Permit ' OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00004
� DEVELOPMENT SERVICES DATE ISSUED: 1/6/03
F`--' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 520 PARCEL: 1S126BC -01506
SUBDIVISION: ZONING: C -G
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: 2FR : 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: 4 VIM. aD
Remarks: Relocate (3) fire sprinkler heads.
Owner: Contractor:
PORTLAND OFFICE ASSOCIATES AFP SYSTEMS INC
BY TC PORTLAND, INC 19435 SW 129TH
8930 SW GEMINI DR TUALATIN, OR 97062
BEAVERTON, OR 97008
Phone:
Phone: FAX- 692 -1186
Reg #: MBT692- 9
FEES LIC REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 1/6/03 $62.50 Sprinkler Final
[TAX] 8% State Tax 1/6/03 $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 - O- thFcujgh OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
callin 03) 246- 6699 1- 800 - 332 -2344.
Iss d By: k i /
Pe rm it
Signature: /` " _ ��i� I _
Call 639 -4175 by 7 p.m. for an inspection the next business day
- I 'uilding Permit Application
e. ., Date received: / G D� Permit no.:4, »�
„,�y City of Tigard
.- I Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 - 4171 Date issued: By: Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
0 I & 2 family dwelling or accessory l U Multi- family U New construction ❑ Demolition
0 Addition /alteration/replacement -Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION
Job address: 9 9 s, U,). . yam• Bldg. no.: Suite no.:52
Lot: Block: Subdivision: I ' Tax map /tax lot/account no.:
Project name: 1 . i ii `_ .. ��
Description and location of work on premises/special conditions:
V '_�
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
(Flood plain, septic capacity, solar, etc.)
Mailing addres•t II S U • • • S r 00 • - aim y . • :•
Egzi'f+'•m State:OR ZIP: • '7 • Valuation of work
Phone: 29 0400 Fax: 221-1 ; E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage /carport area (sq. ft.)
•
EMIllia Covered porch area (sq. ft.)
Mailing address: II Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi- family: vo
CONTRACTOR Valuation of work $ 900,
Business name: *ir Existing bldg. area (sq. ft.) 90:000 /1...— New bldg. area (sq. ft.)
Address: • 3S S d 2- (�
State° a ZIP: 9 'L Number of stories
Type of construction
Phone: ( o _ L ' 4 Fax:1' - 2, -11 E10 E -mail:
Occupancy group(s): Existing:
CCB no.:
-1 New:
City /metro lic. no.: 34 S • Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: G S provisions of ORS 701 and may be required to be licensed in the
Address: `i 25 s • o . ■ jurisdiction where work is being performed. If the applicant is
1332 ► State:p ZIP: 97ap I exempt from licensing, the following reason applies:
Contact person: • . o-k.c. 5 , , Plan no.:
Phone: 241....,• ; Fax:14 , 0 9 N re E-mail:
ENGINEER
Name: ■ Contact person: Fees due upon application $
Address: 111111111111 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 complier with whether specified herein or not. Credit card number: Expires /
Authorized signature:
r • _ Date: I ' a - 03 Name of cardholder as shown on credit card
Print name: Si TZ ttv. r✓t= Cardholder signature $ Amount
Notice: This it application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/00/COM)
it
Fire Protection Permit Check List
A.) ❑ New ❑ Addition ' -Alteration ❑ Repair
B.) Modification to sprinkler heads only:
Describe work to 0 1 -10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required.
Number of sprinkler heads: S
Additional description of work: i o 3 dm—a_ )-
-cl
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet - Dry ❑
Standpipes
Additional Hazard Group
Information Density . i O
Design Area t 500
K. Factor 5. (0
Sprinkler Project Valuation: $ f pp u
B.) Type I. - Hood Fire Suppression System
N/A-- Hood Project Valuation $
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
inclu : Individual Component Yes ❑
N A_ 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
CITY OF TIGARD 24 -Hour
BUILDING - Inspection Line: (503) 639 -4175
INSPECTION DIVISION Busin Line: (503) 639 -4171 MST
BUP
Received Date Requested — 0 1 " 1 AM PM BUP Z Z - 600 La
Location / D ZD -S Suite 5 ZO ,, 0 2 - - 007"18
Contact Person Ph ( 7 No j- 3 ' 13 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
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 / A la ✓ Lv1. 0104_ / 7°°
Fire Sprinkler
Fire Alarm ( ' C/6 3 r2 c
Susp d Ceiling •
Roof
Other:
•
-
'ART FAIL
Post Beam /' •
Undder r 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 ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA l f 2 i `-v ?Inspector _ l
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL