Permit CITY OF TIGARD PERMIT
0. PERMIT #: BUP2004 -00144
�' �, D EVELOPMENT SERVICES DATE ISSUED: 4/19/04
��--' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE PARCEL: 1 S133AD 02200
SUBDIVISION: ZONING: R -7
BLOCK: LOT: 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: 5 -1 HR : sf N: S: E: W:
OCCUPANCY GRP: A2.1 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 1,624 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: $ 31,501.00
Remarks: FPS
Owner: Contractor:
WESTGATE BAPTIST CHURCH WYATT FIRE PROTECTION INC.
12930 SW SCHOLLS FERRY RD 9095 SW BURNHAM
TIGARD, OR 97223 TIGARD, OR 97223
Phone:
Phone: 684 -2928
Reg #: LIC 64077
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 4/1/04 $335.80 Sprinkler Final
[TAX] 8% State Surchar 4/1/04 $26.86
[FLS] FLS Pln Rv 4/1/04 $134.32
Total $496.98
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 4: : • • • h OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calli►. (503) 246 -669• +r 1- 800 - 332 -2344. •
Iss • ed By: 1 i 41 li . 4 �,1� ' !
Pe nn ittee
Signature: J( /
Call 639 -4175 by 7 p.m. for an inspection the next business day
e re Protection Sly I�
�a� M . A
i = System
g �� ,, vv ST 6A' TE _ -'`FOR OFFICE'USE:.ONLX - '
ed
ling Permit Application R ecei • v Building , ..
Date/By: V // Other
G 4 1 P'/ Permit Nof x004 'CO /LI
[ , Planning A pro al
City of Tigard ; �� h
13125 SW Hall Blvd. U / Date /By: Permit No.: s it Plan Review - Other Permit No.: •-
Tigard, Oregon 97223 Date /B y: q • �� "
/p,N Y view Land Use
tit Post - Re
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 PR1 _ o � ' N 1� Date Re 06/09' , Case No.
Internet: www.ci.tigard.or.us CIT y c �`"+ °� Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -41E4u, / TIGA Name /Method: /1 /C-h /x'.40 Supplemental Information
DI VjS IO N
,-....--REQUIRED
New construction ❑ Demolition 4:4.2 FAMILY,DWELL ,
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 / �,Com mercial/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.INF ? ORMATION and'LOCATION • • / ;.. :,::, No. of bedrooms: No. of baths:
Job site address: / Sw /50 /PG Total number of floors
New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Pro Name: \N.QSr(940.✓ 3 p '-j ('ih V PV.14 Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
• REQUIREDDATA: ,,, .. .
• 2.CoMMERCIXL - USE CHECKLIST : '
Subdivision: 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,
e overhead and profit for the work indicated on this application.
03,4001t.,.-1-ire, vi N Y-Lik{'iY' 94 -Q-t/1 $ 31�57� i
Valuation
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
❑ PROPERTY OWNER I ❑ TENANT,,:.a = ., . ,,. „ Type of construction
Occupancy group(s): Existing:
Name: New:
Address:
City /State /Zip:
NOTICE: All contractors and subcontractors are required to be
Pho e: Fax licensed with the Oregon Construction Contractors Board under
Q 0 CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: ( cee, COw h c t jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip:
Phone: Fax:
BUILDING PERMIT FEES
Email: Please ref to fee schedule. •
CONTRACTOR
Business Name: PM t Ro VVo ih Fees due upon application $
Address: 4Q�M �9YNY1
City/State/Zip: $
/State /Zt
Y p� �'1 I�Yf�� 0 � g1'Ir1i
Amount received
Phone:t 5 Wg4'1r Fax: rc 7),Qt2 • 4 0 ri 1 Date received: .
CCB Lic. : (o-d-•0 11 't'
Authorized � { Notice: This permit application expires if a permit is not obtained within
Signature: ����' 7" .. Date: " ! 1/01 180 days after it has been accepted as complete.
/Oa-tw/, RQ *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:ADsts \Pcmiit Forms \l3ldgl'crmitApp.doc 01/03
Fire Protection Permit Check List
Describe work to be done:
A.) ❑ New B.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration. 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: J�
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Wet ❑ Dry ❑
Additional Standpipes .
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $ "�� , 5O! °C)
B.) Type I - Hood Fire Suppres System
Hood Project Valuation: $
C.) Fire Alarm rye;. _. .
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone Sy stem) - =' ; •
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50 ; ... .
Sprinkler Project Square Footage: sq. ft.
Project Valuation Subtotal (A, B & C): $ ? °
Permit fee based on valuation (see attached chart): $ 25.E
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $
FLS Plan Review 40% of Permit Fee: $ 4 , 3 2
TOTAL: $ 41(0 4 ?
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 02/28/03
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP O6( -63
Received Date Requested 9- ' AM PM BUP
Location 0 30 / 3 d 1`d --o-e Suite MEC
Contact Person Q� Ph ( .2- PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
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
- ' prink': �+
• - -rm
Susp'd Ceiling -� � r j—
Roof limmiglowerier
PASS PART FAIL PL- UMBING 1111.111111MINWAO
Post & Beam /T i
Under Slab
Rough -In •
Water Service
Sanitary Sewer
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
ELECTRIC AL.
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL