Permit Building Permit Applicat1LivitCEIVED e.g" 2v
Fire Protection System AUG 31 2020 # FOR OFFICE USE ONLY
Received /i
• - City of Tigard Date/By: 09'01-2020 4W PennitNe S2O2!?—OOO9l5
• 13125 SW Hall Blvd.,Tigard, t51 F TIGARD Plan Review
Phone: 503.718.2439 Fax: 5tp3,U�ICQL DateBy: 9-'S—� Other Permit
Inspection Line: 503.639.4175 G DIVISION Date Ready/By: .. Jw H See Page 2 for
TIGARD (�/
Internet: www_tigard-orgov Notified/ Iethod. i-I/6%/Zp+ 4..Y(' Supplemental Information
L:r`79 if— / 4Ti.0
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
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
. Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
• JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:12855 SW Grant St New dwelling area: square feet
City/State/ZIP:Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:TTSD—Charles F. Tigard Covered porch area: square feet
Cross street/directions to job site: Elementary Deck area: square feet
Other structure area: square feet
____ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK i' work indicated on this application.
Remove IFP1000 board, remove IFP1000 door, install 5820XL board, Valuation: $5533.78
install 5820XL door, replace FAA, program, test as needed Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New.
® APPLICANT 2 CONTACT PERSON NOTICE
Business name:Performance Systems Integrated All contractors and subcontractors are required to be
Contact name:Katie Harbaugh licensed with the Oregon Construction Contractors Board
-- under ORS 701 and may be required to be licensed in the
Address:7324 SW Durham Rd jurisdiction in which work is being performed.If the
City/State/ZIP:Portland, OR 97224 applicant is exempt from licensing,the following reasons
apply:
Phone:( )5036412222 Fax: : ( )5036411464
E-mail:katieh@psintegrated.com
CONTRACTOR BUILDING PERMIT'FEES*
(Please refer In fee schedule
Business name:Performance Systems Integrated Permit fee:
Address:7324 SW Durham Rd
City/State/ZIP:Portland, OR 97224 State surcharge(12%ofpermit fee):
FLS plan review(40%of permit fee):
Phone:( )5036412222 Fax:( )5036411464 (Due upon application submittal.)
CCB lic.:227526 Total permit fees:
•
Authorized signature: /
./` Amount received:
This permit application expires if a permit is not obtained
Print name:Katie Harbaugh Date:8/25/2020 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
L1Buitding\Permits\FPS-PemNApp 031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.). Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices:
® Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K.Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
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 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A, B &C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $
FLS Plan Review(40% of permit fee): $
TOTAL: $
•
J:\_Permit Information\Permit Information-Katie's\Tigard\Fire Protection System A .lication Form.doc