2 - , --(2 - - 9 - i \--,
Call 639 -4175 by 7 p.m. for an inspection the next business day
. ••
Fire Protection Permit Application Plan Check # - - /Z.
CITY OF TIGARD Commercial or Residential Recd By q_
13125 SW HALL BLVD. Date Rec'd X - i?.
TIGARD, OR 97223 Print or Type Date to P.E. d -k3
(503) 639 - 4171,x. 304 Incomplete or illegible applications will not be accepted Date to DST Z /
Permit # Y} -666 7
Called
Job Name of Development/Project Type of System (Complete A or B as applicable)
/- f l> C( . t.( i at c " HC+, 1 in
Address Address
4 /100-Q- r A.) Sprinkler Wet tor' Dry ❑
Name ' 3U Standpipes
q il az5.7.00eci P 7',07/
Owner Mailing Address Hazard Group
Additional (?0
City /State Zip Phone Information Density
Name Design Area
Occupant Mailing Address K. Factor
City /State Zip Phone A.1) Sprinkler Project Valuation
T c,')
Contractor Name B.) Fire Alarm t�q .
(Sprinkler or C N`' yl y ,, If I i 4 ' '�
Alarm Company) Mailing Address Submittal Shall Include Battery Calculations YES ❑
Prior to permit cl ) 1 kJ A.I
issuance, a City /State /C1 f j` Zip Pho ( ;.--0 Individual Component YES ❑
copy Cut Sheets
of all licenses j ,4,,,i_p/Z c 7 A ; )--`- - -qi,r° B.1) Fire Alarm Project Valuation $
are required if State Cons Cont. Board Lic.# Exp. Date
expired in COT Project Valuation Subtotal (A & or B) $
database ( -5 , 5 -, '1 -(x) .
Name �
Permit fee based on valuation $ _
Architect Mailing Address (see chart on back) e ; -. 9 . , S
Surcharge $
4 , 71
City /State Zip Phone FLS Plan Review 40% of Permit $
Describe work A.) New 0 Addition 0 Alteration 0 Repair 0 �d
to be done: TOTAL $ 7 C ri
B.) Modification to sprinkler heads only:
1. 1-10 heads= No plans required Plans required: Submit three sets of plans, including a vicinity map and
2. 11 += Plan review required the location of the nearest hydrant.
----- -- -- -_____ --------_____-- - - - --
__ __ I hereby acknowledge that I have read this application, that the information given is
Number of sprinkler heads: correct, that I am the owner or authorized agent of the owner, and that plans submitted
are in compliance with Oregon State laws.
Additional Description of Work: (,
... � C�vi4GJ 1.3 I. 5 . -i Signature of O r /Agent Date
A.) In Existing Building ❑ New Building ❑ ,) I / I "C)
Building Contact Person Name Phone
Data B.) Commercial ❑ Residential y , 7 k'v% , "f , L'3 - 3`3- -- /C --
FOR OFFICE USE ONLY:
No. of stories: Plat # Map/TL #:
Sq. Ft:
Notes
1 Occupancy Class Type of Construction
i 5 l
i:\dsts\forms\firesupr.doc 11/5/98
M
CITY OF TIGARD
BUILDING PERMIT FEES
TOTAL
STATE BUILDING
VALUATION OF PERMIT F.L.S. TAX PERMIT
PROJECT FEES (40 %) (5 %) FEES
1 -1500 25.00 10.00 1.25 36.25
1,501 -1600 26.50 10.60 1.33 38.43
1,601 -1,700 28.00 11.20 1.40 40.60
1,701-1,800 29.50 11.80 1.48 42.78
1,801 -1,900 31.00 12.40 1.55 44.95
1,901-2,000 32.50 13.00 1.63 47.13
2,001 -3,000 38.50 15.40 1.93 55.83
3,001-4,000 44.50 17.80 2.23 64.53
4,001 -5,000 50.50 20.20 2.53 73.23
5,001 -6,000 56.50 22.60 2.83 81.93
6,001 -7,000 62.50 25.00 3.13 90.63
7,001 -8,000 68.50 27.40 3.43 99.33
8,001 -9,000 74.50 29.80 3.73 108.03
9,001- 10,000 80.50 32.20 4.03 116.73
10,001- 11,000 86.50 34.60 4.33 125.43
11,001- 12,000 92.50 37.00 4.63 134.13
12,001- 13,000 98.50 39.40 4.93 142.83
13,001- 14,000 104.50 41.80 5.23 151.53
14,001- 15,000 110.50 44.20 5.53 160.23
15,001- 16,000 116.50 46.60 5.83 168.93
16,001- 17,000 122.50 49.00 6.13 177.63
17,001- 18,000 128.50 51.40 6.43 186.33
18,001- 19,000 134.50 53.80 6.73 195.73
19,001- 20,000 140.50 56.20 7.03 203.73
20,001- 21,000 146.50 58.60 7.33 212.43
21,001-22,000 152.50 61.00 7.63 221.13
22,001- 23,000 158.50 63.40 7.93 229.83
23,001- 24,000 164.50 65.80 8.23 238.53
24,001- 25,000 170.50 68.20 8.53 247.23
25,001- 26,000 175.00 70.00 8.75 253.75
26,001- 27,000 179.50 71.80 8.98 260.28
27,001- 28,000 184.00 73.60 9.20 266.80
28,001- 29,000 188.50 75.40 9.43 273.33
29,001- 30,000 193.00 77.20 9.65 279.85
30,001- 31,000 197.50 79.00 9.88 286.38
31,001- 32,000 202.00 80.80 10.10 292.90
32,001- 33,000 206.50 82.60 10.33 299.43
33,001- 34,000 211.00 84.40 10.55 305.95
34,001- 35,000 215.50 86.20 10.78 312.48
35,001-36,000 220.00 88.00 11.00 319.00
36,001- 37,000 224.50 89.80 11.23 325.53
37,001- 38,000 229.00 91.60 11.45 332.05
i:\dsts\forms\firesupr.doc 11/5/98
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP f- _ does5
Date Requested ‘— / AM — PM BLD
Location /4 /fin 71- Suite MEC
Contact Person Ph 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 c# 2 c- 4 W ��c�IC ,c✓ T 02�
Insulation
Drywall Nailing
Firewall
ire Sprinkler
ire Alar
Susp'd Ceiling
Roof
Misc:
in
PASS PART FAIL
PLUMBING
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
Approach /Sidewalk
Other Date — / - 00 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
1.l 1,JVU
&up z - c -5 7 Iy�NEW
•
PN WS -AW WA ❑ EXISTING
BACKFLOW ASSEMBLY TEST REPORT ❑ REMOVED
PROPERTY ❑ REPLACEMENT
OWNER: '7- C) C.I E• t, 4 PHONE:
MAILING
ADDRESS: / � G ? / - , - ,/._<_ "7 )
I
CITY - re ( ...•rJ i r)t, STATE ( -.) . ZIP (% l ,.' 2 ,"
ASSEMBLY 3
ADDRESS: � .1e9e'(s / ! (4_ 6`t; I ,' �,r�X , � 7
1 STREET 1
❑R.P.B.A. ❑ D.C.V.A. ❑ R.P.D.A. El D.C.D.. ❑ P.V.B.A. ❑ S.V.B.A. ❑ A. B. ❑ AIR GAP
SIZE: ( l 1 4 1 C-J MAKE: /j% II< I/-< MODEL: e9(-" 7 ,if,
WATER / ' !' "T;' ( SERIAL r
PURVEYOR: C� / { y ff s, 7xe S"" NUMBER: / ` � / /
ASSEMBLY -
LOCATION: l <._..• , ,
REDUCED PRESSURE ASSEMBLY P.V.B.A / S.V.B.A. INITIAL TEST
NI CHECK I DOUBLE CHECK AIR CHECK PASSED ID
PRESS DROP (A)I CHECK #1 INLET FAILED ❑
