Permit BUILDING PERMIT
• CITY OF TIGARD
PERMIT #: BUP2000 -00011
4 DEVELOPMENT SERVICES DATE ISSUED: 01/13/2000
.,� I I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11955 SW TREEVIEW CT PARCEL: 2S11066 -06600
SUBDIVISION: REDWOOD VISTA ZONING: R -4.5
BLOCK: LOT: 008 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: 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: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 3,025.00
Remarks: Fire suppression system
Owner: Contractor:
JT ROTH CONSTRUCTION GRINNELL FIRE PROTECTION
12600 SW 72ND AVE GRINNELL CORP
TIGARD, OR 97223 5921 N MARINE DR
Phone: P 0 P hone NRRuN203 ORIGINAL
Reg #: LIC 000632
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough -In
PRMT BON 01/11/200C $68.50 00- 320996 Sprinkler Final
5PCT BON 01/11/200C $5.48 00- 320996
FIRE BON 01/11/200C $27.40 00- 320996
Total $101.38
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 -1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246 -1987.
Permitee p v
Signature:
Issued By:
Call 639 -4175 by 7 p.m. for an inspection the next business day
V Fire Protection Permit Application (� 1 I
Plan Check
CITY OF TIGARD Commercial or Residential Rec'd By
13125 SW HALL BLVD. Date Rec'd /- 7-OO
TIGARD, OR 97223 Print or Type Date to P.E. 1 CYO
(503) 6394171, x. 304 Incomplete or illegible applications will not be accepted Date to DST 1 / / -0 40!9
Permit # 1 - 'CL?'( I
Called 'J i 3 - P _ 4 '
/Co �.6'
Job Na e of Development/Projec , :__� Type of System (Complete A or B as applicable)
' ;1L1C: i �'
Address Address - A.) Sprinkler Wet liji Dry ❑
Name n Standpipes
- @0 LTY 1
Mailing Hazard Group
Owner Iglebo 1.9 u Additional t3 I)
Ci /State Zip Phone Information Density
t�tR 0 - 97g9-5 I63q - aLP 59
Name Design Area
"1.SP I4-ecj
Occupant Mailing Address K. Factor
• City /State Zip I Phone A.1) Sprinkler Project Valuation $ 3 ��
Contractor Name B.) Fire Alarm U(ii-
., (Sprinkler or 6 ✓►p. I i F; re
Alarm Company) Mailing Address Submittal Shall Include Battery Calculations YES ❑
Prior to permit
S9a. -/ 10 it,tar ,n ii, r. Individual Component YES ID issuance, a City/State Zip Phone t' So3) Cut Sheets
• • copy
of all licenses I P , , _ , , 0 f - , ., - Ai - - o % O B.1) Fire Alarm Project Valuation $
are required if State Cons . ont. Board Lic.# Exp. Date A J
• expired in COT 3 -lit-- GO 6° Project Valuation Subtotal (A & or B) $ --1 U �, s
database 3 -� s
Name Permit fee based on valuation $
(see chart on back) G'8%.5
a
Architect Mailing Address 8% Surcharge $
S,
City/State Zip Phone FLS Plan Review 40% of Permit $
Describe work A.) New &' Addition 0 Alteration 0 Repair 0 TOTAL $
to be done: 141.32
B.) Modification to sprinkler heads only: Plans required: Submit three sets of plans, including a vicinity map and
1. 1 -10 heads= No-plans required
2. 11 += Plan review required the location of the nearest hydrant.
I hereby acknowledge that I have read this application, that the information given Is
Number of sprinkler heads:
correct, that I am the owner or authorized agent of the owner, and that plans submitted
P are in compliance with Oregon State laws.
Additional Description of Work:
Re 5:1..t+ ,, 13 ID Sy $ Signat a of L!.d_I gent . Date
A.) In Existing Building ❑ New Building ❑ G
Building Contact Person Name Phone -
Data B.) Commercial ❑ Residential ❑ S � _ _ . G
FOR OF ICE USE ONLY:
Plat•# - - - Map/TL #: • . . . _.... 1
No. of stories:
Sq. Ft: , 3
3 7 -
Notes
" T 1
Occupancy Class Type of Construction ;
is \dsts \forms \firesupr.doc 10/14/99 - -
I
07/12/2000 Activities for Case #: BUP2000 -00011
8:19:34 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BUPA005 Application received 01/07/2000 DRA RECD No Hold BON 01/11/2000
BUPA010 Permit created 01/11/2000 BON DONE No Hold BON 01/11/2000
BUPA020 Check for parcel restrictions 01/11/2000 BON DONE No Hold BON 01/11/2000 NA .
BUPA030 Plans routed to Plans Examiner 01/11/2000 BON DONE No Hold BON 01/11/2000
BUPA045 Plans checked /approved by PE 01/11/2000 RDP DONE No Hold RDP 01/11/2000
BUPA050 Approved plans routed to DSTs 01/11/2000 RDP DONE No Hold RDP 01/11/2000
BUPA762 Sprinkler Rough -In 01/21/2000 RB PASS No Hold RB 01/21/2000 Hydro Static Test- 210# @
0940 -1150- OK
BUPA763 Sprinkler Final 06/01/2000 KBS PASS No Hold AKJ 06/04/2000 attached backflow test report
BUPA055 DST post - review completed 01/13/2000 KJP DONE No Hold KJP 01/13/2000
BUPA075 Ready to issue 01/13/2000 KJP DONE No Hold KJP 01/13/2000
BUPA085 (F) Issue building permit 01/13/2000 KJP DONE No Hold KJP 01/13/2000
BUPA762 Sprinkler Rough -In 01/21/2000 RB PART No Hold RB 01/21/2000 1. Provide test port plugs for
double check.
