Permit (130) A CITY F TIGARD BUILDING PERMIT
PERMIT #: BUP2002 -00480
X0 ,4, DEVELOPMENT SERVICES D ATE ISSUED: 11/12/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S1156A -00101
SITE ADDRESS: 16200 SW PACIFIC HWY X
SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G
BLOCK: LOT: 001 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: 0.00 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: $ 4,464.00
Remarks: Install a dry pipe system under canopy area
Owner: Contractor:
HARSCH INVESTMENT CORP FIRE SYSTEMS WEST INC
1121 SW SALMON 600 SE MARITIME AVE #300
PORTLAND, OR 97205 VANCOUVER, WA 98661
Phone: 503 - 973 -0248
360 - 693 -9906 Phone: 360- 693 -9906
Reg #: LIC 49732
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler inspection
[TAX] 8% State Tax 10/30/02 $7.30 Sprinkler Rough -In
[BUILD] Permit Fee 10/30/02 $91.30 Sprinkler Final
[FLS] FLS Pln Rv 10/30/02 $36.52
Total $135.12
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 y: L . r ,s .a ' a te /� �' _ 1
Permittee
Signature: , Xl Q c , $ � 1I , (l . to---"--
Call 639 -4175 by 7 p.m. for an inspection the next business day
ir Fire Protection System ll 6 t2__.
A ..-.
Building Permit Application
..417,1_:'11-411' Datereceived: jb %O . )-- Permit no.:i P ✓Da-06W 'i
City of Tigard
Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard. OR. 97223
Phone: (503) 639 -4171 - - r ••- -'z . Date issued: :� Receipt no.:
Fax: (503) 598 -1960 ' Ali/ 1e a w
Case file no.:. Payment type: 1
Land use approval: OCT 3 '• <r�'7 l &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory >3r Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition
Addition/alteration /replacement ❑ Tenant improvement Fire sprinkler /> ❑ Other:
• JOB SITE INFORMATION
Job address: I f.2 O Sri - IC- N tom' Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: t#i A•�51401,....
Description and location of work on premises/special conditions: I'V S - TS-t- N t6•1 13 S YSTW' t FOB
NIA mkt+ 1?-..,oF noteN1 0 t).
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST -,
Name: Sp, 'plc p.J r (Floodplain, septic capacity, solar, etc.)
M. 1 : • r r • " pp . 2.- AIMIMIIMIM 1 & 2 family dwelling: .
City: la -sn.d, -1 • State:0L ZIP: `1")2o Valuation of work $
Phone, ' 7 . -=12 - E -mail: No. of bedrooms/baths
Owner's representative: g _ Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Covered porch area (sq. ft.)
Name: '�I t S'r'S?Z'I''15 t�tSyT Deck area (sq. ft.)
Mailing address: _ . v So l- �tT1 Ni r Avg j�
3
I %M _ _ __ a I ZIP: - 4,g Other structure area (sq. ft.)
F ax: E- mail: Commercial/industrlaUmulti- family:
Phone3L� - r�q - �9�L
CONTRACTOR Valuation of work $ 4,464,=
Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.)
Address: Number of stories
City: State: ZIP:
Type of construction
Phone: Fax: E -mail:
CCB no. c} 7 2 Occupancy group(s): Existing: tjS b
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
• ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 5 lb ern N A NA --10 J - provisions of ORS 701 and may be required to be licensed in the
Address: •• Sc u I -h I ��r • 2-(_..? jurisdiction where work is being performed. If the applicant is
r = - State:De_ ZIP: 00 e exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phoned AMR! Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application • $
Address: 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 o Visa 0 MasterCard
work will be complied with, whether specified herein or not. Credit card number: / /
Expires
Authorized sign. • . , Date: /6'1-4- V Name of cardholder as shown on credit card
Print nam .. fMQ%.... Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -46l3 (6 )OICOM)
M Ct
lie
Fire Protection Permit Check List
A.) ❑ New Addition ❑ Alteration ❑ Repair
B.) Modification to sprinkler heads only:
Describe work to 1. 1 -10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required.
Number of sprinkler heads:
Additional description of work: et.> gt- u Y
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet ❑ Dry
Standpipes
Additional Hazard Group t_ i HT
Information Density o. ( 0
Design Area
K. Factor S
Sprinkler Project Valuation: $ 4,4 6, 4 F AQ—
B.) Type I - Hood Fire Suppression System
Hood Project Valuation $
C.) Fire Alarm
Submittal shall Battery Calculations Yes LI
include: Individual Component Yes ❑
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 y .
INSPECTIOS! DIVISION Business Line: (503) 639 -4171 �T
��// BUP 70u2-G elJ'U
Received Date Requested 1/ / ) AM Art, M BUP
� w l�Gl —'111111111//, �
Location
/ 20 S ( -' Suite MEC
Contact Person Ph ( ) ,k0- �PU� PLM
Contractor Jerry �h ( 3(<a 77 / — Z7 0 SWR
yl Tenant/ �D�S�� ) ELC
0o ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear 1 4 1
Int Sheath/Shear / �� � / ` ; 3
Framing .4
Insulation I� / ✓ /3 60
Drywall Nailing �U
Firewall /�
e l
e
Susp'd Ceiling -r- }-
Roof
•._•
iltri PART FAIL
• I MBING
9
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
SS RT FAIL
ME ANIC
Post & am
Rough -In
Gas Line
Smoke mpe
Final
P S PART IL
ECTRIC •
Service
Rough -In
Low Low :
. - ,
for./
Fi
PA /, ) 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
" AI
SITE Please call for reinspection RE: ❑ Unable to inspect – no access
• Fire Supply Line
ADA 1- Approach/Sidewalk Data ` A C Q � � Inspector c Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL