Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00481
1I DEVELOPMENT I �r SERVICES � 639 -4171 DATE ISSUED: 11/8/02
SITE ADDRESS: 13005 SW ST JAMES LN PARCEL: 2S109A6 -07700
SUBDIVISION: RAVEN RIDGE ZONING: R -7
BLOCK: LOT: 006 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: R3 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: iPitigEgifk "04 DZ7a
Remarks: Stand alone fire suppression. Fees based on 4600 sf.
Owner: Contractor:
JAMES SHULTZ GABE PLUMBING CO.
22723 WEST PLUSS CT 4838 SE 111TH AVE.
WEST LINN, OR 97068 PORTLAND, OR 97226
Phone: 503 - 167 -9119
Phone: 503 - 167 -9119
Reg #: LIC 121158
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 11/8/02 $260.00 Sprinkler Final
[TAX] 8% State Tax 11/8/02 $20.80
Total $280.80
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 lase
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
r Fire Protection System /7 6.' drz_____
i y Building Permit Application
a Date received:lO -J3 -O — Permit no. (� 0- 1/ k i
� , j . • City o Ti gar d
__, �, Project/appl.no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, OR 97223
Phone: (503) 639 - 4171 Date issued: i Receipt no.:
Fax: (503) 598 -1960 OCT ' - 2017 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory O Commercial/industrial ❑ Multi- family O New construction ❑ Demolition
N ❑ Addition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: ! 300 5- S , yv`�S Bldg. no.: Suite no.:
Lot: #-,' 'Block: Subdivision: I Tax map /tax lot/account no.:
Project name: S' n- U 1 % - t - Z--
Description and location of work on premises/special conditions: D iLC iJG F! l2.- t
Vi < (J PPS._ c S sue►)
pp 0 FOR SPECIAL INFORMATION, USE CHECKLIST
V3 ` `
\
' Name: S 4 0 1 - 1 - - 7 _ _ _ 7 (Floodplain, septic capacity, solar, etc.)
Mailing address: I-3 0 () 5 5 pc/ S . c_9- -r 'C S 1 & 2 family dwelling:
City: State: ZI Valuation of work $
Phone: 'Fax: 1E-mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
3 Garage/carport area (sq. ft.)
A, Name: Covered porch area (sq. ft.)
Mailing address: Deck area (sq. ft.)
City: 'State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industriaUmulti- family:
CONTRACTOR Valuation of work $
U k 7)7 q C® Existing bldg. area (sq. ft.)
Business name: — ,e
Address: k•( 3 S S /� / / / '7 - h j9 � (�L� New bldg. area (sq. ft.) V'' (2(
Number of stories
City: Pte,. Fhit el I State: 0 /1 ZIP: Q' 7 26 - Type of construction
Phone: 7G / 9 I Fax: Se -e‘-% E -mail: Occupancy group(s): Existing:
CCB no.: f 2 l I Sd' 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: l 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: 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 compliecschetlfied herein or not. Credit card number: / /
Expires
Authorized signatur . .. -- . -- ate: (4/3 'L Name of cardholder as shown on credit card
Print name: �°r V3-t Y � u �J C3 � $
/ ` 1) Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been acqepted as core lete. 440-4613 (6/00/COM)
1 O
��av:I • 80
�I
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 $
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: $
FLS Plan Review 40% of Permit: $
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