Permit (139) . r.
CITY OF TIGARD PERMIT
PERMIT #: BUP2005 -00075
�I DEVELOPMENT H BMENT OR 2CES 639 -4171 DATE ISSUED: 3/8/2005
SITE ADDRESS: 16200 SW PACIFIC HWY P PARCEL: 2S115BA-00100
SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
REISSUE: � FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: _kt'`f FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: 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: $ 3,000.00
Remarks: Exhaust hood.
Owner: Contractor:
IBJ SCHRODER BANK + TRUST CO SANDERSON SAFETY SUPPLY CO.
BY ALBERTSONS INC #565 1101 SE 3RD AVE
ATTN: CORPORATE ACCTG DEPT PORTLAND, OR 97214
BOISE, ID 83726
one:
Phone: 238 -5700
FEES Reg #: LIC 64969
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 3/1/2005 $72.10
[TAX] 8% State Surchari 3/1/2005 $5.77
[FLS] FLS Pin Rv 3/1/2005 $28.84
Total $106.71
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 y - 800 - 332 -2344.
Issued By: .€.4 - 4.4-4. /J z
.6,6
....
Permittee
Signature: el)' l-r?�
Call 639 -4175 by 7:00 p.m. for an inspection the next business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
. .
02/25/2005 10:25 FAX 5035981960 CITY OF TIGARD Z002/003 •
j
169eo Si vc e .&-VG W-e-vr i
Fire Protection System 17/ . ., .
• . . •
. Building Permit Applicatim
HECEIVA1 ..- i . FoR. - Fri. - . L L O
SE NLY ... .-. _ •
City of Tigard R T
eceived WPA - v
O 1 6 alfan Permit N° t _ •0 \
13125 SW Hall Blvd., Tigard, OR 9 L
Plan Review' 7 Xit
Phone: 503.639A171 Fax 503,598.1960 MAR 0 1 Other Penult:
L'''':-i'''
„ 1 ,4,., i j Date/B : Wi
Inspection Line: l
e: 503.639.4175 • Date Ready/By: c:› •
Internet: www.ci.tigerd.or.us Notified/Method: UNA S libnrformution ktV-t
CITY OF TIGARD
'' ••••'' Y.ii. • • -
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, ',.•.:.;•:,ilii!;-;:i:',1:',,• . :•••:.5;:41;•1;1;.1,f,,I,,:i;,!;',!).!t.•:r.i• ,. ..i. • '•• ": ...11r*PF.::.. P.. :: ::',.;:i.:ii,::J.1.....,:::..: . ::: .,...;;:-$41:21WP.PATAF17 .49 Z Y : PYYALYNG. . ) .
0 New construction 0 Demolition Permit fees are based on the value of the work performed. ..........
Indicate the value (rounded to the nearest dollar) of all
CI Addition/alteration/replacement ErOther: F 5
equipment, materials, labor, overhead, and the profit for the
1 !!' ,-1 :1::: 1 1:1.:::1.:•:;1.:,:: : r;!:7,':j.V. 1 1.:i . ... 1 •:'cAilick•Iii: ,'aisieii*iiiitiii4iiiii:•:•:16.f..1:•:•:::::'••••;11:1.:;j1;.[•;:!:: work indicated on this application. •
':;::'.:;.:•::::.:::•'..: :.... • ..„k.r.,.:,11•::•:::;!.1 "... • • .::: ..':: ...- ...: • ...in .: ...-•:..„ zw-.., ,.!•11.•••••...:....:••.::':;: 17 .':. ':'.:: ,..:...::
CI 1- and 2-family dwelling a6mmercial/in Valuation: s dustrial
0 Accessory building ID multi-family Number of bechooms:
:
0 Master builder 0 Other: Number of bathrooms:
4***...„.::'#::::•:".:::•oo. :.:o0,,.'4-4,6x*.v...::;11,:k,:..-::.:.:::.ii!:::.:!:;-..::.:::::. Total number of floors:
Job site address: 462O " Paeice 61/4-)y_ _ New dwelling area: square feet i
City/State/ZIP: •vi „ 0 '. Ar I 0 Garage/carport area: square feet
i •
Suite/bldgJapt. no.: _ Proj - t name: e Ogee, / c Covered porch area: square feet • • ,
Cross strect/directions to job site: . Deck area: square feet
— . .
Other structure area: square feet
ii!' 40A:7
Subdivision: Lot no.: Permit fees' are based on the value of the work perfortr•NI.
Indicate the value (rounded to the nearest dollar) of all
Tax reap/parcel no.: equipment, materials, labor, overhea■ . .4 I ' ■ r0 t for the
i :.0:(10ticif::10.**i )'5 work indicated on this : ..lie: on •
.------:-' . --
..11/rii( A/5 1---- R102 P'err ""-- Valuation: 000
-searmeasewee.--- --
C/C1('--r. e >1 Ire -z A- 1 j3,1e,c)) Existing building area: square feet
New building area: square feet
7:77 : 7 '' ' '' !' ' ' ' .. s eriitTlilti . '4* I,ii A '.--.....:.....- -.:.%. ;H; fiiiiiki: ...:-: ':::,, Pi Ntuaber of stories:
j j ::■:;.:? - :' . :; - :. 1 . :... : '. ,, , ., ..: ,...,, ,: ..!.;:;. !„ ..,. . , :-. :,,,:kr,I. •;:.,:,,.; i :,... • . :.-: : ..- ' :.. l!i': ' • .• !.. k. -,,,.!: ' .1;1; • r.... —....—...-----.— ‘,
Name: pot.440 "/ "1/,,s k ...e.... Type of construction:
Address: • 0 t•• rbuerl// ...) i• Occupancy groups: •
City/State/Z1P: c / eu„.04 0' . 17223 Existing:
„--
Phone: ( ) rrPg--- , eff c s Fax: ( ) New: -
j :: '.:,:::::. , ,i'iF:;; -: :',;:•1 7 .. ... ; II . lit '
Business name: , ei je 0 ,..., , • All contractors and subcontractors are required to bc
,,
licensed with the Oregon Construction Contractors Boa. d
Contact name: / , 0 e4.4 P" under ORS 701 and may be required to be licensed in the •
Address: j 0/ c ir of
--- jurisdiction in which work is being performed. If the
City/State/ZIP: e)le. 97211/ applicant apply: is exempt from licensing, the following reasons
, --- —
Phone: 501 ) 215.- 57aD Fax:: (PT ) Z31(--S Ye/ I
----- • •
E-mail:
' '''''''' '''• 'PT 11i ..:.-..-::leiiikiaktit:1 I.
.... 1 :
Business name: a .,., ivrd 0 _, , cs..
r . .. .......... ,.
...- D70.RE...Rmrr..„.,..-FEES......,..,'; : i ': - .' ' ....... • : i
Address; /--
.____
GPI Please refer to fee schedule.
City/State/ZIP:
c/ ,
Fees due upon application _zo 6 - 71
Pbone: ( ) I Fax: ( ) /g' Amount received
cc-o lie.: al y '17 d
• ,
•---- Date received:
Authorized signature: , 404r - This permit application expires if a permit is not obmi Jed
r within 180 days after It has been accepted as complere.
rPrint
name; 6 ,, ci.14-- .-- Date: "Z - 2 •
- 3 Fee methodology set by Tri Building Indusiry
Service Board. I
)313mildingVermIrs1F0S-Pemrisitpp.doc 12/03 ado-4613T(t UM/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2005 -00075
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/6/2005
Phone: (503) 639 -4171 � 4p �' ,I1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/25/2005 TIME: 7 :12AM PAGE: 70
SITE ADDRESS: 16200 SW PACIFIC HWY P - MC DONALDS CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE:
PROJECT NAME: MCDONALD'S RESTAURANT
DESCRIPTION: Exhaust hood.
OWNER: IBJ SCHRODER BANK + TRUST CO, PHONE #:
CONTRACTOR: SANDERSON SAFETY SUPPLY CO. PHONE #: 238-5700
Inspection Request Scheduled For: Date: 7/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
920 Suppression trip test 012034 -02 503 - 463.4500 N
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL Fc'R INSPECTION ❑ ADDITI NAL F ES ASSESSED
4 A 25
Inspector: Date: 7 Phone #: (503) 718 -
1111•1111IM�w-NAENFW^AS 1101 S.E1 3RD AVENUE • PORTLAND, OREGON 97214 • (503) 238 -5700
� 4nrsdwi r 850 CONGER • EUGENE, OREGON 97402 • (541) 683 -9333 .
NMSAFETYCOMPANY . mow. SOUTH • SEATTLE, WASHINGTON 98134 • (206) 340 -4300
*
CERTIFICATIO JNSTALLATI NSPECTION ,
Customer Name 0) C D tin a Ids - '
Address 1 Lo 6 5 0 C t� 1.,
Address kpvi
I .
SYSTEM J
Model(s) and serial numbers AN l T - i c- Z 5 a I) o to Scl S 4'v`
Number of nozzles and Part No. D c .4^ J/ €%\U.1/t T U l Le- 3
Number of detector(s) and degree rating I g 66
Energy shut -off devices — type and size nvC,VaJAkca, ` -rt. V G- lea
Other acceupry equipment provided (pull station, switc es, l etc.) I
COOKING /VENTILATING EQUIPMENT
Number of duct(s) and size t ! 41
/\ `
Hood size and plenum size 2 , •� Pie n Lotti" )& 11 A
Cooking Appliances and size of cooking surface. (NOTE: List appliances from left to right and indicate those
being pro cted.) �[ (�.
1. e. ,�s r ! /` 1 1 t` 4.
2. 5.
6.
3.
FIRE EXTINGUISHER INSPECTION NOTE:
❑ Kitchen ❑ Facility
TO BE COMPLETED BY INSTALLER
k YES ❑ NO
The fire suppression system is installed in accordance TO BE COMPLETED BY CUSTOMER
with the manufacturer's instructions, NFPA Standard
96 and 17 (current issue), and all applicable state and
local codes. Exceptions to other provisions of NFPA 96 ❑ YES El NO
that were observed are noted below. I understand that it is the recommendation of ANSUL
Exceptions: and of the National Fire Protection Association
Standard 96 and 17 that the fire suppression system be
inspected and maintained every 6 months to ensure
continued efficiency and reliability and that failure to
do so may result in failure f the system to operate
'
properly. /'�
i
A /!
UB. NAM D � ly
c. � F A ! k W.
`∎.. ' i f ' . ----'
O YES El NO t ;
All electrical work or work provided Eby others to SIGNATURE
complete this system installation has been completed. DATE
INSTALLER NAME I/ '*l_' A . i I l h M 1 �J
• SIGNATURE ill tom -
: (IP ' Tri T
DISTRIBUTOR 1 � 1 6 I Se* r"' '3
{
1" 6Y � � q�
t \ 611d f
ADDRESS [� l � ' -
Gut () et A14 ce 4_,2:L '_ 1 , A '
/
DATE _ /zt/o
V .
11•1111•11111ew s 1101 S.E. 3RD AVENUE • PORTLAND, OREGON 97214 • (503) 238 -5700
1111MORI VM O NOWYSIV 850 CONGER • EUGENE, OREGON 97402 • (541) 683 -9333
'SAFETY COMPANY AtR Y, SOUTH • SEATTLE, WASHINGTON 98134 • (206) 340 -4300
CERTIFICATION INSTALLATIO /INSPECTION
Customer Name ( t l( ItU ) F . 1 rAV
Address (01,409 S f (1C� c f t 9
SYSTEM n 1 1
Model(s) and serial numbers Nt)tA I
`` `- �C `
Number of nozzles and Part No.OU( t ' I 9 1 - \ } 4(1 rO (Q
!
Number of detector(s) and degree rating e_ -- 2d9d
Energy shut -off devices — type and size 1 /L�
Other accessory equipment provided (pull station, electric switches, etc.) qu11 cal -elec 1
`= , . - k In ill c&
COOKING /VENTILATING EQUIPMENT
Number of duct(s) and size
1 � j ` 1 x ' ' � " ? '/
Hood size and plenum size�Uu J r �'�U�IM / �
Cooking Appliances and size of cooking surface. (NOTE: List appliances from left to right and indicate those
being protected.) / �7
1.7, �c :cble) ��(0 '' � C.g 4.
2. 5.
3. 6.
FIRE EXTINGUISHER INSPECTION NOTE:
❑ Kitchen ❑ Facility
TO BE COMPLETED BY INSTALLER
<1 YES ❑ NO
The fire suppression system is installed in accordance TO BE COMPLETED BY CUSTOMER
with the manufacturer's instructions, NFPA Standard
96 and 17 (current issue), and all applicable state and
local codes. Exceptions to other provisions of NFPA 96 ❑ YES ❑ NO
that were observed are noted below. I understand that it is the recommendation of ANSUL
Exceptions: and of the National Fire Protection Association
Standard 96 and 17 that the fire suppression system be
inspected and maintained every 6 months to ensure
continued efficiency and reliability and that failure to
do so may result in failure of the system to operate
properly.
CUSTOMER NAME AND TITLE
YES ❑ NO
All electrical work or work provided by others to SIGNATURE
complete this system installation has b e completed. DATE
INSTALLER NA 1A'n s J ha �o'
SIGNATURE �/ "' Z`?--� / ,� v \l ' \
laN °7G£Qt ( . Alp
DISTRIBUTOR vq
DR SS ' 0 1 �. r `.� � � 5� ��
4 ,• k
DATE � 2 G (CC
MINIKIE'AIIIACrk501111 1101 S.E. 3RD AVENUE • PORTLAND, OREGON 97214 • (503) 238 -5700
- IVM IP ]V 850 CONGER • EUGENE, OREGON 97402 • (541) 683 -9333
MiMiU L SAFETY COMPANY 2600 AY, SOUTH • SEATTLE, WASHINGTON 98134 • (206) 340 -4300
*
CERTIFICATION - I SIALL.AT /INSPECTION
4 _
Customer Name 1001 a k�_S .- Y a
Address �Z r ! �� GA ■ L w
1-1°V-1- + Uh e S CI .
SYSTEM
e / Al. Z 3 4r / /e� .,6 S - /e 1 '1'`-
Model(s) and serial numbers He 9
Number of nozzles and Part No. u 4 1 °� - .,‘..4 Cl
Number of detector(s) and degree rating Fe -'l(/t/.
Energy shut -off devices — type and size to 6" A/h• I CG. 1 &.X vCe I VZiod
Other acce sory equipment provided (pull station,electric switches, etc.)
e_ Ywri -- f L . IN t S L) . -- c-ke S 1r �t t.c.;, -{ a cv r)
COOKING /VENTILATING EQUIPMENT
Nu of ducts) and s t � 4 /I
Hood size and plenum size 2 " X .9 )(51
r •r!
Cooking Appliances and size of cooking surface. (NOTE: List appliances from left to right and indicate those
being prof ed.)
1. 3 J e `r5 if ( X I! 4 ' 4.
2. 5.
3. 6.
FIRE EXTINGUISHER INSPECTION NOTE:
❑ Kitchen ❑ Facility
O BE COMPLETED BY INSTALLER
YES ❑ NO
The fire suppression system is installed in accordance TO BE COMPLETED BY CUSTOMER
with the manufacturer's instructions, NFPA Standard
96 and 17 (current issue), and all applicable state and
local codes. Exceptions to other provisions of NFPA 96 ❑ YES O NO
that were observed are noted below. I understand that it is the recommendation of ANSUL
Exceptions: and • cf the National Fire Protection Association
Standard 96 and 17 that the fire suppression system be
inspected and maintained every 6 months to ensure
• continued efficiency and reliability and that failure to
do so may result in failure of the system to operate
properly.
CUSTOMER NAME AND TITLE
IYES ❑ NO
All electrical work or work provided by others to
SIGNATURE
complete this system installation ha een completed. DATE
INSTALLER NAME L - ih–h £ k 1»• •_A ,o.•'•- _ /� 1 j r f� 11%r
SIGNATURE /7'11� W4/),0 C
DISTRIBUTOR SaikkeNCGO Q -
ADDRESS 1 \0 S 1 ( '`~ fc:_::..gfc)
50(-
DATE _ 1 f 7�O 65 .. 7