Permit . ,
I BUILDING PERMIT
A - CTY O F TIGARD PERMIT #: BUP2003 -00490
ilk DEVELOPMENT SERVICES DATE ISSUED: 8/13/03
`�'�" � =-° 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13066 SW PACIFIC HWY PARCEL: 2S102CB -02600
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT: 020 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 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: $ 1,800.00
Remarks: Type 1 Hood Fire suppression system.
Owner: Contractor:
CAPONE, ANTHONY M UNIVERSAL FIRE EQUIPMENT
13056 SW PACIFIC HWY 8049 SW CIRRUS DR
TIGARD, OR 97223 BEAVERTON, OR 97008
Phone:
Phone: 641 -8702
Reg #: LIC 86723
FEES REQUIRED INSPECTIONS
Description Date Amount Final Inspection
[BUILD] Permit Fee 8/13/03 $62.50
[TAX] 8% State Tax 8/13/03 $5.00
[FLS] FLS Pln Rv 8/13/03 $25.00
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 -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:
.� , ,(Q/td._. „air ; i 4,0 0°..."-
PermIttee
Signature:
Ca 9 -4175 by 7 p.m. for an inspection the next business day
`dire Protection System
• FOR OFFICE USE ONLY
BIIII(�1Tci Permit • t1oII Received , / Buildin g
Per it No.
QQ,, '50P200.3 — 0 0Z /g6 Date/By: � � `' �� -0q (J m
City of Tigard Planning Approval Permit No.:
Date/By:
13125 SW Hall Blvd. AUG 1 3 2003 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 5D1ITAttfi � �H µ'1 Post - Review Land Use
B B c.";" . ► r.. I ; Date/By:. Case No.
Internet: www.ci.tigard.or.us BUILDING DIVI Contact Juris.: 0 See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
ddition/alteration/replacement ❑ Other:
CATEGORY OF C STRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ,ommercial/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 $
JOB SITE INFORMATION and LOCATION . No. of bedrooms: No. of baths:
Job site address: /30 6 G &Q.. (fi19 /T"" Total number of floors
New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name:p..1.4 .yr 3 4 s 44.4 Aex 6f9Lt c•-t. Covered porch area (sq. ft.)
Cross street/Directions td job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: I Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
t( 141--200 overhead and profit for the work indicated on this application.
ge_6 - 0 ca•»,n + F 5 r . S % i�, Valuation $ / g 0 °
� Existing building area (sq. ft.)
b't 1; J'e-- -- . New building area (sq. ft.)
• Number of stories 1
PROPERTY OWNER I ❑ TENANT Type of construction
_ Name: p aca v� Occupancy group(s): Existing:
New:
Address: /30 6 6 rA 1° d4rZ 1-kJ 7
City/St /Zip 1 ,< ac', 97 "iJ
P one ) 3) 6K, -r70 Fax: l'_� • 6 Y.- /tt 7Z NOTICE: All contractors and subcontractors are required to be
APPLICANT ❑CONTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: �,8,., A) e- $' „9._ � > �C'L [.� �w�w'7`jurisdiction un where work is being performed. If the applicant is exempt
Contact Name: cc-3 6-Ieg4- 6, from licensing, the following reason applies:
Address:
City/State /Zip:
Phone: I Fax:
BUILDING PERMIT FEES* - •
E -mail: Please refer to fee schedule.'
CONTRACTOR
Business Name: lin AAJL 'S'a �'i V t v c • C / p %es due u a $
Address: K 1 cS.t.q C rrc S L) r
City /State /Zip: /Q:240 velSc,✓1 c-r- �-/ Amount received $
Phone(. F) 6 Y/ -rza2 Fax: CSD?, . . 3 -fc( 72. Date received:
CCB Lic. #: K_ 2 3 9 -9 -oil
Authorized G �J 7 'v� Notice: This permit application expires if a permit is not obtained within
Signature: t7 iii � DateeJ 180 days after it has been accepted as complete.
— t e-4- / 4 *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name) •
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03
Fire Protection Permit Check List
Describe work to be done:
A.) ❑ New B.) 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: Rem0 �'-' 0 (. STs-( — 14 h1 S' - -'7 ./„.
a &_30D Type of System (Complete A, B, C or D as applicable): -
A.) Commercial Sprinkler
Wet ❑ Dry ❑
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $ ) 'Zoi
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50
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): $ /p 7f) '="
Permit fee based on valuation (see attached chart): $
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $
FLS Plan Review 40% of Permit Fee: $
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 02/28/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 74175
INSPECTV Business Line: (503) 639 - 4171 MST
I[X
BuP 3 & X96
Received Date Requested E AM PM BUP
Location / 36 t' Suite MEC
Contact Person �4� Ph ( ) 6q1-87 PLM
Contractor lQJ Ph ( ) SWR
BUILDING Tenant/Owner ELC
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: 7" SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof `�' - y /
CHI • : l
a �'
! �
PART FAIL
• I 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 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Date Inspector �/ (� ector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL