Permit CITY OF TIGARD
_ DEVELOPMENT SERVICES BUILDING PERMIT
PERMIT #: BUP2003 -00464
ibik SSUED: 7/30/03
1312 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15230 SW SEQUOIA PKWY 190 PARCEL: 2S112DA -00300
SUBDIVISION: ZONING: I -P
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: 5N : sf N: S: E: W:
OCCUPANCY GRP: M 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 : H NDICP ACC:
BEDRMS: ,, IMP SURFACE: PRO CORR: PARKING:
VALUE: 5 /b. 0 0
Remarks: Demo office sprinklers and add (2) new heads in new restrooms.
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 7/30/03 $62.50 Sprinkler Final
[TAX] 8% State Tax 7/30/03 • $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 -0010 hr-o.ugh OAR 952- 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
"
calling (5 246 -669 r 1- 800 - � 332 -2344.
Issued B 0 i i j, 4 44 , i s 4 A j- ,
I,
Perm ittee ,f
Signature:
/,'
Call 639 -4175 by 7 p.m. for an inspection the next business day
Fire Protection System
B uilt ing Application FOR OFFICE USE ONLY
Received � Building A n_ i 4.r
City A Permit No.: /WV 560 Q�
Cl d Planning Approval Other p /,
ty of Tigard
g Date/By: Permit No.: U PA — e 39
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 - 1960 " . 1"'Iditgilil- Post - Review Land Use
Internet: www.ci.ti ard.or.us C. Date/By: Case No.
g '' Contact his.: ® See Page 2 for
24 - hour Inspection Request: 503 639 - 4175 Name/Method: f /a , Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction ( emolition p "b., p tZ1C^ 7 . 1 & 2 FAMILY DWELLING
Pr Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling I Commercial/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: 6230 5E&( D1I pa )44/ Total number of floors
New dwelling area (sq. ft.)
Suite #: iaa I erd'Apt.#: 14 Garage /carport area (sq. ft.)
Project Name: (,J lmjel. 1 35, p It 5 / /!z__ Covered porch area (sq. ft.)
Cross street/Directions to 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,
D E14 0 O �� z n , i / , I N s 7 overhead and profit for the work indicated on this application.
/ugu✓ `6 ic��J �f/ /N Ai r e d of /�ri kris, Valuation $ 1.0c-5- ��TL7.� Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
PROPERT" OWNER I ❑ TENANT Type of construction
Name: // 4 C u Sr Occupancy group(s): Existing:
Address: / t 3 S7) 5 bd r I tow 0 /Q PKtoy. Q New:
City /State /Zip: feartg - ivh 00 1 7z2'
7 S NOTICE: All contractors and subcontractors are required to be
6
Phone: 7 F ax: licensed with the Oregon Construction Contractors Board under
K. APPLICANT ❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: f .E c)P CO jurisdiction where work is being performed. If the applicant is exempt
Contact Name: r i _ LGa✓ P�122.SB 1.1 from licensing, the following reason applies:
Address: 939L{ St,6 - ( ST •
City /State /Zip: 0 (L. 61-72-Z.. 3
Phone e,A1,2„614_� ax( ) 4c.Z3 cez. Iitl
BUILDING PERMIT FEES *.
E -mail: r— Please refer to fee schedule.
CONTRACTOR
Business Name: / B 10 Fees due upon application $ ( S D
Address: 9 � � fo D g l,,,
Cit /State /Zip: GAL , dX 97� Amount received $
Phone: bzo --6 I Fax: (20 -6/¢/ Date received:
CCB Lic. #: 4374
Authorized
Signature: ate: ���1 v Notice: This permit application expires if a permit is not obtained within
I 180 days after it has been accepted as complete.
YLtiC,F. . PEr e---5 *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03
1►
Fire Protection Permit Check List
Des cribe work to be done:
A.) ❑ New B.) Modification to sprinkler heads only:
a Addition ❑ 9 -10 heads: No plan review required.
U1 ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: A6 1> 2
�� c 0FFlG Sp2t n� Ll t:7L s
Additional description of work:
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: $ Sto-
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
C.) Fire Alarm
Submittal shall Battery Calculations Yes LI
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): $ 5l D
Permit fee based on valuation (see attached chart): $ (02.
Permit fee based on square footage (D) (see fees above): $ -e-
State Surcharge 8% of Permit Fee: $ co
FLS Plan Review 40% of Permit Fee: $
TOTAL: $ (0'2 -5D
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 - 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
CDN 076v3 - do V6,,/
Received Date Requested /2 Z Z ^v AM PM BUP
Location r SZ 3 S'F C) U i► Suit: / 9) MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
•
UILDING _ Tenant/Owner ELC
Footing
Foundation Access: ELC
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
PART FAIL
PLUMBING
- 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 El Please call for reinspection RE: El Unable to inspect no access
Fire Supply Line
ADA D / Z` Z • 2 / 4 inspector Ext
P
Other:
Final DO NOT REMOVE this inspection record from the.,ob site. -
PASS PART . FAIL