Permit � ' -' ® '.a r � l .. TT11 h{ � ' '' ,,,
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T i DEVELOPMENT SERVICE �'F_Rt`�I •�r_ .. n . , t 11:x` 7-- ,r,'�,1 6
1,� S �L I! 1 3125'SW' Hal! Blvd., Tigard, 0R 97223, •(503),639. 4171• • ' . '� • � ! T' I S ; ; '= : ai C / 1 ' " 7 .
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' OCCUPANCY ICY G(�F-'- g R 1, „ '�.O°6 AL- - -_ - _ e ' . ,': �{' • ''''ROOF COi'JST F':I'RE F_ - ''
0,CCU CAD'o ', 0 ' •:,.. BASEMENT".' fl - - 0 s.f , AREA SEP:e RATED Li , •
S T OR, - r .HT-:' 0 ,, ft. ' GARAGE, . , o '{• , { 0CCL! SEP; Rca� ED a -
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DWELLING UN I-TS €- 0 - ,'FRNT . ;'. ft REAR's` 0
f' FIR" LRM o Y H \D I CP' ., ACC t ,
'BED RWNSe' ,0 BATHS; 0 , ,IMP SURFACE; 0 ',_ ' PRO CORR; -PARKING ; .
'VALUE. .`$ ;, 145 `
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1 30 .. . {.-- H .S l,i{\I .. . - t - " -. "f"'l Rill l $ 1..1'0n Jr11 „JSD,. 0:, /. .4/ 9:? 97.7-29',1, 7;2
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F''I! a 1 L• tY 888-456-'-5.300 , .r. - :-0 160. i 2 TOTAL, _ 'i {, • 1 , '
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• :1 ' • -- , . REG:U.LRED. INSPECT1:.ONI ,-- --
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'r:!pprevEi plans.„ 'Thli5 Nc,.7,07 2i e:hp :ti ' .'�ilut, 'sfdl,'u
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Fire Protection Permit Application Plan Check # "? ` eo&c--
!TY OF TIGARD Commercial or Residential
�w..� C1+ / t:Jw _ I �_ , r_. 1(\4e Recd a
1 Bloat/ 517
'!GAR'D, OR 97223 Print or Type Date to P.E.
503) 639 -4171 Ext 304 Incomplete or illegible applications will not be ccepted Date to DST
Permit # Oa 11
L-. 15f g4_ ' Called 11. el CO
Name of OevelopmenUPro)ect . P
Job��� Type of System (Complete A or B as applicable)
Address Address \ A.) Sprinkler Wet p pry 0
1 ,Li �7 X50 I �ui c f l i t - Standpipes
Name
).Yl �.i ly t�.Sf Hazard Grou
Owner M ing Address p
?&D I l a c . k�� 1+ (7 1 Density
/State Zip I P hone Information ry
i GAI eVV r Yt 6>l� • 9a7a -- Design Area
Occupant Mailing Address K. Factor
City/State Zip Phone Sprinkler Project Valuation $
COT Business Tax or Metro # Exp. Date B.) Fire Alarm
Contractor Name Submittal Shall Include Battery Calculations YES 0
tel
10 �� l P�i� Individual Com on
(Sprinkler or Mailing Address p ent YES 0
Alarm a (O rem Cut Sheets
Company) City/State Zip P Fire Alarm Project Valuation $ s - z„,,,,, l figek
1/ ()C; `` L1A-A' V °1}�� U � .te _ . . - - - - - - .. -
Attac State onstCor Board Lic.# Exp. Dgte / Project Valuation Subtotal (A or B) $ 5 600 ill p
Current C T �Busin T or Metro # Exp Date ' Permit fee based on valuation $ I I g�
Licenses -— l2 j 3 G,/,317- (see chart on back)"
Name ! 5% Surcharge $ 2
Architect Mailing Address FLS Plan Review 40% of Subtotal $ .i)�
z i -) I, lo' Alicks ily _
;State Zi i5 Phone TOTAL $ c
Describe work A.) New ) a Addition 0 Alteration 0 Repair O PLANS MUST BE SUBMITTED. approved and a perm issued I to installation.
to be done: Three sets of plans and site plan (and vlcnity map) required whiff 4/3 W
f snows Iocalon of O /3
nearest hvdn
B.) Basement 0 HoodNent 0 Spray Booth 0 I hereny acknowledge Mat I have read this appiicanon. that the information given is
Complete 4 Partial 0 Exrtway 0 correct. that I am the owner or authorized agent of the owner, and that plans submitt
are in compliance with Oregon State laws.
Additional Description of Work:
Sig re of er/ nt Date
i RA d/27A7 ,
A.) In Existing Building ❑ New Building Con ct Pe o me fi Phone
Building At/ tie- 620 —OgGS
Data B.) Commercial ❑ Residential ID FOR OFFICE USE ONLY:
Plat # • MapITL#: -.
No. of stones:
Sq. Ft Notes
ao,„57V
Occupancy Class Type of Construction
s :stftresupr.doc
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CITY CF TTGARD ,
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TOTAL
PLAN STATE BUILDING
VALUATION PERMIT ELS REVIEW TAX PERMIT
CF. RO.. E C ;- FEE- S (40 %) (65 %) 5% FEES
1-1.500 25.00 10.00 16.25 .1.25 T 52.50
1.501-1.200 25.50 10.20 17.23 1.33 55.66
1.501 -1.700 23.00 11.20 18.20 1.40 x8.80
1.701 -1,800 29.50 11.30 19.18 1.48 61.96
1.801 -1,900 31.00 12.40 20.15 1.55 65.10
1.501 -7.300 • 32.50 13.00 21.13 1.63 68.26
2.001 -3,000 38.50 15.40 25.03 1.93 80.86
3,001 -4,000 44.50 17.80 28.93 2.23 93.46
4,001 -5.000 50.50 20.20 32.83 2.53 106.06
5,C01 -6,000 56.50 22.50 36.73 2.33 418.66
6,001-7.000 62.50 25.00 40.53 3.13 131.26
7,001 -3,000 68.50 27.40 44.53 3.43 143.36 -_ ..
8,001 -9,000 74.50 29.30 48.43 3.73 1566.46
9,001 - 10,000 80.50 32.20 52.33 4.03 169.06
• 10,001 - 11,000 86.50 34.50 56.23 4.33 181.66
11 .001-12,000 92.50 37.00 60.13 4.63 194.26
12.001= 13,000 98.50 39.40 64.03 4.93 206.86
13.001- 14,000 104.50 41.30 67.93 523 219.46
14.001- 15,000 110.50 44.20 71.83 5.53 232.06
15,001- 16,000 116.50 46. 20 75.73 5.23 244.56
16.0C1- 17,000 1 49.00 79.63 6.13 25S "6
17.001- 18,000 123.50 51.40 83.53 6.43 259.36
13,001 - 19,000 124.50 53.30 87.43 6.73 282.46
19,001- 20,000 140.50 56.20 91.33 7.03 295.06
0,001- 21,000 146.50 53.50 95.23 7.33 307.66
2 1,001 -22.000 152.50 51.00 5 7.53 320.25
22.001- 23.000 1.::::-...50 53. 103.03 7.93
332.36
23.001 - 74 164.50 25.30 106.93 8.23 g.46
.
2 - 25.000 170. =0 63.20 110.83 8.53 353.06
5 .001 - 23.000 175.00 70.00 113.75 8.75 367.50
1 .001- 27.000 175.50 71.30 1155.58 3.9.3
.:io'. S 6
27,001-73.000 13 73.50 119.50 9.20 386.40
/3.001-/c1,000 183 75. 122.62 9.43 395.85
2 9,001- 30.000 1".00 77.20 125.45 9.65 405.30
30,001-31,000 197.50 79.00 128.38 9.38 414.73
31,001- 32,000 202.00 80.30 131.30 10.10 424.20
=0 82. 20 • 134.23 10./3
33,001- 34,000 711.00 84.40 137.15 10.55 443.10
r 2 : .
= 50 86.20 1 40.03 107 3 4 -
..',.,Q1- .: 0,1...17 215.50 140.03 .^t.:'S