INITIAL OPENED AT
(B) I TIGHT 1Y47 / OPENED AT: PRESS DROP
TEST MIN 2 PSID pSIU DATE:
RESULTS BUFFER (LEAKED ❑ �� /' /
A - B = I CHECK #2 PSID PSID C
MIN 3 PSI
RELIEF VALVE 'TIGHT 0 ?,t) DID NOT FAILED SYSTEM
PASS ❑ FAIL ❑ 'LEAKED MD OPEN ❑ ❑ PSI
COMMENTS
REPAIRS
AND /OR
•
PARTS
REDUCED PRESSURE ASSEMBLY P.V.B.A. /S.V.B.A. AFTER REPAIRS
NI CHECK
TEST PRESS DROP (A) CHECK #1 DATE:
RELIEF OPENED AT PRESS DROP
AFTER OPENED (B) T IGHT PSI /
REPAIRS WW2 MD
BUFFER CHECK #2
A•B- ■04 J� TIGHT El PSID PSID PSID PASSED El
IN COMPLETING AND SUBMITTING THIS TEST REPORT, THE TESTER CERTIFIES THAT THE •
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS.
GAUGE CALIBRAT O. DARE LL,IZE DETECTOR METER READING
r -
�]''[� ,.z/ is :'r • l);;
/1, !I;� - CERT
.�� N pg�tj1'�p LC: r l 'KS fv
•
5133 R IVntWIN fr i=Cr{; ::.. O(!� 1 6'7241 5n3- 2Rq -41V10 GAUGE H
TESTERS ADDRESS PHONE H.
Lirinnell Fire Gr[p.CIipo
COMPAN E/ i
i T i� ✓� - Ca G Cr- SERVICE RESTORED
REPORT RECEIVED BY: (REPRESENTATIVE OF OWNER)
WHITE • Water System Copy PINK • Customer Copy YELLOW - Tester Copy
CITY OF TIGARD BUILDING INSPECTION DIVISIO
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP ?bX 2OOS 7
Date Requested ; : AM )( PM BLD
Location I L IDO() 1 Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
1 1 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 44v. -. Tel s meS/Ecrion> �2S
Firewall
e Sprin' = /'V S'i L4.ATI oit/ /��C .9c
Fire arm
Susp'd Ceiling
Roof
Misc:
Final
FAIL
PLUMING
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 [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: / [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date 3 _' Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
07/12/2000 Activities for Case #: BUP2000 -00057
12:32:51 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BUPA005 Application received 02/22/2000 GEO RECD No Hold DEB 02/24/2000
BUPA010 Permit created 02/24/2000 DEB DONE No Hold DEB 02/24/2000
BUPA030 Plans routed to Plans Examiner 02/24/2000 DEB DONE No Hold DEB 02/24/2000
BUPA045 Plans checked /approved by PE 02/25/2000 RDP DONE No Hold RDP 02/25/2000
BUPA050 Approved plans routed to DSTs 02/25/2000 RDP DONE No Hold RDP 02/25/2000
BUPA762 Sprinkler Rough -In 03/08/2000 KS PASS No Hold RB 03/09/2000 Hydro Static Test- OK
Piping /Heads- OK.
BUPA763 Sprinkler Final 06/01/2000 KBS PASS No Hold AKJ 06/04/2000 attached backflow test report
BUPA055 DST post - review completed 02/29/2000 KJP DONE No Hold KJP 02/29/2000
BUPA075 Ready to issue 02/29/2000 KJP DONE No Hold KJP 02/29/2000
BUPA085 (F) Issue building permit 02/29/2000 KJP DONE No Hold KJP 02/29/2000
BUPA950 Case Fineled 06/04/2000 AKJ DONE No Hold AKJ 06/04/2000
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