Permit .,
ih,' CITY OF TIGARD PERMIT
PERMIT #: BUP2003 -00530
�� �; � DEVELOPMENT SERVICES DATE ISSUED: 9/10/03
13125 SW Ha Blvd., Tigard, OR 17223 (503) 639 -4171 PARCEL: 2S102CC -00500
SITE ADDRESS: 13500 SW PACIFIC HWY 17 OLD CNTRY BUF
SUBDIVISION: 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: 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: $ 4,245.00
Remarks: Sprinkler modification.
Owner: Contractor:
OCB RESTAURANT CO. FIRE SYSTEMS WEST INC
1460 BUFFET WAY 600 SE MARITIME AVE #300
EAGAN, MN 55121 VANCOUVER, WA 98661
Phone: 651 - 365 -2142
Phone: 360 - 693 -9906
Reg #: LIC 49732
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 9/10/03 $91.30 Sprinkler Final
rm
[TAX] 8% State Tax 9/10/03 $7.30
[FLS] FLS Pln Rv 9/10/03 $36.52
Total $135.12
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: '
Pe mi ittee
Signature: x 1 •
/ Call 639 -4175 7 p. for an inspection the next business day
r -. Fire Protection System P -a.o s
Building Permit Application
Date received p p 3 Permit no
b, City of Tigard ii.
aop -ads 30
j
Address: 13125 SW Hall Blvd, Tigard, OR 976/,•3 Project/appl. no.: Expire date:
City of Tigard Phone: (503) 639 -4171 „rj Bj �j Date issued: I Receipt no.:
Fax: (503) 598 -1960 ?IV' Case file no.: Payment type:
Land use approval: l &2 family: Simple Complex:
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory O Commercial/industrial O Multi - family O New construction O Demolition
O Addition/alteration /replacement Tenant improvement Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: 1 —4.0 -- P (-{t -+ isiwy Bldg. no.: Suite no.:
Lot: Block: Subdivision: _ %• Ky.-4 �a� Tax map /tax lot/account no.:
Project name: - 1 - 0141 T'
Description and location of work on premises/special conditions: ? 4 C- 4iu.AmI - p_P
41451/6T5194. X41 Selo CCU
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: Pm 11,X., (Floodplain, Sept is capacity, solar, etc.)
Mailing address: 1 f b 0 F,u'.T WW
City: 1& 2 family dwelling:
, (A
Phone: 451 - I State: MN ZIP: tj5 Z' Valuation of work $
' 4 -- �I Fax: �E mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: Email: 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: Commerciallindustriallmulti- family: CO
CONTRACTOR Valuation of work $ 4'2
Existing bldg. area (sq. ft.)
Business name: r 4 r 'T 7 » a a,,�C�T' (NI— New bldg. area (sq. ft.)
Address: WO �A M Ave
'`t� Number of stories
City: z ., fAU =,' G State. i ZIP: ' 't , Type of construction
Phone:%0•0;1?O Fax :267,.2.70b E -mail:
CCB no.: Occupancy group(s): Ex
New:
City /metro lic. no.: 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: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: .. Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application • $
Address: Date received:
City: State: ZIP: Amount received $
Phone: I Fax: 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 laws and ordinances governing this 0 Visa 0 MasterCard
work will be complie er specified herein or not. ,,gi�pp Credit card number: - en ; s
P
Authorized signature: • Date: v7 / d�O3 Name of cardholder as shown on credit card
Print name: IDNV' 0 1 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 (MXVCOM)
j
Fire Protection Permit Check List
A.) ❑ New ❑ Addition Alteration ❑ Repair
B.) Modification to sprinkler hea s only:
Describe work to 1. 1 -10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required.
Number of sprinkler heads: (p (�S\A/ 2S egL C9�'
Additional description of work:
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet A Dry ❑
•
Standpipes
Additional Hazard Group 14Al Tr
Information Density (7--20
Design Area ISCOrj
K. Factor - (o
Sprinkler Project Valuation: $ ifa
B.) Type I - Hood Fire Suppression System 1c
Hood Project Valuation 1 $
C.) Fire Alarm N/A
Submittal shall Battery Calculations Yes LI
include: Individual Component Yes Li
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A, B & C): $ 1-21""°
Permit fee based on valuation (see chart): $ q� •
8% State Surcharge: $ - 2,0
FLS Plan Review 40% of Permit: $ '. (o .
TOTAL: $ J 5. ii
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
Bu -2003- 0037
Received Date R nested 9/3/'b AM PM 3- 0053 0
Location /35 fah`df L. / / Suite MEC
Contact Person Ph ( ) PLM
Contractor /14/4‘e----‘45 w Ph ( ) SWR
BUIL G Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
S PART FAIL
P 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA 7103 Inspector Ins Ext
Approach/Sidewalk Date r p
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL