Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00457
DEVELOPMENT SERVICES DATE ISSUED: 8/11/03
A-. II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15115 SW SEQUOIA PKWY 150 PARCEL: 2S112DA -00800
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
REISSUE: Q G, F LOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: r / 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: 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: $ 1,750.00
Remarks: fire protection
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 7/24/03 $62.50 Sprinkler Final
[TAX] 8% State Tax 7/24/03 $5.00
[FLS] FLS Pin Rv 7/24/03 $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: .6 ,/./-
Pe rm ittee
Signature: �` ,
Call 639 -4175 by 7 p.m. for an inspection the next business day
1;; $k/ .SEQUOIA P%.607
AO P 8" H - o3 13.s1S
., 4 6 ), Building Permit Application
, Datereceiv � Permitno uP D o . 3 --
ta A - C>t of T>< and
1 )1 ' .` �� ` J g RECEIVE projecdappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 JUL 2 4 2003 Date issued: BT-f) I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approval: BUILDING DIVISION l&2 family: Simple Complex:
TYPE OF PERMIT
O} & 2 family dwelling or accessory E' Commercial/industrial ❑ Multi- family ❑ New construction O Demolition
U'Addition/alteration/replacement VrTenant improvement ia sprinkler /alarm 0 Other.
JOB SITE INFORMATION
Job address: rj S S . _r • ' • a A Bldg. no.: Suite no.: ( &
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: . „,„. g _lb._ 1
Description and location of work on premises/special conditions: Lt.., • S - • ' , i e_ S
r: o _, . C)
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: • raw- US (Floodplain, septic capacity, solar, etc.)
Mailing address: 1' SO ) 5. _ I : • __ _ 4V-- 300 l & 2 family dwelling:
• �l _:. 12111=7:1 ZIP: • - 12Z Valuation of work $
Phon -t-, , ,t. • • IMFRSIM E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: ESIIIIII E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: 4 • �-rop Covered porch area (sq. ft.)
Mailing address: - ` T I t � , 5r . Deck area (sq. ft.)
CM r r ZIP: • -722,3 Other structure area (sq. ft.)
Phone( 6 , j ,► Faxip ►` _ E -mail: Commercial/industrial/multi-family:
CONTRACTOR
Valuation of work $ 11$0 °
Business name: T . . Existing bldg. area (sq. ft )
Address: _ ��, ■ New bldg. area (sq. ft.)
ddress: •
ZIP• ' ? ZZ2� Type of construction
Number of stories
Phon= - 'r .` I ►► .� !i. , E -mail:
Occupancy group(s): Existing:
CCB no.: . :it - New:
metro 1 no.: • iSIIIIIIIIIIIIIMIIIIM Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: *".3 .t`
■ p v �� provisions of ORS 701 and may be required to be licensed in the
Address: ___:0 :nubt A _ Nam jurisdiction where work is being performed. If the applicant is
ZIP. - . exempt from licensing, the following reason applies:
1133112M Arra Contact person: Plan no.:
Phon-_ , .y E- mail:—
ENGINEER
Name: Contact person: Fees due upon application $ q.Z.
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 cads, please call jurisdiction for more information
attached checklist. All provisions of laws and ordinances governing this O Visa O MasterCard
work will be complied ' , whetherr specified herein or not. /g Credit card numb pires
/
Authorized signature: 1 . l. L [4aak L 1e • 5 . te: 7�,1[ /0 Name of cardholder as shown on credit card
Print name: �f • (if '. >. bkE 7[ 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 (6100/COM)
Fire Protection Permit Check List
A.) ❑ New t (ddition 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:
low -{-e- I. D
Additional description of work:
Type .of =.System_';•(Complete "A,, B or..0 as applicable ):':.y
Al Sprinkler Wet ❑ Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: _ $ I-moo&
B.) Type I - Hood Fire Suppression System
Hood Project Valuation I $
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes LI
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A, B & C): $ 11 t)
Permit fee based on valuation (see chart): $ (02. SD
8% State Surcharge: $ 5 DV
FLS Plan Review 40% of Permit: $ 25. o
TOTAL: $ a 2—.50
i:\dsts\forms \FPSchecklist.doc 06/07/01
CITY OF TIGARD 24 -Hour
BUILDING 4. Inspection Line: (503) 639 -4175
INSPECTION Business Line: (503) 639-4 MST
1 3 00 ys7
• Received Date Requested - /3) AM PM BUP
Location f S/ / S SEC) o h ! ( /4-1/y Suite l5 fie, 3 - e905
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
SUILDI Tenant/Owner ELC
Foundation ELC
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
•
PART FAIL
PLUMBING
Post & Beam
Under Slab
Water he
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
FAIL
Pos -
Rough -In
Gas Line
Smoke Dampers
7')1a 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 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date �� 3/6 / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL