Permit (2) a
Building Permit Application 13- (oh Z 26
Fire Protection System RECEIVED FOR OFFICE USE ONLY
City of Tigard v Received ` -
p g < Datem 0 Pernct No.: /t fJi. �.� Cn
13125 SlV Hall Blvd.,Tigard,OR /7223 A t\ Plan Review
/I '/ CJ{..!
_. Phone: 503.718.2439 Fax: 503.598.1960 O C T 2 G 2024 Date/Q : 11 4 20 44-4. Other Permit
TIGARD Inspection Line: 503.639.4175 CITY 1. I IGARD Date Ready/By: ) ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method:// /7 i/ _0I _. Supple ental Information
BUILDING DIVISION 41t, • --7£- -/,, emu( S`r,
' " TYPE`. OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING !
I]New construction ❑ Demolition Permit tees*are based on the value of the work performed.
--- — --- Indicate the value(Irounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,matcrisls,labor,overhead,and the profit for the
CATEGORY OF' COWS' U i`W IG ,I work indicated on his application.
x I-anddwelling Valuation: $ �/ !1/1
❑ 2-family g ID VV
❑Accessory building ❑Multi-family Number of bedrpoms:
kl —
❑Master builder ❑Other: Number ofbath bathrooms:
JOB SITE INFORMATION AND LOCATION Total number oltflol: 3(� Q
�7 � �j -p-�-�- 7
Job site address: /f�'V�V �����// 1/ I\ /n fi New dwelling area: uare fee[
City/State/ZIP: �`'\ a vIA' D l- 2 2 l f Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: l ] Covered porch area: square feet
Cross street/directtiioonss to job ssite: pp Deck area: square feet
lam_ Other structure area: square feel
'1E44ARED-DAtA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: / Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the valueounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK °I`, work indicated on this application.
InstallingL new 13D fire sprinkler system Valuation: ! $
'•'{,�/71QI,��yj(J�L► ,f7(y..�� Existing g area: square feet
"7 /- �a� �+ - � __.._ _ - _- New buildio building
_
area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name. Pi •1 C__ Type of construµttion:
Address: I --_--
V' Occupancy groups:
City/State/ZIP: 2Z3 Existing: --- --
Phone:( -04 4 I- _p Fax:( )
New:
❑ AP1'LICA\'I' CONTACT PERSON
_----- -- ---- _ __.F�,., r NOTICE
Business name: eft{J 'I � Ci.I
All contractors and subcontractors are required to be
Contact name: t V, licensed with the Oregon Construction Contractors Board
Address: under ORS 701 an�may be required to be licensed in the
• 1 jurisdiction in which work is being performed.If the
City/City/State/ZIP: ' q_Ci v- ( c p ���Q V�^ applicant is exempt from licensing,the following reasons
V aPPIY
Phone:(3 S 2l L,6 ki `1`{ Fax: :( )
E-mail: p VJ 1 61. �i `�-� 71co, col" • . t�- ---- ---
CONTRACTOR a — I r! w0 Q a Cc Al
--- BUILDING PERMIT FEES*
Buvness name: Geo
_tense refer to fee schedale)
— —____ Plumbing LLC
Address: --- -- -- Permit fee:
1710 Ne 199th St -----
- - ----- --- f.e(12%ofpermitfee):City/State/ZIP: Ridgefield, WA 98642 State surchar�
_ ____._ ________.. FLSplr iev (40°An of ermitfee —
Phone:( 360)500-0999 Fax:( P ,)
-- _ (lan ap upplicntimi submittalJ
___
CCB lic.: 216827 Total permit fees:
Authorized signature:
��q+� Amount received:
Vn This permit application expires if a permit is not obtained
Print name: George Chechelnitskiy I Dale: 10-21-20 within 180 days after it has been accepted as complete.
"--_" -- * Fee methodology set by Tri-County Building Industry
Service Board. •
I:,QuiltingTermlls\FPS-PermltApp_I13lllifi.doe 440-4613T111l112/COM/WEB) 1
I
I
RECEIVED
City of Tigard: Fire Protection Permit Checklist • OCT 2 2 2020
Page 2- Supplemental Information CITY N I lGARD
BUILDING DIVISION
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: 29 Number of alarm devices:
❑ Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices:1 Affidavit required and
Alteration (3) copies of sketch showing area (3) copies()f sketch showing area
to existing of work within building structure of work within building structure
system
E1 11+ heads: Plan review required and ❑ 6+ devices:)Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
13D Multipurpose system
Type of System (Complete A, B, C or D as applicable): D(Multipurpose)
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet ❑ DrL
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No _
Ilazard 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 - :� iH `ii
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 I
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,: $
h\Building V Permits\FPS_Pc r r itApp_O31016.doc 2