Permit CITY OF TIGARD PERMIT
PERMIT #: BUP2003 -00348
�, #� DEVELOPMENT SERVICES DATE ISSUED: 6/11/03
'` , 'I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 06650 SW REDWOOD LN 150 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 • ZONING: I -P
BLOCK: LOT: 002 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: $ 350:00
Remarks: Relocate (3) sprinkler heads and add (1).
Owner: Contractor:
PACIFIC REALTY ASSOCIATES FIRESTOP CO
15350 SW SEQUOIA PKWY #300 -WMI 9384 SW TIGARD ST
PORTLAND, OR 97224 TIGARD, OR 97223
Phone:
Phone: 620 -6140
Reg #: LIC 63846
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee . 6/11/03 $62.50 Sprinkler Final
[TAX] 8% State Tax 6/11/03 • $5.00
Total $67.50
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
952-001-01 : _ • • h OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling • 03) 246 -669 • • r 1- 800 - 332 -2344.
444_,64."
Pe rm ittee r
Signature: API, .1 ; ,,ai,.iy1/ ,c'? e _ J
I,
Call . 9-4175 by 7 p.m. for an inspection the next business day
. .
Building Permit
� � , _ Date received: /d 0 Permit no.: , 5-4,5 (
1j �-� j C o f T
? Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 - 4171 Date issued: By: I Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
�� TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory t>tl'S:.ommercial/industrial ❑ Multi- family ❑ New construction 0 Demolition
G 'Addition/alteration/replacement Tenant improvement t 'Fire sprinkler /alarm 0 Other.
JOB SITE INFORMATION
Job address: , , • 5 _ l2 - -a _ pp to _ a -- Bldg. no.: j , Suite no.: ( q o
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: 1 Ag D • L •
Description and location of work on premises/special conditions: A (1 el_ k spe- Z.v1_k_1.22 • • as'
)'Le l oc[) -'I-t_
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: VAC, , c r" ( Floodplain ,septiccapacity,solar,ctc.)
Mailing address: I 'SO - i . it A f , 1 `il 3OO 1 & 2 family dwelling:
City: O • ._ _i_. State: t LQ�.T/7MM Valuation of work $
Phon ;: -∎- ,2, - ,,,,,,• IMMINIMI E -mail: No. of bedrooms/baths
Owners representative: Total number of floors
Phone: 201.1 E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Covered porch area (sq. ft.)
Mailing address: • N1, . • CL.' . S . Deck area (sq. ft.)
City: I - , a t? ZIP - ZZ Other structure area (sq. ft.)
Phon 503, _A _ BIM Jh1 flI E -mail: — Commercial/indasMaUmalti- family: •
CONTRACTOR Valuation of work $ 3S0 .00
Business name: Existing bldg. area (sq. ft.)
�� New bldg. area (sq. ft.)
Address: e• S S C T% 0 - -
4 � N um b er o stor
r_ �� � � L '(I' 4 Type of construction
Phone: . Fax' , _3 b E -mail:
CCB no.: _ � _ Occupancy group(s): Existing:
New:
Ci , no.: - 7 Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
• ��� V jurisdiction where work is being performed. If the applicant is
Address: S - • b1 • - �&
Essis ,....1.64_, exempt from licensing, the following reason applies:
• te: Q ! ZIP: - Z
Contact person: Plan no.:
Phone �ir'� ,1.., . 1'� Fax: (0 - 1 E -mail: -
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: 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 ❑ MasterCard
work will be complied . 'th, whethe..,, - cified herein or not. Credit card number: / /
/D 6- � Expires
Authorized signature��/�L, ,� L i!J� � y ' = � te. W Name of cardholder as shown on credit card
Print name: T /�''`s1'J��0 626 Cardholder signature $ Amount
my
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 l 'Addition li 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: .A c& l 12 -lX�k LlL2 -V�
Additional description of work:
°Type _of S:yste.m: (Complete :A; B or: C;as
A.) Sprinkler Wet ❑ Dry ❑
•
Standpipes
•
Additional Hazard Group
Information Density
Design Area
_ K. Factor
Sprinkler Project Valuation: _ $ 350. DO
B.) Type I - Hood Fire Suppression System
Hood Project Valuation I $
•
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
•
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A, B & C): $ 3 O cb
Permit fee based on valuation (see chart): $ to2. - Sc'
8% State Surcharge: $ 5 -0C>
FLS Plan Review 40% of Permit: $ --�
TOTAL: -$ (01, 50
i:\dsts \fomu\FPScheddist.doc 06/07/01 •