Permit BUILDING PERMIT
CITY OF TIGARD
PERMIT #: BUP2004 -00125
IP DEVELOPMENT SERVICES DATE ISSUED: 4/5/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S12600 - 00300
SITE ADDRESS: 09644 SW WASHINGTON SQUARE RD G -13
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: 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 : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,000.00
Remarks: Fire sprinkler TI, 18 heads.
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 -
[BUILD] Permit Fee 3/17/04 $62.50 Sprinkler Final
[TAX] 8% State Surcharl 3/17/04 $5.00
[FLS] FLS Pln Rv 3/17/04 $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 (5e _ _ . _- •9 or 1- 800 - 332 -2344.
__.'
Issue • By: 1 . _ IMINIIIL 1 1 b 1 I f
Pe rm ittee .
Signature: Y -/ ��
/� Call 639 -4175 by 7 p.m. for an inspection the next business day
dt i ir e Protec System
QI «/va .
Mu111 In Perm>< 4. ion FOR OFFICE USE ONLY
Received Building Ariji, Err
Date/B : a ® � Permit No.. % — 10/e9 4 .
City of Tigard
Plannin g A pp rove Other
Date/B 13125 SW Hall Blvd. MAR 1 7 2004, Plan Review ` Other
Tigard, Oregon 97223 Date/B : . ".> Permit No.:
-0 Permit No.:
Phone: 503 639 - 4171 Y5 5�I: a I 444 I ■ . Post - Review Land Use
.I I � Date/B : Case No.
Internet: www.ci.tigardBlJt4� • N DING ® ' ° Contact 0 See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: • `.- Su, lemental Information
TYPE OF WORK REQUIREDDATA: .
❑ 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 INFqRMATION and LOCATION _ . No. of bedrooms: No. of baths:
Job site address: Ci (P 14 \`Wlt7 ul N orotJ SQ . D Total number of floors
New dwelling area (sq. ft.)
Suite #: I Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name: FAR, t _ r $$ Golkeeri;21e- 5 Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
. • - ,• , REQUIRED DATA: , -
:nCOMMERCIAI - USE CHECKLIST ; .
Subdivision: 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.
Valuation $
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
❑ PROPERTY OWNER I ❑ TENANT , 5. . .. . : ;, - Type of construction
Occupancy group(s): Existing:
Name: New:
Address: •
City /State /Zip:
NOTICE: All contractors and subcontractors are required to be
Phone: Fax: licensed with the Oregon Construction Contractors Board under
❑ APPLICANT . ❑ CONTACT PERSON • ° ' provisions of ORS 701 and may be required to be licensed in the
Business Name: Sqe Gi NtruotoP ') 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: r �,.,. t c<<,
�l °'''`` G` ERMIT ES* " -
. CONTRACTOR
E- mail:
.. xF:�; ' v ...,B�D�? L � -.. � _ :; - : .
4-ii �'S : t- . •,i' lease'referto fee,scbedule.
T .
Business Name: \N'(tntk- N,Y& V YD c - h ()hI Fees due upon application $
Address: Ct 0417 .$\N1 PA ?y WIrla IA
City /State /Zip: Tt g , o 1114-5 Amount received $
Phone: (c, j vg4- • X43 Fax: 503 ` 1pg4 . A t451 Date received:
CCB Lic. #: t94o1
Authorized
Signature: ..� /�� Date : Notice: This permit application expires if a permit is not obtained within
/��� �i, �� 180 days after it has been accepted as complete.
ieCt -i47, [� / `�Ck'� irc____ *Fee methodology set by Trl- County Building Industry Service Board.
(Please print name)
i \Dsts \Permit Forms\BldgPermitApp.doc 01/03
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.
id Alteration 11 11+ heads: Plan review required.
❑ Repair C
Number of sprinkler heads: 12,
Additional description of work: lop Awe
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler d Wet Dry ❑
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
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): $1,10pp o'
Permit fee based on valuation (see attached chart): $ (02. c�
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $ 5 . oO
FLS Plan Review 40% of Permit Fee: $ °"
TOTAL: $ Qti.S
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