Permit �`" BUILDING PERMIT
CITY OF TIGARD
P ERMIT #: BUP2004 -00255 • — 13125 SW , ; _� I � & . D EVE L i O P B M E NT r S o E RV II C E S � 639 -4171 DATE ISSUED: 6/2/2004
SITE ADDRESS: 07204 SW DURHAM RD Q300 PARCEL: 2S113AC- 00103
SUBDIVISION: PACTRUST ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: Art I FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 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: $ 1,400.00
Remarks: Modify 10 heads.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES DELTA FIRE INC
15350 SW SEQUOIA PKWY #300 -WMI 14795 SW 72ND AVE
PORTLAND, OR 97224 PORTLAND, OR 97224
Phone:
Phone: 620 -4020
Reg #: LIC 64174
FEES • REQUIRED INSPECTIONS
Description Date Amount Sprinkler inspection
[BUILD] Permit Fee 6/2/2004 $62.50 Final Inspection
[TAX] 8% State Surchan 6/2/2004 $5.00
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 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: Al �i A .. ,
Permittee
Signature: r ,i m J � , 411_,L__
Call 639 -4175 by 7 p.m. for an inspection the next business day
•
Fire '1- Protection System
' Building Permit Application FOR OFFICE USE ONLY
�1 V Oi
City of Tigard Received Date/B Permit No.•
13125 SW Hall Blvd Tigard, Plan Revie
Phone: 503.639.4171 Fax: 3. 98.1960 / a ✓ • R., y' i lt�I /
/ /y � q l/ r ts\ Other Permit: ()d A5 '
2, OQ � . 4t It
' �
Inspection Line: 503.639.4175 � ,, y ' �, Date Ready /By: See Page 2 for
Internet: www.ci.tigard.or.us ,\ n pD • Notified/Method: Supplemental Information
011G. IC*
`Ism.t,, ;�. a kr,;•: "r s ,� CO �
` 6124M41 4 :. 0011 , , r , i!7%1 ' , LI ' ;'
, .., ,�y� �`# ' ,� " t 'a.*g i 4. �4' ,. y , ,, , `fir REQUIRED DATA N 2°�FA DWE L NG'
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❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
,
- >Ys.:, �; s u ,ry �;,- ^sr aa »,.x ,:�t< .:>sgr,.."_,: . „sw>>. y., .�:� ,ky, t , work indicated on this app
� � � ra ~~� � t N��� application. 5. ” r ;,:: CATMY O , G QNSTRU M lalkAM° : t g ,1 filial'
Valuation: $
❑ 1- and 2- family dwelling Commercial /industrial
171 Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
az`- --7 . :;3,a --. $p,*;, -ar? , ,gott ` ,,, s. varl3t; ,v,i, LYoclxt -A,r s:> ;;X*;C„ _ ,. , r, - c" r: ;p�4,41
,, ,c >w ° ^ ,,, Total number of floors:
� ` ltgA : 11 ,, ,r' JOB „SITE:�INFORMATION 1 14 ? T ,� a
sta ��'-:. a: w: ft::>” 1� ,�^�,�- �s4FJl�ixw"5`I�+kzEa�'. za,3r,�s_s,,. ,x?us�',a -=i. .� ,�:� r ;� * ➢= ?si'�i, � `� �`' t %`
Job site address: 9p.eq S D Jed-IA-in New dwelling area: square feet
City/State /ZIP: 4 7aati Garage /carport area: square feet
Suite/bldg. /apt. no.: SO Project name: Cfwsu 0...Lk LU L R— Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
'.REQUIRED D AT C USE L C FIECKLIST' ",'
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
*;� #:,)�s� ..� - et7 � "= ,: ':, -,°: [<a.'•mc�:�_.:_�:ci`+,�::.+ -„c *:-'s ,,;>:t�;.k: _ eFF '.;�:,�: ^qt
r :::r:a1;7*VAc,> Wi ;,_ .ti-`"' a ' e-.w' ,.. A'U`3.ta'' :«i.� ," �ro.r
r A :, F 3. DE CRI g :t
4F�'ORK ; I ,0 , # - , , work indicated on this application.
Valuation: $
' Existing building area: square feet
New building area: square feet
•u � "�:a iae >.� •,: , - >;.vz - .. „.....,_,: '.t ^r• T'�z>a::::,;4t5` > - - V ; x- "T -.r c « =-s � , -;,: ,:` +`" - -..ti >: ;ti :a ;, ;a'
! ar PROPERTY OWNER t o , §f E w izi N T -b k Number of stories:
.''Melt.. ti ..> 4.,L, 6-,;, 4a .. - . =.AU .b, -.i „. , ;1;a -W. .4,,,„4„1-4,4!,'
r..,i 4!,' , .gut s"* „e
Name: Type of construction:
Address: - Occupancy groups: -
City/State /ZIP: Existing: .
Phone: ( ) Fax: ( ) New:
>'S,vy -.:': p.'. „r; ^,GO.'yt :_a > # `. .> , :NINA ,',�" X .f.n"x.A: ^ , 5 � "- ^`- ,15:;' s,tt: - ':3',r; ', *:'G -
A M, ARRLICANT .. a .!- . ; -, ❑,'GONT .-.A01RERSOPI° `: z e„ rRgh -" e s g � i .
_.,,�...�.:«..m,.^°€ -. _. �8a-.e^ -�„�,: n;', a.a.ss�;ar,�a.,, �' .,.,...,.. �,., -I x, .,, .. .„, Sx � . e. 2� t ,Y: ° , « � ICI '_
�.. . t s ". aZx: k>'* 3' u'` ��= niki»> U* �; �:: Y" Y' 1ct����ics:: ttt �TM4xPt•.;= �iR? ` „ Ma`�`:i`..s "3°'�� > �... �
Py R'2' -. -
Business name: L) ez... 7 i /2E All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
- E -mail:
_ ...f, i`xs;'"" '`id ;'3 a' k.'�°�3":' :C,.� ...- Yyx :::?.:kyZ �a::�8`53k 'ups- a :a�: z ti :�� ' "!'.�°.�:;i?*: ;" 'A�"M�. . tr„�. _
,V r; k R', a CmONTRACTOR � K ° ", e -
a��`a,W }; �tim ,, +�K:y�;a� -.a �?�.` >t .<i..,n,,�,„, , .;, �„ o.. �: wrr;, ���4i�5a�� ;:' "ff�`��t����':�«''rf�`, w
Business name: ip 62.4-73 r7 QC , , ;a f , ' ," :1: .,DIN : ',.:
' �- y} � " >PERIVLIT ,FEES *' ..•: .;4, -
Address: /ii 7 7 ^ 5 Su) '7,2-w0 4-0 6 Please refer to fee schedule.
City/State /ZIP: pax, , 02 . 7 a a T
Fees due upon application
Phone: (5 3 ) 4o- 47 I Fax: ( )
CCB lie.: 6, 4/ 7 4 Amount received
,� / � D ate received:
Authorized signatur • " )41A /W V t This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name / Date: / / ) * Fee methodology set by Tri- County Building Industry
l r f Service Board.
i; \ Building \Permits \FPS- PermitApp.doc 12/03 440- 4613T(II /02 /COM/WEB)
•
Fire Protection Permit Check List
.d -�'
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
x ., - .�.,�, e;. ,w.vrm ,,,;r. i,. r..� ,.�.. :..,, ^" .NYY'',. ",: u r-,�e., w ',N �?;k �.,. ,: "S:', :^a;� " "kk• ;a 3k� "k �:^r =r'_k
A° 9 �'- 3 t .�§sm. �r .�. � s " a � � e � P � ... u.,�
FTYP.e o f S ,(„C6mplet A C pr D,as appi ,.v..M .v ' : ;.,h ...,_.
'� f `tl�'i�E in t i v :� t "` h k ii r'+ k '�.°" ay d� �, '¢s' ` € 3` e i T '"` u '�,�:
�'') ` €Commercia1TSprmkler� � �f� , #� ". '.k o �:� a 3 k .� �. ti.r N�; °..�, :. , �� ;' �: � �' _s, ''
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group • •
Density
Design,Area
K. Factor
Sprinkler Project Valuation: $
..�:« �..re .: �.. a:° 17g �...,,,w�.,. ; ,.�,. <.,i =,..�r� ,.: , .,A.k: ':,, .�,� v, �.. rrc r,,:A +.a. ^ �h:5 ", i &Y.- -
� � p 8 iq 2� S�3 rte' 'S"t�� r'k �; � �
B) ;Type IkltW d System .t :_ . i �,'i:Ntt '1i 4 iL ,. h hay
Hood Project Valuation: $
��C ' � � r `;s�,�'� e fir- -� ' t'r t' r -`a'�.'� a &�s � � ':v x s , €�
.):F><re Alar -tea.., �.,r�n� .� �,�. ������ ¢ �� #,��� ���. o�,���.� �..��:�,� -�� ��.�� .3. � Y� , >� v �.��,� .� .14.z
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
id` " "` "? ; E'er' a -4 ,: �'�'
D) Res><dent><aI Sp r><n:*at Stan Al one S yste m) , • 3 i
Square Footage: Permit Fee: ' "�� C - ''':f
0 to 2,000 $187.50
2,001 to 3,600 $232.50 x fi ; tf
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): $ j 400,o0
Permit fee based on valuation (see attached chart): $ !o A. 66
Permit fee based on square footage (D) (see fees above): "$
State Surcharge 8% of Permit Fee: $ . 06
FLS Plan Review 40% of Permit Fee: $ f 7
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.
i:\ Building\Forms\FPSchecklist.doc 12/24/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPErCTIOR4•DIVISION Business Line: (503) 639 -4171 MST
BUPOOq
Received Date Requested ( AM PM BUP
Location 7 cD--0 '( D Suite MEC
Contact Person 41 11 1 , ; Ph ( ) ' 0a6 PLM
Contractor 6")/1 Ph ) 33 a—" q eye SWR
BUILDING Tenant/Owner e / ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing .
Insulation 4A CAI r M3iNk■
Drywall Nailing
F ire wa inkle NO L.'
�4 # 4 .4.∎∎ sl ✓�► O � �_ — ►--
Fire arm �� '' � ir t ( l
Susp'd Ceiling
Roof
PART FAIL
• u T : ING
Post & Beam I
Under Slab � I �
Rough -In 1 AP
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 Q ' � •
Rough -ln _ / _
UG /Slab de ' . �
Low Voltage
Fire Alarm MEOW r
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
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL