Permit (120) CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2007 -00651
COMMUNITY DEVELOPMENT DATE ISSUED: 1/8/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 115 BA -00100
SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALBERTSONS ZONING: C -
SUBDIVISION: TIGARD TOWNE SQUARE LOT: JURISDICTION: TIG
PROJECT: ALBERTSONS
Project Description: TI - Fire alarm
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: 1,338 BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: Y REQD SETBACKS REQUIRED
FLOOR LOAD: psf . LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 4,700.00
Owner: Contractor:
IBJ SCHRODER BANK + TRUST CO FOCUS MICRO INC.
BY ALBERTSONS INC #565 4640 CAMPUS PL. #100
ATTN: CORPORATE ACCTG DEPT MUKILTEO, WA 98275
BOISE, ID 83726
Contact #: PRI 425 - 293 - 0123
Phone: 208 - 395 - 4711 FAX 425 - 293 -0393
Reg #: LIC 176457
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 12/19/2007 $83.95
[TAX] 8% State Surcha 12/19/2007 $6.72
[FLS] FLS Pin Rv 12/19/2007 $33.58
Total $124.25
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: , Permittee Signature:_
Call 503.639.4175 by 7:00 a.m. for an inspection that 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.
. , A-03 1' 7- .)s f In 202) C-P Ftc coy
.
Fi!e Protection System
Building Permit Applica FOR OFFICE USE ONLY
of Tigard ������D Received // / �
City DateB : Mo ill .. / i iQ I0I i A
° 13125 SW Hall Blvd., Tigard, OR 97 2001 Plan Review �. �
1A1
Phone: 503.639.4171 Fax: 503.598. L Date/E3 : �� �� f Other Permit:
_
TIGARD Inspection Line: 503.639 n TIGARD Date Ready/By: ® See Page 2 for
Internet: www.tigard or.gov CITY OF 1 � Notified/Method: FM Supplemental Information
BUILDING DIVISIO N
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees' are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement , 'Other: ?r15fz../f Smoke_ Ofe r equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
• Valuation: $
❑ I- and 2- family dwelling ,CommerciaUindustrial
ID Accessory building 171 Multi-family Number of bedrooms:
❑ Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1(9?00 S(,(' Pete 1 f f'e && y New dwelling area: square feet
City /State/ZIP: -Tlr9�ar -Q) n e 7 � � Garage/carport area: square feet
Suite/bldg. /apt. no.: i7 , I Project name: Ptiberitoils s(pS Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
, l� DDESCRIPTI __ ON __ OF WORK work indicated on this application.
cInSta t( .2 g Mtn*, P e ,i-nsp & klk- Valuation: $ 1 1700
A4 , a , m (�_ S _L _ _ 6 Existing building area: square feet
1 C l Ca T�.j' 1'1 New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State/ZIP: Existing:
Phone: ( ) Fax: ( ) N ew:
❑ APPLICANT (CONTACT PERSON NOTICE
Business name: Focus m : ' Ier e , ` All contractors and subcontractors are required to be
Contact name:. J oun e.n 1 0 P licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: i{{ Campus Ph tee .e-e / / OD jurisdiction in which work is being performed. If the
City /State /ZIP: fyi u K 1 Ito LAD PI q 8A75 applicant is exempt from licensing, the following reasons
apply:
Phone: (4.99 Ag3- 043(0 Fax: : (426)349-5a 1 SI
E-mail: JSen il, ..e„ usmle-to, corn
CONTRACTOR BUILDING PERMIT FEES*
_ (Please refer to fee schedule)
Business name: � � � (e Y
,-p �J-- 0_,
Permit fee:
• Address: i fLD 0,02 m us 1 laze_ oz) State surcharge (8% of permit fee):
� L
City /State/ZIP: I-K t lido, (2) t r0 )7j
FLS plan review (40% of permit fee):
Phone: (I )493_o(a1.3 I Fax: (.v (Due upon application.)
CCB lic.: / 7 /p1C5 (Q • (e {_ . ( Total permit fees: i,,A
Authorized si + ,1 �� Amount received:
� � �_ This permit application expires if a permit is not obtained
Print name: 'L I I Loh; �L /1 j .11i, Date: /P-/1 ii. o f 11 within 180 days after it has been accepted as complete.
• Fee methodology set by'Iri- County Building Industry
Service Board.
doc 03/23/06 440-4613T( I 1/02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION #: l3UP2007 -00651 0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/0/2008
Phone: (503) 639 -4171 ��, t
Inspection Requests (24 Hrs.): (503) 639 -4175 67 I —.,
INSPECTION WORKSHEET FOR DATE: 3/21/20013 TIME: 7:01AM PAGE: 12
SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALBERTSONS CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SOUARE LOT #: TYPE OF USE:
PROJECT NAME: ALBERTSONS •
DESCRIPTION: TI {Fire alarm J - - --
OWNER: IF3J SCHRODER BANK + TRUST CO, PHONE #: 208-396-4711
CONTRACTOR: FOCUS MICRO INC. PHONE #: 42Fr293.0123
Inspection Request Scheduled For: Date: 3/21/2008 • W Pour Time: joi j j •
/v
;W
# Inspection Description Confirm # Contact # Mes e
99 Final inspection 067141 -01 425-269-5694 Y
Co t ections /Comments /Instructions:
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P ASS 11 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:
V(A Date: / l - � � Phone #: (503) 718- 2 " - 1 2- Y )
CITY OF TIGARD •
i BUILDING DIVISION PERMIT #: BUP2007 -00651
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/8/2008
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 F __
INSPECTION WORKSHEET FOR DATE: 3/20/2008 TIME: 7:02AM PAGE: 12
SITE ADDRESS: 16200 SW PACIFIC HWY Z - ALBERTSONS CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE:
PROJECT NAME: ALBERTSONS
DESCRIPTION: TI trim i, T
OWNER: IBJ SCHRODER BANK + TRUST CO, PHONE #: 208. 3854711
CONTRACTOR: FOCUS MICRO INC. PHONE #: 425
Inspection Request Scheduled For: Date: 3/20/2008 Pour Time:
•
Code # Inspection Description Confirm # Contact # Message
209 Final inspection 067048 -01 426-269.5684 N
Corrections /Comments /Instructions:
r
•
❑ PASS ❑ PARTIAL APPROVAL } CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-