Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2020-00101
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19/2020
TIGARD 9 Parcel: 2S 101 DA02000
Jurisdiction: Tigard
Site address: 6980 SW VARNS ST
Project: Madrona Office TI Subdivision: VARNS ACRES Lot: 3
Project Description: Adding fire alarm request to non sprinkled B occupancy under 100 occupants
Contractor: WESTERN STATES FIRE PROTECTION Owner: MRC RE LLC
17500 SW 65TH AVE 7000 SW VARNS ST
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
PHONE: 503-657-5155 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/19/2020 $231.32
12%State Surcharge-Building 10/19/2020 $27.76
Type of Use: COM Plan Review-Fire Life Safety-COM 10/19/2020 $92.53
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 10/19/2020 $4.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 10/19/2020 $12.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Yes Alarm Type: Automatic
Pull Station Required: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $368.11
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $14,995.00
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 the 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 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: `` 1 Permittee Signature: Or app' IC O
(}`11�J1o11 Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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.
Building Permit Application q 2112,0 - a
' Fire Protection System p}�{P¢-[,g*�-yg�+�i1�g'�TiI^�'- FOR OFFICE USE ONLY
City of Tigard RECEIVE 4 Y 4 S !P L _ I1.'ecei d /0 O/ 7�
Ihi DateBy: / / /2a2 ,w Permit No.:FPS2020 e0/0/
Hall Blvd.,Tigard, Plan Review / �►^
Phone:13125SW 503.718.2439 Fax: 503.598OR97223.1960 S E P 2 1 2020 Date By: O ' O plT.+ Other Permit:
T I G A R D Inspection Line: 503.639.4175 _ Date ReadyBy: iA C Juris: ® See Page 2 for
Internet: www.tigard-or.gov �! '�1 t` IGA�Q Norified/Method: /p,iq/'� �t/t I Supplemental Information
BUILDING DIVISIC� !C
g�`'1 q-r cl- M i kc
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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.Renovation equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder E Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 6980 SW Varns St New dwelling area: square feet
City/State/ZIP: Portland/OR/97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Madrona Office TI Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW 72nd Ave 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 work indicated on this application.
Adding fire alarm per customers request to non sprinkled B Valuation: $ 14,995.00
occupancy under 100 occupants Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name. Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
II APPLICANT 0 CONTACT PERSON
NOTICE
Business name: Western States Fire Protection All contractors and subcontractors are required to be
Contact name: Mike Teague licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:17500 SW 65th Ave jurisdiction in which work is being performed.If the
City/State/ZIP: Lake Oswego/OR/97035 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)657-5155 Fax: :( )
E-mail:mike.teague@wsfp.us 1
CONTRACTOR BUILDING PERMIT FEES*
Business name: Western States Fire Protection (Please refer tojeeschedule)
Permit fee:
Address:17500 SW 65th Ave
State surcharge(12%of permit fee):
city/State/ZIP:Lake Oswego/OR/97035 FLS plan review(40%of permit fee):
Phone:(503) 657-5155 Fax:( ) (Due upon application submittal.)
CCB lie.:104570 Total permit fees:
Dqif i'y signed°y Mse Tea9ve Amount received:
Authorized signature: Mike Teague DN:C-US.E.n ke.teapue®wsry.o.0-Western Onus Fee
b ProtucSon,eN.Mike Teapue
oate:Yazp.09.tatz:41s9.07Ot, This permit application expires if a permit is not obtained
Print name: Mike Teague Date:9/16/2020 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:13uildmg\Permits1PS-PermilApp_031016.doc 4404613T(11/02'COMIWEB)
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: 39
El Addition or El 1-10 heads: Affidavit required and El 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: $ 14,995
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: $
I:\Building\Permits\FPS_PermitApp_031016.doc 2