Permit (20) al
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CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00494
a �� DEVELOPMENT SERVICES DATE ISSUED: 9/9/03
�,.� I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16200 SW PACIFIC HWY A PARCEL: 2S115AB -01900
SUBDIVISION: TIGARD TOWNE 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: A3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 207 BASEMENT: sf AREA SEP. RATED:
STOR: 1 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: $ 6,175.00
Remarks: Fire suppression system.
Owner: Contractor:
BIT HOLDINGS LTD PARTNERSHIP INSTANT FIRE PROTECTION CO.
BY FORUM PROPERTIES INC 3385 PORTLAND RD. N
LAKE OSWEGO, OR 97035 SALEM, OR 97303
Phone:
Phone: 503 - 362 -4511
Reg #: LIC 88324
FEES REQUIRED INSPECTIONS
Description Date Amount Misc. Inspection
[BUILD] Permit Fee 8/15/03 $110.50 Final Inspection
[TAX] 8% State Tax 8/15/03 $8.84
[FLS] FLS Pln Rv 8/15/03 $44.20
Total $163.54
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: , 4 ti
Pemilttee / // _
Signature: _ i� i '~
/
Call 639 -4175 by 7 p.m. for an inspection the next business day
FPF ire Protection System
�: �°C2 . ': .77",t, .77",t, FOR OFFICE USE ONLY
Building Permit Application Received, Building
DateBy:15 -1 S -03 6 6 Permit No.: B u �a003 — 00
City of Tigard Planning Approval Other
g EIVED Planni y: Permit No.:
13125 SW Hall Blvd. Plan Revie Other
Tigard, Oregon 97223 RECEIVED to 0) P Permit No.: ` ,�
1N & Post - Review Land Use �)
Phone: 503 -639 -4171 F „S0 �98,.1 `- a s . e l 1 Date/By: Case No. \
Internet: www.ci.rigard.or �jj e77 [UU3 �i' - Contact Juris.: ® See Page 2 for ��
24 -hour Inspection Request: 503- 639 -4175 Name /Method: �i Supplemental Information N
CITY OF TIGARD
BUILDING DIVISION •
TYPE OF WORK REQUIRED DATA:
K New construction 0 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:1 gt 5✓pi?Re9s ?ant. Valuation $
JOB SITE INFORMA ION and LOCATION No. of bedrooms: No. of baths:
Job site address: r(oA 00 5, C t' ] /` c; P IC. h{w �/ Total numbcr area (sq. ft.)
Suite #: 7 4- Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: 7 f H 13 0 r A p_4--- Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: 1 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.
F ' v.e55 i Qom` 5i< ewl Valuation $ 6/7S 00
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
❑ PROPERTY OWNER I ❑ TENANT Type of constructionE.. /.. .,S.a..PRt'S ..'f
Name: Occupancy group(s): SVS`f ?W\. Existing:
fr New:
Address:
City /State /Zip:
Phone: Fax: NOTICE: All contractors and subcontractors arc required to be
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:/715 4- F; e_ PR CO. jurisdiction where work is being performed. If the applicant is exempt
Contact Name: ithAy yl e _ 7 14021 p_so Ai from licensing, the following reason applies:
Address: 33 srS 1p,� #1 t•• A RD . Al
City /State /Zip: SgL� 97 3 D3
Phone:so3 =36 a -4<S /t Fax: So--3 3 Ca-4' 3$
BUILDING PERMIT FEES *
E -mail: Mayon vr e- ifici4i P3i, a di, 1415tH• a «✓1 Please refer to fee schedule.
CONTRACTOR �,, /�
Business Name J ,.514 4f FRcz_ aok,c -I(N Co, Fees due upon application $ /63, S Si
Address: 3_. 7,2fis4.-.13 pi?, N r
city /State /Zip:4�_,,,, O ? 97,303 Amount received $
Phone:So3 3i,9.• - [ Fax :, - 36a -44S35 Date received: •
CCB Lic. #: ' `,:. o _5, - .; 7 •
Authorized , r Notice: This permit application expires if a permit is not obtained within
Signature: . - i, vla.,.. _ a ate: g� 705 180 days after it has been accepted as complete.
r 2 74c( i5 , 772`7J� -S / / *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Fotms\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.
❑ 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: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $ [7S, o 0
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): $ 6/7s,
Permit fee based on valuation (see attached chart): $ i / D,
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $ r S4
FLS Plan Review 40% of Permit Fee: $ 9111940
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 Lihe: (503) 639 -4175 Q
INSPECTION'DIVISION Business One: (503) 6394171 /1-, MST oO0
'9 Ili
Received Date Requested ` A • •
Location 1 A Suite A MEC
Contact Person Q Ph (C2___) S. S7 °adL PLM
Contractor Ph ( ) SWR
DI Tenant/Owner 77, 77 AV ELC
0o ing
Foundation ELC
Access:
Ftg Drain
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing 4' s '-��/\ k . W J
Drywall Nailing
Dryll N
Firewall
e ‘1.■‘.--C9 4
Fire Alarm f c
Susp'd Ceiling '�'^ •
Roof -r _ t
ma ��-
SS PART FAIL
i BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
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: 0 Unable to inspect - no access
Fire Supply Line
ADA r
Approach/Sidewalk Date S->/es Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL