Permit CITY OF TIGARD BUILDING PERMIT
P ERMIT #: BUP2003 -00644
.� IA DEVELOPMENT I Tigard, SERVICES 1 639 - 4171 DATE ISSUED: 1/23/04
SITE ADDRESS: 09095 SW BURNHAM ST PARCEL: 2S102AD 01300
SUBDIVISION: ZONING: CBD
BLOCK: LOT: JURISDICTION: TIG
REISSUE: fi FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: • 1 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: 61 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: $ 10,000.00
Remarks: Fire protection for remodel.Not connected to city water at this time.
Owner: Contractor:
WYATT, DEWEY WYATT FIRE PROTECTION INC.
c/o WYATT, EUGENE 9095 SW BURNHAM
9095 SW BURNHAM TIGARD, OR 97223
TIGARD, OR 97223
Phone: 503 - 684 -2928
Phone: 684 -2928
Reg #: LIC 64077
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -
[BUILD] Permit Fee 11/7/03 $139.30 Sprinkler Final
[FLS] FLS PIn Rv 11/7/03 $55.72
[TAX] 8% State Surchart 11/7/03 $11.14
Total $206.16
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 • • low the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -01 -1110 throug •AR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
cal . g (503) 246 -6699 0 1- 800 -332 -2 6-kird/U/L-01_,
I sued By: 1 �i fi . 1
Permi e' W V ,1�'r\
Signature: (c 1C
Call 639 -4175 by 7 p.m. for an inspection the next business day
Fire Protection System
j uu
• it � s ) 1 f , FOR OFFICE USE ONLY '
Perm / s � f w ''_� ii;�l Iliil Received / Building
T o ' ij S S D /*IAA/' Date/By: I /7 / 6 � Permit No.: D k C3 - ✓Ot�J
. Of TIQ and In I / ��l.1n 3. Planning Appra a1 Other
,� b Date/B Permit No.: e U leca -- OCjf b
13125 SW Hall Blvd. Plan Rev e Other
Tigard, Oregon 97223 CITY OF TIGARD Date /By) L '3 'O? t3S 13 Permit No.:
Phone: 503- 639 -4171 Fax: :.7i'llif. OQ /ISIf j ��'II Post- Review Land Use
I J
Internet: www.ci.tigard.or.us '' Date/By: Case No. Contact Juris.:
® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information
'MVSN 5gM Z? TYPE "OF W0It'.g 'k, _ r.. ` E M i.j ,
� �� z ,;.„,.,._. ....�:..�_ .. . ��. ,, . a REQUII2ED;DA<T�A -
❑ New construction El Demolition , z * st _I;& F ' -
❑ Addition/alteration/replacement ❑ Other:
4. y4 ;, 4CA'TEGORYtOFICQNSTRUCTION ,_ Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ❑ 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 $
if( egettm4.0031$14EANTOIMXTIONIalfaNWAVIUNOVINAS2 No of bedrooms: No of baths:
Job site address: 9'095 SW BURR MAel Total number of floors
New dwelling area (sq. ft.)
Suite #: . Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: CaDv\1 QYop2r(t k. J) Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
,.4-1,.Y R ` -" 4 . � 4 z
Subdivision: Lot #:
_ '. A1,4 , ti USE CHECKLIST ri. �.. , r .; T.� la
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
' `. v 'a' ,.` :il ; ; DESCRIPTION OF: W � : . : -'°';•:` ;� QRK the value (rounded to the nearest dollar) of all equipment, materials, labor,
e»,� >
overhead and profit for the work indicated on this application.
o
$-f:-1 1,J FG x, &iuu0
Valuation $ 10 ,00C)
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories 2
~' FROP:ERTN OWN•Elitg it _. TENANT : &, , n,., 1 .,,...,:. Type of construction V B
Name: C- W k \tom i3.0" Occupancy group(s): Existing: i3" �' /
Address: qugS Sv\\ La'lhayvL.
04 c New:
City /State /Zip: 'I Oo( c:3\2....> 81 223
Phone: ( .'Lc\ 'k Fax: 614 • q (O S - 1 NOTICE: All contractors and subcontractors are required to be
_ . licensed with the Oregon Construction Contractors Board under
k MI APPLICANrT, ,. 3 CS I `CONTACT ; ,.,., `. ,
provisions of ORS 701 and may be required to be licensed in the
Business Name: 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: . s 4w
E -mail: "0 i U *,s < �5 ,w,
fe
.. � 3 - ' "` q Please r efer toi ... a sche ui ; =. N. s r, ,
S 6Setti t A`� _z ; CONTRACTOR, ;t41. 11•40110
Business Name: \NI I A tint -q r.2 RYty Fees due upon application $
Address: G 0c c ,' -0 6 1 V J '- jW�Yulain L,
City/State/Zip : - fi • Qxc., chz, q -j 223 Amount received $
Phone: 614- .' c L3 Fax: 0'64 • 9 cosi Date received:
CCB Lic. #: C040
Authorized
Signature: ���� Date: // ] v3 Notice: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
g I GI I `T.. *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \BldgPermitApp.doc 01/03
-11
r
Fire Protection Permit Check List
, • . .
Describe work to be done:
A.) U New • B.) Modification to sprinkler heads only:
U Addition U 1-10 heads: No plan review required.
U Alteration U 11+ heads: Plan review required.
U Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
Wet 10 Dry Ei
Additional Standpipes i1/4•
Information: Hazard Group c.)24)'±_'' 1-1.6141
Density
Design Area 15 dt•D •
K. Factor
Sprinkler Project Valuation: $ /0 000
:
Hood Project Valuation: $
r-03iPt
Submittal shall Battery Calculations Yes U
include: Individual Component Yes U
Cut Sheets
Fire Alarm Project Valuation: $
:101VReird:elittara400005:01.1014 itAgNigit
Square Footage: Permit Fee: •
0 to 2,000 $187 . ,
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): $ /o 000
Permit fee based on valuation (see attached chart): $ I 2 j. 30
Permit fee based on square footage (D) (seejees above): $ ,
State Surcharge 8% 'of Perrriitfee: $ , /1. 14.
FLS Plan Review 40% of PermirFee: .$ 55 ;
TOTAL: '$ ' 2-66
Plan review requires a completed application and 3 sets of plans at
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.
hdsts\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
X-3 -- 5 07) 6 Received �� -CAD .�
// Date Request d M PM BUP
Location ��t� / Suite MEC /
Contact Person Gt. Ph ( ) &Y K — 2-9 af PLM
Contractor Ph ( ) SWR 7
BUILDING V Tenant/Owner ' ' l l l 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 l
Fi i
Fire Sprinkle
1
ire
-
Susp'd Ceiling
Roof
O s-
'AS PART FAIL
PLUMBING
Post & Beam
•
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
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 17,— ti –
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL