Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00586
���,& DEVELOPMENT SERVICES DATE ISSUED: 9/25/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S126C0 -01107
SITE ADDRESS: 09616 SW WASHINGTON SQUARE RD G -4
SUBDIVISION: WASHINGTON SQUARE 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: : 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 : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 600.00
Remarks: Adding (2) new sprinkler heads to existing tenant space.
Owner: Contractor:
PPR WASHINGTON SQUARE LLC WYATT FIRE PROTECTION INC.
BY THE MACERICH COMPANY 9095 SW BURNHAM
9585 SW WASHINGTON SQ. RD. TIGARD, OR 97223
PORTLAND, OR 97223
Phone:
Phone: 684 -2928
Reg #: LIC 64077
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 9/25/03 $62.50 Sprinkler Final
[TAX] 8% State Tax 9/25/03 $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 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: ;,fit./ 444
Pe rm ittee , l i
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
Firrotection System
- Bnildi> g Permit Application FOR OFFICE USE ONLY
Received Q QQ,J Building 0 n "_ Q �
Date/By: 0`7 Q Permit No.:e IiWJ '� "1,
City of Tigard Planning Approval Other
Date/By: Permit No .
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 / v } '1 I (
A Post - Review Land Use
� - Date/By: Case No.
Internet: www.ci.tigard.or.us "' Contact Ju See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: 0 Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
❑ 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 ❑ 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: 96" ' r4 •O r. lf11Y1 an S2 . Total number of floors
JJ `"TJ New dwelling area (sq. ft.)
Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: Sorvv vi Sil\feN Covered porch area (sq. ft.)
Cross street/Directions to job siteJ 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,
overhead and profit for the work indicated on this application.
A00 - M) N A-0,5 Co_ OBA) \t1 Ar1A-
Valuation $ (000.00
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stones
❑ PROPERTY OWNER ❑ TENANT Type of construction
Name: Occupancy group(s): Existing:
New:
Address:
City /State /Zip:
Phone: Fax: NOTICE: All contractors and subcontractors are required to be
El APPLICANT ❑ CONTACT PERSON licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip:
Phone: Fax:
BUILDING PERMIT FEES*
E-mail: Please refer to fee schedule.
CONTRACTOR
Business Name.: W #, Fir - pm-Yea-ion , X\C • Fees due upon application $
Address: ot (A �''s)I.1. 'IbwwOna xvt-.
City /State /Zip: -ci p ica/ OR_ a -( 22- Amount received $
Phone: 1pS 4 • ?,012S Fax: (0'b4 • G1(o S Date received:
CCB Lic. #: ( ,401 -- (
Authorized q Notice: This permit application expires if a permit is not obtained within
Signature: Date: !� / 03 180 days after it has been accepted as complete.
C141\ 90 kg---- Y---- *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03
• k.. •
Fire Protection Permit Check List
- Describe work to be done:
A.) ❑ New B.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
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: $ 4030 .00
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: $
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): $ ( 3O ,00
Permit fee based on valuation (see attached chart): $ (02-W
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $ S .00 t 7.5-0
FLS Plan Review 40% of Permit Fee: $' •
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 02/28/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 639 -4175
INSPECTION DIVISION Business Line: ( 639 =4171 MST
BUP 3 "60S`0
Received / Date Requested (— 3 AM PM BUP
Location 96 • SQ el) Suite G MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner _i .4.4 _` 'i 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
ire Sprinkler
Fire Alarm
Susp'd C g -�C.
Roof
Other: " /
-
4i0 •A'• S *ART FAIL (I
P ING 1 1
Post & Beam
Under Slab •
Rough -In )1,j
Water Service J'
Sanitary Sewer
Rain Drains 9.
Catch Basin / Manhole V
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 k(7 3
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL