Permit CITY OF TIGARD PERMIT
PERMIT #: BUP2002 -00124
�1�,� DEVELOPMENT SERVICES DATE ISSUED: 4/16/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136AD -04001
SITE ADDRESS: 11539 SW PACIFIC HWY
SUBDIVISION: VILLA RIDGE ZONING: C -G
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: : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0.00 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: 41 I 'DO.
Remarks: Installation of two systems one serving the (3) fryers and the second serving the chain broiler
Owner: Contractor:
SMITH, EDITA M CARBON DIOXIDE
BY NORRIS + STEVENS 3357 SE 21ST AVE
520 Rone N50 SW 6TH #4 R 00 g7�114 PORTLAND, OR 97202
P o PhP387 Phone: 232 -6646
Reg #: LIC 143295
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler inspection
PRMT CTR 4/8/02 $62.50 27200200000 Sprinkler Final
5PCT CTR 4/8/02 $5.00 27200200000
FIRE CTR 4/8/02 $25.00 27200200000
Total $92.50
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Pe rm itte
Sign ure: , A- s. N A (1 k Cr ✓`-,
\
' .'-- - CtCh-Alit
Issu By: kR i
Call 639 -4175 by 7 p.m. for an inspection the next business day
7 . .,, .
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Building Permit Appli_ cati
c - ... - cus Datereceived: Y E 4 iL Permit no.: 69, _ /
;,) �y1 City of Tigard c ,i "
Address: 13125 SW Hall Blv Tigard, OR 97223 Project/appl.no.: ( B I )ReceiPtno.: E ' edate:
City of Tigard Phone: (503) 639 - 4171 Date issued:
Fax: (503 598 - 1960 �Y c `
1 i %/ Case file no.: Payment type:
Land use approval: �'"� ? n� I &2 family: Simple Complex: }
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory
)g
Commercial/industrial Multi - family U New construction U Demolition
U Addition/alteration /replacement Tenant improvement l Fire sprinkler /alarm U Other: t
JOB SITE INFORMATION
Job address: 56/ r} r- '`'"f /1S S • C / -c-.-c to �j Bldg. no.: Suite no.: I'
Lot: I Block: ISubdlvision: ( 'Tax map /tax lot/account no.:
Project name: �\
Description and location of work on premises/special cond i ns:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: (A) e s 1` ICJ =� (Floodplain, septic capacity, solar, etc.)
Mailing address: f ?— & /• •� f�1 /� U 1 & 2 family dwelling:
City:5 ..,, D , . .. I State{- I ZIP: 9 )1-3e Valuation of work $
Phone['( vfTs(3aUp 1E-mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
Garage/carport area (sq. ft.)
Name: Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: 'State: 'ZIP: Other structure area (sq. ft.)
Phone: Fax: E - mail: CommerciallindustriaUmulti- family: �
CONTRACTOR Valuation of work $ /m�i�^W
Business name: Cm, r L M I `Oh .\ P . , , ptt Existing bldg. area (sq. ft.)
Address: 33 S' 7 � G P- [ s 7- It v C New bldg. area (sq. ft. )
Number of stories
City: Pot^ 1- I State:D /� I ZIP: q ,19 Z
f� Type of construction
Phone :9`03 4 2.3 _(0 lcx: E -mail:
CCB no !y 3 5' 5" Occupancy group(s): Existing:
New:
City /tic. no.: 3 3 -) Notice: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: I Plan no.:
Phone: Fax: E -mail:
Name: Contact person: Fees due upon application $
Address: Date received:
City: 'State: 'ZIP: Amount received $
Phone: 1 Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of lawsrand ordinances governing this ❑ Visa ❑ MasterCard
work will be complie wh er spec fi herein or not. Credit card number: / /
^ � 6 ` 7 ' / r , v � Expires
Authorized signature: , /// Date: �f Name of cardholder as shown on credit card
Print name: T 2 '� 5 f _ Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440.4613 (6/00 /COM)
•
Fire Protection Permit Check List
A.) ❑ New ❑ Addition ❑ Alteration ❑ Repair
B.) Modification to sprinkler heads only:
Describe work to 1. 1 -10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required.
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet LI Dry LI
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation $ kU
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A, B & C): $
Permit fee based on valuation (see chart):
-� .
8% State Surcharge: $ 0 0
FLS Plan Review 40% of Permit: $ • • 0
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.
is \dsts \forms \FPSchecklist.doc 11/21/01