2. Protect main riser from
freeze- left brochure on site.
3. Protect all fire line w /in attic
from freeze- left brochure on
site.
BUPA950 Case Finaled 06/04/2000 AKJ DONE No Hold AKJ 06/04/2000
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/
(kes=r) U �t opt I
Date V l te Requested Y 0 V AM PM BLD
Location ( 1 2 ire.O Suite MEC
Contact Person e .Q� Ph PLM
Contractor Ph SWR
firidab Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear �, �J
Ina Sheath /Shear i v ON ,
, ' - ; � Z ) ,� /� /'1 f Framing �/ � � I ->� �J` 1 ` (,J _/
Insulation I �1
Drywall Nailing 1 � i1► 6
Firewall
i re Sprink a A / go
Fire Ararm l ,, q,, _
Susp'd Ceiling C�-''J� . U" �I�C/
Roof 40 •
Misc:
Final ,
PASS • FAIL e—, , - -..hibm■ •
PLUMBI
Post & Beam ' l
Under Slab C —z • (IJ
Top Out
Water Service / ( �
Sanitary Sewer D �
Rain Drains e � f- 4 1A •
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
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk 1
Other
Date /2 a I) Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site
` — 1 2'1
sup Z000 - cool t
®
PN WS -AW WA BACKFLOW ASSEMBLY TESTREPORT ❑ REMOVED
PROPERTY 1 / ` ❑ REPLACEMENT
OWNER: ---..--7 j4j. f `< 6-,,A �`` • PHONE:
MAILING i ADDRESS: 12- 00 5 V 7 Z N /4 ve V 7 ' Z ° n
CITY -5 YG ✓ 4 STATE t2 /' ZIP y7-70-5
ASSEMBLY _ _
ADDRESS: // r S (, L" /v - 0 - e r,,✓ r (L '
STREET '
❑ R.P.B.A. 6 D.C.V.A. ❑ R.P.D.A. ❑ D..0 ?.A ❑ P.V.B.A. ❑ S.V.B.A. ❑ A.V.B. ❑ AIR GAP
SIZE: I I (I•I (1 l`'1 n MAKE: «�n 4J MODEL: / 2 . - AV , -- ; -
WATER SERIAL
PURVEYOR: / ," NUMBER: / ~ 0r -'
ASSEMBLY �
LOCATION: `2 .P y ) e C L<
REDUCED PRESSURE ASSEMBLY P.V.B.A. / S.V.B.A. INITIAL TEST
NI CHECK ( DOUBLE CHECK AIR CHECK PASSED to
PRESS DROP (A l CHECK #1 a OPENED AT: PRESS DROP INLET FAILED ❑
INITIAL RELIEF VALVE IA I
TEST OPENED AT ( B �) TIGHT / DATE:
RESULTS BUFFER MIN 2 PSID ,LEAKED ❑ PS1U / '<' / / (---Y
A - B = I CHECK #2 PSID PSID
MIN PSI
RELIEF VALVE 5.- DID NOT FAILED SYSTEM
E ,TIGHT ,'�]�
PASS ❑ FAIL ❑ 'LEAKED PSID OPEN ❑ ❑ PSI
COMMENTS
REPAIRS
AND /OR ,
PARTS
REDUCED PRESSURE ASSEMBLY P. V.B.A. /S.V.B.A. AFTER REPAIRS
RI CHECK D,C,V,A.
PRESS DROP (A) DATE:
TEST RELIEF (CHECK #1 OPENED AT PRESS DROP
AFTER OPENED (B) TIGHT ❑ PSID / /
REPAIRS BUFFER ' , CHECK #2
A - B - .m,,.a ITIGHT ❑ PSID PSID PSID PASSED ❑
IN COMPLETING AND SUBMITTING THIS TEST REPORT, THE TESTER CERTIFIES THAT THE
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
RULES AND REGULATIONS OF THE WATER SYSTEM, AND STATE REGULATIONS.
GAUGE CALIBRATIO DATE - DETECTOR METER READING
TESTER SIGNATURE \ #2709 9E T
TESTERS NAI I®tlJtl GAUGE M
TES ACI { N. Marine Dr. Portland, OR 97203 503 -2Rq -9080 PHONE M
COMPANY nfl neli Fire ProtectiollG A • •( 1, /
vu t. ca RESTORED
REPORT RECEIVED BY (REPRESENTATIVE OF OWNER)
CITY OF TIGARD BUILDING INSPEC TO* DIVISION `'
24 -Hour Inspection Line: 639 -4175 Business Line: 639 - 4171
BUP
Date Requested (0/1/0 AM PM BLD
Location i 19 — TI n 2P,) i T,c) Suite MEC
Contact Person a .d ,a, Ph 20.9- 0 S PLM
Contractor Ph SWR
DING Tenant/Owner ELC
e aining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing 1 60 SSE ArrtAct -16- 0/ KG2oc.r
Insulation
Drywall Nailing
Firewall
(F ire Sprinkle
ire Alarm
Susp'd Ceiling
Roof
■i
ina
SS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date to — / Inspector Ext
Final
PASS PART FAIL DO NOT FEMOVE this inspection record from the job sate.