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Permit CITY OF TIGARD SITE WORK PERMIT A DEVELOPMENT SERVICES PERMIT # : SIT2006 -00014 c - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED : 9/21/2006 PARCEL : 2S102BA -02000 SITE ADDRESS: 12353 SW GRANT AVE ZONING : R -4.5 SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT: 045 JURISDICTION : TIG Project Description: Site work with fire line. • CLASS OF WORK: NEW PAVING ?: Y RESO. NO: TYPE OF USE: COM GRADING ?: Y VALUE: 27,500.00 EXCV VOLUME: 200 cy LANDSCAPING ?: Y FILL VOLUME: 100 cy SITE PREP ?: Y ENG FILL ?: U STORM DRAINS ?: Y SOILS RPT REQD ?: U IMPERV SURFACE: 20,350 sf Owner: FEES ELITE CARE Description Date Amount 2300 SW 103RD [BUILD] Prmt Fee -Valu 9/21/2006 $305.80 PORTLAND, OR 97225 [TAX] Valu 8% State Surcha 9/21/2006 $24.46 [FLS] FLS Pln Rv 9/21/2006 $122.32 [BUPPLN] Pln Rv -Valu 9/21/2006 $198.77 Phone: 971- 506 -0151 [ERPRMT] Erosion Control 9/21/2006 $80.00 _..— Contractor: [ERPLN] Erosn Pln Rv CWS 9/21/2006 $26.00 [EROSN] Erosn Pln Rv COT 9/21/2006 $26.00 R + R ENERGY RESOURCES [WQUANT] Water Quantity 9/21/2006 $1,787.50 PO BOX 12564 [FLS] Addl FLS Pln Rv 9/21/2006 $200.00 PORTLAND, OR 97225 Total $2,770.85 Contact #: PRI 971 - 506 -0151 REQUIRED ITEMS AND REPORTS Reg #: LIC 71865 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 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 copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By: , ` Permittee Signature: ■ /r Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. i . Site Wor :171"--:.:11‘1:'.- � � ' A i Building Permit Application iot- FOR of ii USE O N�L CI Of Tigard �" Received Permit No.: ,/ 111 City DateB : a a l ry 6 d Oo °° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 0 : , Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 Date/By: TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: l (G+ Supplemental Information " ' : TYPE -OF= WORK, , • '. 1R 1 ". " , `4 tEQUIRED DATA: -1 AND'2'FAMILY'DWELLING'' Al New construction ❑ Demolition 1 " v PeMnitfees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition /alteration/replacement ❑ Other: AUG 'rnc equipment, materials, labor, overhead, and the profit for the t! l! i. -" " a '. work indicated on this application. ,. - _. CATEGORY OF-CO 1 ,i k 1 � Valuation $ ❑ 1- and 2- family dwelling jk Commercial/in dttstr} U + �� • ❑ Accessory building ❑ Multi- family L2' d I 1 - r ' T lJrt uA t . 1pber of bedrooms: a� ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION . '. Total number of floors: Job site address: /733N) S t4.> ( rai cz... New dwelling area: square feet City/State/ZIP: ( Garage/carport area: square feet Suite/bldg. /apt. no.: / Project name: 6; , aN ! (,L '/ f f,c Covered porch area: square feet Cross street /directions to job site: Yl, Deck area: square feet Other structure area: square feet �..r}I UIRED DATA :;COMMERCIAL- USE,CHECKLIST Subdivision: 1 1 — - otn 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 . " / DESCRIPTION OF "WORK, - . work indicated on this application. .ci,4 tt/n.d v* 11.0 GV 3c.;% f�1 4/ /J;, 4 t � i..� Valuation: $ a � 00 Existing building area: square feet New building area: 3) ) 9 square feet ":` ‘PROPERTY 'OWNER ` ' , ❑ TENANT Number of stories: Name: Li r f ei A2 L Type of construction: 5 if Address: A) l0 ) f / Occupancy groups: c I City /State /ZIP: 0 2r 4477 b/ - 9 72' - 3 Existing: v Phone: ( ) ?7(— 506 "c'/ 5 7 Fax: ( ) New: ' ❑ A PPLICANT ' . . ' : ❑ CONTACT • PERSON NOTICE. " • Business name: E/ / 7 (-4.,.. , All contractors and subcontractors are required to be Contact name: ,Y r1 ` (, /G3 ' ' licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: �. 19/62_ y Z jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons • apply: Phone: ( ) ?'7 /_ s3,6-V/371 Fax:: ( r ) E -mail: � /P �,i`T Pd 1eL CS�T it!' Can-1 - -.: CONTRACTOR - , - - . Business name: . W - 4 . BUILDINGPERMIT FEES* • Address: / , ,-, aG /2,(' (Please'refertofeeschedtrl� Ae r / ! i ,e/ (/ i' e , Structural plan review fee (or deposit): City /State /ZIP: Phone: (77� ) ,..cp ,..9/ j.. l Fax: ( ) FLS plan review fee (if applicable): CCB lic.: 7 (''6 . ,�, -9e - 0 ly Total fees due upon application: Amount received: • Authorized signature: 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 Service Board. 1:\Building \Permits \SIT - PermitApp.doc 06/26/06 440- 4613T(11/02 /COM/WEB) rt N City of Tigard: Site Work Permit Checklist Page 2 - Supplemental Information' r : ; 1J i Commercial, Multi - Family and One- and Two - Family Dwellings: No permit is required if fill is less than 50 yards (5 dump truck loads), or less than 3 feet deep and will not be supporting a structure. If a building will be constructed on the fill, it must be engineered fill. If fill is in a flood plain, drainage way, or wetland, the applicant must apply for a sensitive lands review (SLR). Please complete all items below, unless otherwise noted. , i II Excavation Volume: cu. yds. Grading Volume: (Soils report required for >5,000 cu. yds.) cu. yds. Fill Volume: --, i.o- +'l (Fill exceeding 12" in depth shall be compacted to 90% of maximum density)) , ; s cu.y}tils: Retaining structure? (Check one) •t `ito k C ❑ CMU ❑ Concrete • ❑ Other: *Total new impervious area including all buildings, sidewalks, and paving: sq. ft. Site Utilities Plumbing Work: ; - sy I. ..r11` k. s t e'-1 . a tY l.?y " f'\ - i':, '1s]`ti.' ° °, Complete the Plumbing Permit Application for site uti plum work. ' Plans Regjtired: See "Site Work Permit Application - Plan Submittal Requirements" attached. The f Mowing must accompany this ap lication: will ❑ Site Plan w Vicinity Map showing *Parking (including ADA) and ADA ca npliance Lighting Plan ❑ Gradi ii lag and details ❑ *Landscaping Plan El Erosion Control Plan and details El Soils Report (if required) ❑ Retaining Structures *Does not apply to One- and Two - family dwellings. # of Plans TYPE OF SUBMITTAL Required at (Includes - New, Additions or Alterations) Submittal Commercial 2 Multi- Family R -1 Occupancy 2 One- & Two - Family Dwelling 2 1:\Building\Permits \SIT- PermitApp.doc 06/26/06 2 • 7 FIE co „,‘<?, c 40 o- • Fire Marshal's Division Offices N D North Division South Division East Divisin ( 14480 SW Jenkins Rd. 7401 SW Washo Court 624 7th SWeet Beaverton, OR 97005 Tualatin, OR 97062 Oregon City, OR 97045 Tualatin. Valley (503) 356 -4700 (503) 612 -7000 (503) 657 -1365 Fuse & Rescue Fax (503) 644 -2214 Fax (503) 612 -7003 Fax (503) 657 -7913 FIRE FLOW and HYDRANT WORKSHEET This worksheet is required to be submitted to and approved by the Authority Having Jurisdiction (AHJ) before any permits for new building construction, building expansion, or fire hydrants will be issued by any building department within the TVF &R District. Please complete, sign, and date the PREPARER INFORMATION block. Then complete the GENERAL BUILDING INFORMATION block. Lastly, complete either item A or B, and items C, D, E and F on page 2 titled CALCULATING REQUIRED FIRE FLOW. Please clearly print all requested information, See the instruction book for help filling out the form or call one of the above numbers. PREPARER INFORMATION Preparer: ARSOO Lt) Cd ¶ c. tv1 p, \- 2 . 91 - (o Fax: ( 2 ,g2 Phone: Architect 1 Engineer of Record: C.IZt Gt futi2744A / -� Phone: C 5O) lJ r 5O0S Fax: .. Preparer Signature: 0- Date: 03, GENERAL BUILDING INFORMATION 1. Project Name: G I Cr r F/l_s 6A-rte. - - T /-401441 2. Project Address: 1 2- 3 4-S C1 R ni City: 714 Pc 1 County: Zip: `/2'22- 3. Construction Type(S) O Type I Fire Resistive or Type II Fire Resistive O Type II One -hour or Type III One -hour Type IV Heavy Timber or Type V One -hour O Type II Non -rated or Type Ili Non -rated O Type V Non -rated 4. Total Building Area: 1 Square Feet 5. Total Fire Area: ' 7I Z ' 1 Square Feet 6. Building Fire Flow: �, Gallons per Minute (Table A- Ill -A -i) . mil Lp)i 1 5 - Fvr.4.}1 5Pa1)l iu --67' 7. Describe the Fire Area: (If more than one fire area, include an 8 112 X 11 or 11 X 17 drawing indicating the various fire areas) 8. Type of Occupancy or Use of Building: Q ).d V I 44 t THIS UNE IS FOR FIRE DEPARTMENT USE ONLY FMZ I I Val Henzel - TVFR2.jpg Page 1 ! _ CALCULATING REQUIRED FIRE FLOW J A. Single Occupancy Hazard (If using item A, DO NOT use item e) 912,50 Al Building Fire Flow I l 44.S GPM c i ) A2 Occupancy Factor 1 4 00 A3 (Multiply line Al by line A2) Required Fire Flow I l 6021 GPM B. Multiple Occupancy Hazard (if using item B, DO NOT use item A) B1 ....Determine percent of each occupancy hazard in the fire area. (Occupancy Hazard Class) (Fire Area) (Total Fire Area) (Percent of Fire Area) Light Hazard SF _ SF x 100 = Ordinary Hazard Grp 1 SF _ SF x 100 = Ordinary Hazard Grp 2 SF _ SF x 100 = % Extra Hazard GRP 1 SF _ SF x 100 = Extra Hazard GRP 2 SF _ SF x 100 = Add all of the percentages in the last column, they must equal 100% 82 ....Calculate Fire Flow (Occupany Hazard Class) (Factor) (Fire Area) (Fire Flow) .(Bldg Fire Flow) Light Hazard 1.00 x % x GPM = GPM Ordinary Hazard Grp 1 1.20 x % x GPM = GPM Ordinary Hazard Grp 2 1.30 x % x GPM = GPM Extra Hazard Grp 1 1.40 x % x GPM = GPM Extra Hazard Grp 2 1.50 x % x GPM = GPM B3 Required Fire Flow GPM C. Calculate the minimum number of fire hydrants required 2 rn Required Fire Flow (A3) or (B3) r(o 25' GPM T 1500 = 1. No. of Hydrants (Minimum 2 Req.) D. Reduction of fire flow (check one box only and then complete the calculation in Section E) D1 0 Multiply either line A3 OR line B3 by 75% for a full fire alarm D2 0 Multiply either line A3 Q$ line 83 by 50% for automatic sprinklers D3 'Multiply either line A3 QB line 83 by 25% for central station supervised sprinkler protection E. Required fire flow Fire Flow I r o t GPM x Reduction % = Total Req. Fire Flow 47' 245 GPM' (Line A3 er 83) (Line D1, D2, or D3) • Minimum 1500 - Maximum 3000 GPM F. Available Fire Flow to the Building Test Results: GPM Please attach documentation of the flow test that was made. It shall include date, time, location of static/residual and flow hydrants, and the testers name, phone number and address. Val Henzel - TVFR3.Jp -g _ - - - - - Page 1 Fire Marshal's Offices ° = iv) / $4. 4 . tp0, • North Division • 14480 SW Jenkins Rd., Beaverton, OR 97005 0 PH (503) 356.4700,oi `x (S03) 644 -2244 Tualatin Valley South Division - 7401 SW Washo Ct, Ste. 101, Tualatin, OR 97062 • PH (503) 6414'e`Fax ( )R&-7003 .j'' 4 Fire & Rescue �` . � j' Building Survey Report 4 FMZ : _ (to be filled out by TVF &R) Code Edition: 1 t2'-- 1 Name of Facility: 'i ?*41 s -n(2,t *4.41-g g X1 5 U VIJ Name of Building: et--11V- giCT , 5-D 1I 1 Address: 2.3 /, Q' c3- Owner: e l I Telephone No. ( 5'03) ';- ' 44 Architect: C / M,at4 1. Telephone No. (1?f3) 1 ` Architect Address: .4 i2 l-oo 04/4 LA-e.6 h' j) Q/Z. • t `I ?'OAS ITEM COMM DESCRIPTION I. Occupancy Type _ `Use A )'.YI G? Capacity -364/ I LN /IW-. ' • r. r 1 2. Construction Type — Year Built 200 3. Area (Sq. Ft) Total 2 , 2:31 I nrgest Floor j , t 000 Basement p Jo j 4. Stories No. / Height 30r High Rise ❑Y E1N 5 a. Exterior Wall Construction 12— b. Opening Protection Y d Rj 6. Interior Wall Construction 1504 7. Floor Construction I (Z 8. Roof Construction I 4-I-R. - WRAF 9. Attic Draft Stops No. }J-a iq ., I0 Occ. Sep. Wall Construction No, b. Opening Protection }• D l la. Fire Wall Construction No. Du b. Opening ProtectionD tL� 12a. Smoke Barrier Wall Construction No. 1.La,=1a b. Opening Protection D 13a. Corridor Wall Construction J b. Opening Protection / e2p..a 14a. Corridor Ceiling Construction ' b. Opening Protection N D D 41444 5 15a. Shafts N I IT b. Opening Protection CiFL a &rV DyL Val Henzel - TVFR4.Jpg - - — _ _— P ag el Building Survey Report FMZ : (to be filled out by TVF &R) Name of Facility: ' '-1 ]Z � E -L-(l- C: t"12 -A-6s3 1- ITEM COMM DESCRIPTION 16a. Stair Enclosure No. b- Opening Protection 1 1 17. Stairs No. }+1. (/ 18. Ramps No.�� 19. Interior Finish Class Room i : 2 ,4171,0 .-- Corridor p Exit Frtcl 20. Exits No. /.i Total Width 1}�� 21. Exit Hardware Type ✓ ✓ ,y 22a. Exit Signs/Illumination 0/1'41-0(1/i/ I 1.4-1-14 1.4-1-14 eKi c5) b. Emergency Lighting ?7k7771-1°.(Z11( 1 P/ „ W I . / Z 23. Auto Sprinkler Coverage `1� tiO v im v 24. Standpipe Class/Locations RTV 25. Fire Alarm Type/Coverage Yg 26. Heating, Ventilation & Air Conditioning Type .----IFuel A Ac3 27. Electrical Installation 1- � 4 28. Stage/Platfomr Nia- 29. Hazardous Area 30. Other Comments: Alternate Materials & Methods TVF &R Use Only Inspected By: I Date No. Attachments Reviewed By: I Date Updated 1 ` / I f t ' ' Fire Marshal's Division Offices Tualatin Valley North - 14480 SW Jenkins Rd., Beaverton, OR 97005, (503) 356 -4700 Fire & Rescue South - 7401 SW Wash Ct., Tualatin, OR 97062, (503) 612 -7010 I . _ Fire Flow and Hydrant Worksheet This worksheet is required to be submitted to and approved by the Authority Having Jurisdiction (AHJ) before any permits for new building construction, building expansion or fire hydrants will be issued by any building department within the TVF&R District. See the instructions for assistance completing this form or call one of the above numbers. Preparer Information Preparer Name: 'Val I Phone: I Fax:I I Architect / Engineer of Record: I I Phone:) I Fax:1 I General Building Information I Project Name: (Grant Street Elite Care I Project Address: 112345 Grant St I City:ITigard I County:IWashington I Zip:I97223 I Construction Type(s): IType IV and V -A I Total Bldg Area: I 31,279Isgft Total Fire Area: I 31,2791sqft Bldg Fire Flow: I 3183IGallons Per Minute (Light Hazard) Describe Fire Area: (if more than one fire area, include an 8 1/2 x 11 or 11 x 17 drawing indicating the various fire areas) Type of Occupancy or Use of Building: 'Assisted Living CITY OF TIGARD BUILDING DIVISION PERMIT #: SIT2(I06 00t }14 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: W21/2006 Phone: (503) 639- 4171 @ Inspection Requests (24 Hrs.): (503) 639 -4175 �.' INSPECTION WORKSHEET FOR DATE: 6/1/2008 TIME: 7:00AM PAGE: 10 SITE ADDRESS: 12363 SW GRANT AVE CLASS OF WORK: SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 046 TYPE OF USE: PROJECT NAME: GRANT STREET ELITE CARE DESCRIPTION: Site work with fire line. OWNER: ELITE CARE, PHONE #: 971-506-0151 CONTRACTOR: R + R ENERGY RESOURCES PHONE #: 971 -506 -016 i Inspection Request Scheduled For: Date: 5/1/2008 Pour Time: o p , 4.../ Code # Inspection Description Confirm # Contact # Mes- - • : � 495 Misc. inspection 069181-01 971-506-1973 / 10 Corrections /Comments /Instructions: / 0 ) (9bA j 4 ( 1) PVC I .i. ‹f4 a . 7 11.3 e l1 3 PRAib 66.. 1 - TRAT 4-1, cool d 4 OF 4. S IV lev-ti, ?Aavib Le... ix,rigiAL himka. 1?6,44t Gen %Pleb ., ia-rtgit.., Fg.dist.,.. te' I ` toc419. ClriallAir n PASS I 1 PARTIAL APPROVAL ❑ CANCEL n NO ACCESS AIL II CALL FOR INSPECTION ADDITIONAL FEES ASSESSED i . / {, 1-412i - 5 Al " Inspector: ` "*' Date: fd ` art Phone #: (503) 718- , CITY OF TIGARD ' - o -6 -006- 1 BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 it Ah p� ' Inspection Requests (24 Hrs.): (503) 639 -4175 °fL. INSPECTION WORKSHEET FOR DATE: ')/ (9; /Z " TIME: PAGE: SITE ADDRESS: i ls CLASS OF WORK: SUBDIVISION: L OT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 46 9 6-L,Le , Corrections/ omments /Instructions: g a644.-k r di al 2,-0061 - cdod 3 J-c_1,4,1c 7,r 2 . 6)(,/ •. Cco)s...._ iel 8 - v L am, ;--- - li-e-. z 1 ee-■ 6 . 1 1 r 7t)(). -- 0 Ob_C 4 PASS ❑ PARTIAL APPROVAL H CANCEL n NO ACCESS FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: l4 - - Date: / 7/( / Phone #: (503) 718 -. P---i CITY OF TIGARD BUILDING DIVISION 4 / .. PERMIT #: SIT2006 00014 13125 SW Hall Blvd., Tigard, OR 97223 r DATE ISSUED: 9/21/2006 Phone: (503) 639 -4171 A' "tll!i411ilii II Inspection Requests (24 Hrs.): (503) 639 -4175 „' INSPECTION WORKSHEET FOR DATE: 5/8/2008 TIME: 7 :01AM PAGE: 17 SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK: SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 046 TYPE OF USE: PROJECT NAME: GRANT STREET ELITE CARE DESCRIPTION: Site work with fire line. OWNER: -. BARE PHONE #: 971 - 606 -0151 CONTRACTOR: R + R ENERGY RESOURCES PHONE #: 971 - 506.0151 Inspection Request Scheduled For: Date: 5/8 /2006 Pour Time: Code # Inspection Description Confirm # Contact # Message Lies' 499 Final inspection 069596 -06 971 - 606 -1973 N /' c Corrections /Comm nts /Instructions: k CA,e 26 ciCS - 00003 IP 6 �a - 06055 6/k_ 1 3 - G C %.\( w � � • n PASS /% "ARTIAL APPROVAL ❑ CANCEL n NO ACCESS I Li FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED I nspector: Z4sA(/..Date: S -700 Phone #: (503) 718- 2,�L'J CITY OF TIGARD + - '7,007.0033 /p BUILDING DIVISION '-� PE #: __ — 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: �` Phone: (503) 639 - 4171 °'4'yi u� I Inspection Requests (24 Hrs.): (503) 639 -4175 - 'I� r f INSPECTION WORKSHEET FOR DATE: VA 16 • TIME: PAGE: SITE ADDRESS: 1 2 - 1/2 / G ca./AA a. % CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT TION: � r- , 5tr C' I �t Co-Are- DESCRIPTION: ���wVVV�"`--- "'���- OWNER: PHONE #: CONTRACTOR: PHONE #: ---j it---- Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Co tact # Message A c 5rjii (.\ t\,,i 0- Corrections /Comments /Instructions: n g / [Q0-te -- ‘, 1■1 , -e-c_C■f-- C___eL ja (1>(,)e-,4\ce,t/t -- - lice.r< C:4 Li, a 6.. A\ ----- C caj- h,� 4-- t c2).,...ck ___OkL-4b 11) — ° 1DI 4 / VOzLl 't $ Vit ti- .._ 0 1 0 i, 0 t47/ 1 / •611 ) u.,3 - 0 4 , 0 It5- PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES A ESSED Inspector: � Date: �/ 6 Phone #: (503) 718- 1 CITY OF TIGARD i i BUILDING DIVISION PERMIT #: SIT2006-00014 13125 SW Hall Blvd., Tigard, OR 97223 __.DATE ISSUED: 9/21/2006 Phone: (503) 639-4171 / Inspection Requests (24 Hrs.): (503) 639-4175 .-44 ' i INSPECTION WORKSHEET FOR DATE: 9/2612007 TIME: 7:01AM PAGE: 29 • SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK: SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE: PROJECT NAME: GRANT STREET ELITE CARE DESCRIPTION: Site work with fire line. OWNER: ELITE CARE, PHONE #: 971 CONTRACTOR: R + R ENERGY RESOURCES PHONE #: 971-506-015 I Inspection Request Scheduled For: Date: 9/26/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message ' 420 Sprinkler supply lines 056380.01 971-506-0151 N Corrections/Comments/Instructions: ----- e (1 1—/ ---- (iK 4- r ---- „ PASS PARTIAL APPROVAL CANCEL I I NO ACCESS FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED ‘4,( 9/ ( 2 2,ci z (1 Inspector: Date: Phone #: (503) 718- . . CITY OF TIGARD BUILDING DIVISION PERMIT #: SIT2006-00014 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/21/2006 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 f-11. INSPECTION WORKSHEET FOR DATE: 1/10/2007 TIME: 7:03AM PAGE: 26 fe7 • SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK: SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE: PROJECT NAME: GRANT STREET ELITE CARE • DESCRIPTION: Site work with fire line. OWNER: ELITE CARE, PHONE #: 971-50'6-0151 CONTRACTOR: R R ENERGY RESOURCES PHONE #: 971-506-0151 Inspection Request Scheduled For: Date: 1/10/2007 Pour Time: 9:00 Code # Inspection Description Confirm # Contact # Message 205 Footing 041961-01 971-506-0105 Y Do - Ce• 'g Corrections/Comments/Instructions: / " • C/ 0 9(9 - sc OLf 17,-) yARZA-SL C4kla ak-q7.2 A/ I I PASS 4 PARTIAL APPROVAL El CANCEL NO ACCESS FAIL n CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED ti/0/0'1 Inspector: Date: Phone #: (503) 718- Mrti CITTOPTIGARD BUILDING DIVISION PERMIT #: SIT2006-00014 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/21/2006 Phone: (503) 639-4171 iAc1\ ;411 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 1/30007 TIME: 7 07Am PAGE: 40 SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK: SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE: PROJECT NAME: GRANT STREET ELITE CARE DESCRIPTION: [ERtd vioiki`rith fire line, OWNER: ELITE CARE, PHONE #: 971-506-0151 CONTRACTOR: p + R ENERGY RESOURCES PHONE #: 971-506-0151 Inspection Request Scheduled For: Date: 1/3/2007 Pour Time: 9 Code # Inspection Description Confirm # Contact # Message 205 Footing 041718-01 971-505-0105 Corrections /Comments/ Instructions: fA 4 1 . 7 k/ 1 W - 6 1 _17 2 -P - Fauce t At I via FPFT1kL7 1,(L fl PASS PARTIAL APPROVAL 0 CANCEL I NO ACCESS FAIL CALL FOR INSPECTION I I ADDITIONAL EES ASSESSED Inspector: / MY Date: ( 3 L/ , Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: Z. -- L- j 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: I Phone: (503) 639 -4171 gnu l�lpiryf�l Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: / / J TIME: PAGE: SITE ADDRESS: V CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: .J7 C PHONE #: CONTRACTOR: PHONE #: q 1 1 6o c� ©cis Inspection, Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message Zc G• t 7'? c Corrections /Comments /Instructions: /—? 9/ U ' G �r 4- 0A4N.5csou � . - _.I� i r, , ww f — -- — - — 10 P 1 ❑ PASS ✓ PARTIAL APPROVAL 11 CANCEL ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: r Date: � V • Phone #: (503) 718 tVal Henael ;TVFR3.jpg Page 1 5 f T CO. ,— Crtm 1 ,, ;, + !4` • ,, /, ' Fire Marshal's Offices .. d. , , ,,, cr:r , r - V • -,k I r)i T lit i \ ,' l p , , ■.• \Y' ''' • ._. .... vf d .,,... North Division - 14480 SW Jenkins Rd., Beaverton, OR 97005 • PH (503) 356.4700•kf (503) 644-224 1 1 Tualatin Valley South Division - 7401 SW Washo CI, Ste. 101, Tualatin. OR 97062 • PH (503) 612-Z000'• Fax (5)8f}12= Fire & Rescue 4 Buildi nq Survey Report .....'''''' FMZ : (to be filled out by TVF&R) Code Edition: 1/ -O.71 Name of Facility: :::-1 (: , ,...,,,,„ _.. A ,,,-,,..,- -:,„,,,_-_, Name of Building: ' ..-- C%'--i --..1- -0‘ 1 - - - - :%<- 7- ±1-';--6V-i; P . -'---' ';"?..),..- Address: )- - 3 Z--- (-1 :2-A ':.-,-c `...7.:7""i,. - ' i... i' •". -: "7 : 2 - 2 .-' Owner: r"' .....j._-. :.--4f: - - -- '' A • , Telephone No. ( '5) !) ' - - -; -- Architect: " 4"-- V. ,17. '...-,:.A,.f;) ,-; 42-,. Telephone No. (r.f_r; ) fil-:.0 --- i" - .. A ---) -- r , I , ' ' 4n •-• i • -; Architect Address: -I's'''. -.:- , ■----) e" . Y — ^-' • ' .-- ...-" frt. / f /:= X- 1 ;%-' -: )71 • ..:. - I •=•;' 5 ' ITEM COMM DESCRIPTION 1. Occupancy I Type -1 _ I Use A - :.' - t )- t - .:;;; Y :' Capacity 2. Construction Type 7" Year Built 3. Area (Sq. Ft.) Total -2 ; .--; .--. ',.1 Largest Floor 4. Stories I No. .- Height - ..- High Rise 0 Y ON 5 a. Exterior Wall Construction H iL . b. Opening Protection Y; 'i LI- ,`"- 6. Interior Wall Construction :.S. 7,:,;0,..'..,z. 7. Floor Construction 1 Hr rz_ I S. Roof Construction I 1 -1--i-r,L 9. Attic Draft Stops No. 10a. Occ. Sep. Wall Construction No. b. Opening Protection I Ia. Fire Wall Construction No. ' ; i b. Opening Protection 1 1 --1- 1---' 12a. Smoke Barrier Wall Construction No. b. Opening Protection I I:3a. Corridor Wall Construction 1 . b. Opening Protection .--.: 14a. Corridor Ceiling Construction 1 - r b. Opening Protection \--.: . . 15a. Shafts No. Type ---; ft ( I b. Opening Protection -4 "-"- 3. :- , . .-.-- ..c; - ;:::1-;71: LVal Henze! - TN/FR4jpg Page 1 building survey Report FMZ : (to be filled out by TVF&R) Name of Facility ITEM COMM DESCRIPTION 16a. Stair Enclosure No. b. Opening Protection 17. Stairs No 18. Ramps No. 19. Interior Finish Class Room • . Corrid or 4 Exit Etitelosu r P r •,; 20. Exits No. - Total Width 21. F.xit Hardware Type 22a. Exit Signaillumination - b. Emergency Lighting f }-..1 23. Auto Sprinkler Coverage 24. Standpipe Class/Locations 25. Fire Alarm TypeiCovcrage 26. Heating. Ventilation & Air Conditioning Type 7, Fud /, 27. Electrical Installation f;?.3 21t. Stage/Platform 29. fltrzarclous Area r 30. Other Comments: Alternate Materials & Methods TVF&R Use Only Inspected Date No. Attachments I Reviewed By. I Date Updated !c # ; Ah'° ' y Fire Marshal's Division Offices Tualatin Valley North - 14480 SW Jenkins Rd., Beaverton, OR 97005, (503) 356 -4700 Fire & Rescue South - 7401 SW Wash Ct., Tualatin, OR 97062, (503) 612 -7010 Fire ' Flo *: and 'Hydrant Worksheet I This worksheet is required to be submitted to and approved by the Authority Having Jurisdiction (AHJ) before any permits for new building construction, building expansion or fire hydrants will be issued by any building department within the TVF&R District. See the instructions for assistance completing this form or call one of the above numbers. Preparer Information Preparer Name: (Val 1 Phone:( I Fax:I I Architect / Engineer of Record: I I Phone:) I Fax:1 I General Building Information I Project Name: (Grant Street Elite Care I Project Address: 112345 Grant St I City:ITigard I County:IWashington I Zip:197223 I Construction Type(s): (Type IV and V -A I Total Bldg Area: I 31,2791 sgft 1 Total Fire Area: I 31,279Isgft Bldg Fire Flow: I 3183IGallons Per Minute (Light Hazard) Describe Fire Area: (if more than one fire area, include an 8 112 x 11 or 11 x 17 drawing indicating the various fire areas) Type of Occupancy or Use of Building: (Assisted Living A. Occupancy Hazard I Al Determine percent of each occupancy hazard in the fire area. Oicirp°aricy Hazard Classx., _..fir _z r'''te. `' - :Fire'Area _. ? ;, rtTotal:FiieArea:.. °S. =F -.' a, a Percent'of.Ft tp Light Hazard 31279 SF hi 31,279 SF :x:100 _:= ` _ , 100 % Ordinary Hazard Grp 1 0 SF - 4.1 1 SF 43( r i= :' -'7 4 0 % Ordinary Hazard Grp 2 0 SF ' °/ _ 1 SF ir100rc "..:.' 0 Extra Hazard Grp 1 0 SF •4 : 1 SF it 100: " °,= 0 % Extra Hazard Grp 2 0 SF . 11 1 SF ix100. " = 0 % Total Must equal 100% I 100 % I A2 Calculate Fire Flow - Hazaid Class ; :Factor Fire Area : _ ;• Fire Flow;; : J:; i:; =' `:Bldg Fire Light Hazard 1.0 , z 100 % -'x 3183 GPM -c' 3183 GPM Ordinary Hazard Grp 1 1.2 x 0 % x: 3183 GPM > c 0 GPM Ordinary Hazard Grp 2 1.3 x 0 % r x 3183 GPM _.._ 0 GPM Extra Hazard Grp 1 1.4 x 0 % • x•: 3183 GPM -: ,' 0 GPM Extra Hazard Grp 2 1.5 :x 0 % x 3183 GPM =..,. 0 GPM A3 Required Fire Flow I 3183 GPM I I B. Minimum Number of Fire Hydrants Required I Required Fire Flow 3183 = I 3 I No. of Hydrants Required I C. Reduction of Fire Flow - Reductions are based on the following: I Cl - Reduced by 25% for all Group R Occupancies without fire sprinklers (multiply by .75) C2 - Reduced by 25% for a NFPA 72 Fire Alarm System (multiply by .75) C3 - Reduced by 75% for NFPA 13 Automatic Sprinklers (multiply by .25) ID. Required Fire Flow D1 - Group R occupancy I No Ix I 1 I = I 3183 GPM (Max. 3000 - Min. 1500 gpm) D2 - Fire Flow 3183 GPM x I 0.25 I = I 1500 GPM (Max. 3000 - Min. 1500 gpm) I E. Available Fire Flow to the Building Test Results: I I GPM Manually enter available fire flow here. Please attach documentation of the flow test that was made. It shall include date, time, location of static/residual and flow hydrants, and the tester's name, phone number and address. Page 1 of 2 Report Run Date: 05/08/08 Report Run Time: 14:32:41 71 -01 -6261 Cl: ELITE CARE AT FANO CREEK(NO HARDCOPY) 12353 SW GRANT AVENUE TIGARD, OR 97222 All Events Detail w /Codes 05 -08 -2008 - 05 -08 -2008 DATE DAY TIME CODE SIGNAL DESCRIPTION USER INFORMATION 05/08 Thu 10:14 Event Operator: 84A at: 00 Acct Opn /Clo: n/a Out -Of- Service: 05/08 Until 05/08 StrL: 10:13 Until: 13:00 Zone(s): Comment: KEN TILL 1300 05/08 Thu 10:14 ON TEST OUT OF SERVICE Comment: OUT OF SERVICE PER KEN RUTTLEDGE W /PC TILL 1300/0P84 Passcard Name: KEN RUTLEDGE Completed on: 05/08/2008 at: 10:14:18 Operator: 84A Disposition: System Out of Service 05/08 Thu 11:13 E628000 RCORD ONLY INSTALLER PROGRAMMING DONE 05/08 Thu 11:13 E305000 RESTORAL SYSTEM RESET 05/08 Thu 11:19 E203001 ENVIROMNTL GATE VALVE LEVEL V 05/08 Thu 11:21 R203001 RESTORAL GATE VALVE LEVEL V 05/08 Thu 11:21 E113001 FIRE ALARM WATERFLOW- UNSPECIFIED AREA 05/08 Thu 11:21 R113001 RESTORAL WATERFLOW- UNSPECIFIED AREA 05/08 Thu 11:23 E115001 FIRE ALARM PULL STATION - UNSPECIFIED AREA 05/08 Thu 11:26 E401000 RESTORAL MANAUL USER RESET 05/08 Thu 11:26 R115001 RESTORAL PULL STATION- UNSPECIFIED AREA 05/08 Thu 12:13 E627000 RCORD ONLY INSTALLER PROGRAMMING 05/08 Thu 12:15 E628000 RCORD ONLY INSTALLER PROGRAMMING DONE 05/08 Thu 13:00 OFF TEST RETURNED TO SERVICE 05/08 Thu 13:54 Event Operator: 72A at: 00 Acct Opn /Clo: n/a Out -Of- Service: 05/08 Until 05/08 Strt: 13:54 Until: 16:00 Zone(s): Comment: 05/08 Thu 13:54 ON TEST OUT OF SERVICE Contact Called: KEN RUTLEDGE Phone Number: Contact Result: Auto -Dial at: 13:53 - 13:54:16 Comment: OUT OF SERVICE PER KEN RUTLEDGE W /PC TIL 1600 OP72 Passcard Name: KEN RUTLEDGE Completed on: 05/08/2008 at: 13:55:12 Operator: 72A Disposition: System Out of Service 05/08 Thu 14:06 E115001 FIRE ALARM PULL STATION- UNSPECIFIED AREA 05/08 Thu 14:10 E401000 RESTORAL MANAUL USER RESET 05/08 Thu 14:10 R115001 RESTORAL PULL STATION- UNSPECIFIED AREA 05/08 Thu 14:20 E115001 FIRE ALARM PULL STATION- UNSPECIFIED AREA http: / /alceste.simsweb.com/SW HIST.CMD 5/8/2008 Page 2 of 2 05/08 Thu 14:22 E401000 RESTORAL MANAUL USER RESET 05/08 Thu 14:22 R115001 RESTORAL PULL STATION- UNSPECIFIED AREA 05/08 Thu 14:25 E110001 FIRE ALARM AN UNKNOWN TYPE - UNSPECIFIED AREA 05/08 Thu 14:26 E401000 RESTORAL MANAUL USER RESET 05/08 Thu 14:26 R110001 RESTORAL AN UNKNOWN TYPE - UNSPECIFIED AREA http: / /alceste.simsweb.com/SW HIST.CMD 5/8/2008