Permit (119) CITY OF TIGARD BUILDING PERMIT S 7277us
PERMIT #: BUP2003 -00148
AA DEVELOPMENT SERVICES DATE ISSUED: 4/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16200 SW PACIFIC HWY Y2 PARCEL: 2S1156A -00101
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: 3N : 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: $ 11,200.00
Remarks: Phase 1, Lease A: Fire protection for new 8,000 sf retail building.
Owner: Contractor:
•
BIT HOLDINGS LTD PARTNERSHIP DELTA FIRE INC
BY FORUM PROPERTIES INC 14795 SW 72ND AVE
FIVE CENTERPOINTE DR STE 290 PORTLAND, OR 97224
LAKE OSWEGO, OR 97035
Phone:
Phone: 620 -4020
Reg #: MET 00001934
FEES LIC REQUI4A INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 4/1/03 $158.50 Sprinkler Rough -In
[TAX] 8% State Tax 4/1/03 $12.68 Sprinkler Final
[FLS] FLS Pin Rv 4/1/03 $63.40
Total $234.58
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:
Pe rm ittee
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
_ ,,,
A- 'CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00148
A iehA DEVELOPMENT SERVICES DATE ISSUED: 4/21/03
..� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16200 SW PACIFIC HWY PARCEL: 2S1156A -00101
9' , I
SUBDIVISION: TIGARD TOWNE SQUA E 1 ' 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: 3N : 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: $ 11,200.00
Remarks: Fire protection for new building.
Owner: Contractor:
BIT HOLDINGS LTD PARTNERSHIP DELTA FIRE INC
BY FORUM PROPERTIES INC 14795 SW 72ND AVE
FIVE CENTERPOINTE DR STE 290 PORTLAND, OR 97224
LAKE OSWEGO, OR 97035
Phone:
Phone: 620 -4020
Reg #: MET 00001934
FEES LIC REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 4/1/03 $158.50 Sprinkler Final
[TAX] 8% State Tax 4/1/03 $12.68
[FLS] FLS PIn Rv 4/1/03 $63.40
Total $234.58
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 0 throug •AR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
callin 503) 246 -6699 o 1- 800 - 332 -2344.
Iss ed By: k , , . ' �ti
1
Perm' ee _ - / ' A
Signature: L�f _� _ m il J 1
/ _
Call 639 -4175 by 7 p.m. for an inspection the next business day
boa f w ,Ac/ /c H
ire rotectI n System
ppx0 V0 e 1 rA l L.ALOG/G -
A c. Building Permit Application
/a
Date received: ITO Permit no.: ,, _,,, ,•
..;4 ,� City of Tigard v
+ Address: 13125 SW Hall Blvd' Tigd;'0 �22f. Project/appl. no.: Expire date:
City of Tigard Phone: (503) 639 -4171 By: I Receipt
Date issued B Recei t no.:
Fax: (503) 598 -1960 MAR 3 1 2003 Case file no.: Payment type:
Land use approval: CITY OF TIGARD 1 &2 family: Simple Complex:
a ■ 1 %VISION 1
TYPE OF PERMIT Co
0 1 & 2 family dwelling or accessory Commercial/industrial O Multi- family 0 New construction 0 Demolition W
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other.
JOB SITE INFORMATION
Job address: [ /pO _ drarenintmmommum Bldg. no.: Suite no.: 0
Lot: Block: Subdivision: > Tax map /tax lot/account no.:
Project name: q ac e -1, 1 n.2 *tetra. C
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: (Floodplain, septic capacity, solar, etc.)
Mailing address: 1 & 2 family dwelling:
City: State: ZIP: Valuation of work $
Phone: Fax: 1E-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.)
rl _ _ I 'r'LY, Covered porch area (sq. ft.)
Mailing address: / j`��/ 1e( Deck area (sq. ft.)
EMPr
l ` j r Other structure area (sq. ft.)
Phone' �LJ — ,ba f T mre_w 4 E -mail: Commercial/industriaUmultl- family:
CONTRACTOR Valuation of work $ /6 a20
Business name: ( (1,.. /,. Existing bldg. area (sq. ft.)
Address: el aA dsfr , New bldg. area (sq. ft.)
Cit . `dpa bia /_ Ux,c) ` State , ZIP: � ad, Number of stories
Type of construction
Phone' // ■ C)).C) E -mail: Occupancy group(s): Existing:
CCB no.: 04 7 New:
City /metro lie. no.: • Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: [ tt, I I provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
�
WOW :1J `1 __ ZIP: "rem exempt from licensing, the following reason applies:
Contact person 1 errIr. Plan no.:
Phone' , . i Id r, • . Fax: /20— o , E -mail:
ENGINEER
Name: Contact person: Fees due upon application • $
Address: Date received:
City: 'State: (ZIP: Amount received $
Phone: 1 Fax: 1E-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 0 MasterCard
work will be complied wi h they . - i red h - in or n Credit card number: I /
Authorized sign. lL! ; ice' l t , .► late: ,y'r) Name of cardholder as shown on credit card Expires
Print name: `J % - Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6R)0/COM)
Ir
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:
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet ❑ Dry ❑
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation I $
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
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.
i:\dsts\forms \FPSchecklist.doc 11/21/01