Permit °" BUILDING PERMIT
CITY F TIGARD PERMIT #: BUP2002 -00013
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A DEVELOPMENT H BMEN , 639 -4171 DATE ISSUED: 1/17/02
SITE ADDRESS: 12830 SW PACIFIC HWY PARCEL: 2S1026D -01701
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT: OOA JURISDICTION: TIG
REISSUE: r� r/ ✓K FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: r FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: 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: $ 1,000.00
Remarks: Upgrade fire suppression system to UL300.
Owner: Contractor:
DAVIDSON, WILLIAM G + DIXIE L HUSER SALES + SERVICE INC
8915 SW COMMERCIAL 1313 NW 17TH AVE
TIGARD, OR 97223 PORTLAND, OR 97209
Phone: Phone: 503 - 227 -6688
Reg #: LIC 116821
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Final Inspection
PRMT CTR 1/17/02 $62.50 27200200000
5PCT CTR 1/17/02 $5.00 27200200000
FIRE CTR 1/17/02 $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 it V _ fi):6A-„, ■ •
Signature:
Issued By: iR '-�' �,�. ( / '
7 ( 6 , ,, L 6 i ec
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Permit Application
iii
Date received: / — 0 -o Y Permit no.? R - Oaf 13
''JN' { " i� City of Tigard
Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR '
Phone: (503) 639 - 4171 Date issued: B tl,O" Receipt no.:
Fax: (503) 598 - 1960 ' - t Case file no.: Payment type:
Land use approval: l &2 family: Simple Complex:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi-family 0 New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other: iiPE PA/TET+vn/
JOB SITE I NFORMATION
Job address: 1 2433 S kJ P *et rte f t oy T rc, 4an, o to- Bldg. no.: Suite no.:
Lot: I Block: 'Subdivision: I Tax map /tax lot/account no.:
Project name: DALlocOa/ S C kSa AA — 0r,11 6rt/t;
Description and location of work on premises/special conditions: .. , 1 L' . / • - 4 ,
V UL. 1 ! I
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: DAVI nsodi S (Floodplain, septic capacity, solar, etc.)
Mailing address: ) 2,653 o 50 ID}f _iiCt C ii-o`/ 1 & 2 family dwelling:
City: 'T)G j p O I State:O/Z I ZIP: Valuation of work $
Phone: IFax: IE-mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi- family:
CONTRACTOR G Valuation of work $ /6(90 ,
Business name: ti LIS�(L St/411:5 a 5 EavjaL Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.)
Address: TL 2,3( f, j lI LL AvoleN 57 y 7 22 Number of stories
City: a TLA -A/A I State:0/l ZIP:
Y Type of construction
Phone: Aye- le 403 ( Fax; — 7071( E -mail:
Occupancy group(s): Existing:
CCB no.:
I log32. New:
City /metro lie. no.: 4 Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER 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: I State: I ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application • $ ? • SD
Address: Date received:
City: (State: IZIP: Amount received $
Phone: I 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 mote information.
attached checklist. All provisions of laws and ordinances governing this 0 Visa 0 MasterCard
work will be complied with whe er specified herein or not. Credit card number: / /
Expires
Authorized signature: Date: I — I7 -02- Name of cardholder as shown on credit card
Print name: b to K t El 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 ❑ Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation $ / ODO. 0
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): $ 60a_ CO
8% State Surcharge: $ .5.0
FLS Plan Review 40% of Permit: $ P-5. v0
TOTAL: $ , _ c
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
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP coa a - o60 i 3
Received Date Requested 2- .7-7 AM JBUP
Location l g3 tgz-e-(16.;/ Suite MEC .
Contact Person Ph ( ) 9 3.97 PLM
Contractor Ph ( ) SWR
mil, Tenant/Owner ELC
ELC
Foundation Access:
Ftg Drain • ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 62cro 71 U J O ar
Drywall Nailing
Firewall /115. ` f l �� ,)
Fire Sprinkler -
Fire Alarm
1 Susp'd Ceiling
Roof
o._ GPs
/_PART FAIL
BING
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 E Please call for reinspection RE: ❑ Unable to inspect – no access
Fire ADASupply Line Z /1-1
Approach/Sidewalk
Date — 1--"--Inspector \, Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL