Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
114
s COMMUNITY DEVELOPMENT Permit#: FPS2020-00133
Date Issued: 1/14/2021
TIC;,A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY
Project: PacTrust Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: Fire alarm permit:(38)devices.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/14/2021 $285.12
12%State Surcharge-Building 01/14/2021 $34.21
Type of Use: COM Plan Review-Fire Life Safety-COM 01/14/2021 $114.05
Class of Work: ALT Type of Const: IIIA Info Process/Archiving-Lg$2.00(over 01/14/2021 $12.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 01/14/2021 $6.00
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:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $451.38
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $19,049.00
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: ,\cv I\1�\ \V G ��`� \ Permittee Signature: \ ay
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.
.i ding Permit Application a , - '
* Fire Protection System 4 Y E� FOR OFFICE USE ONLY
Cityof Tigard RECE G Received r1 ���� Permit No.:F' vv`3 t
6 Datealy: !ice , ••+ J
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Other Permit: r, W/7
Phone: 503.718.2439 Fax: 503.598.1960 DEC 212020 DaceBy: i"lei_a i- ' r
Inspectionne:Li 503.639.4175 Date Ready/By: t Jim, "A See Page 2 for
<,r\1L 1)
Internet: www.tigard-or.gov ;`� OF r'n n oft Notified/Method: //i 2.1 i�J Supplemental Information
• IIx 4
"- TYPE OF W! 1 IRED 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: equipment,materials,labor,overhead,and the profit for the
TEGORY OF: work indicated on this application.
'
Valuation: $
❑ I-and 2-family dwelling ®Commercial/industrial
Number of bedrooms:
❑Accessory building ❑Multi-family
❑Master builder El Other:
Number of bathrooms:
S Total number of floors:
...1 .yIYAI,i[e •` ' .. s ' A`tt2 OCA 1:'.
Job site address:12909 SW 68'Parkway New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 ��JJ Garage/carport area: square feet
Suite/bldgJapt.no.:082 Project name:PPC082 /tq,0''1'i..Jv f- 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: 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 WORKINIMMINE
work indicated on this application.
Valuation: $$19,049.00
Fire Alarm Notification
Existing building area: square feet
New building area: square feet
t PROPERTY OWNER Number of stories:
Name:PPC082 Type of construction:
Address:12909 SW 68th Parkway#082 Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
d J rt ❑ CONTA $`SO It NOTICE 'e'' -
Business name:Point Monitor Corp. All contractors and subcontractors are required to be
Contact name:Brooke Williams licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:5863 Lakeview Blvd#100 jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:Lake Oswego,OR 97035 apply:
Phone:(503)627-0100 Fax::( )
E-mail:bwilliams@.pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES* '
."_ (Please refer to fee schedule)
Business name: Point Monitor Corp. Permit fee:
Address:5863 Lakeview Blvd#100
State surcharge(12%of permit fee):
City/State/ZIP:Lake Oswego,OR 97035 FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( ) (Due upon application submittal.)
CCB lic.:135901 Total permit fees:
Amount received:
Authorized signatur
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Ben Breit Da ' 12/17/2020
* Fee methodology set by Tri-County Building Industry
Service Board.
' I:�Building�Petmiti'FPS.Permi*AFP_031016.doc 440-4613TO 1/02/COM/WEB)
)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices: 1$
® 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: Fire Alarm Notification
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 El 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: $ 19,049
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: I 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: $
C:\Users\bwilliams\Desktop\PERMIT FORMS\Fire permit-city of tigard.doc 2
Branden Taggart
From: Branden Taggart
Sent: Thursday, January 14, 2021 2:38 PM
To: Brooke Williams (bwilliams@pointmonitor.com)
Subject: PacTrust Fire Alarm Permits: FPS2020-00133 & ELR2020-00140 - 12909 SW 68th Pkwy.
Attachments: Invoices.pdf
Hi Brooke,
The fire alarm permits for PacTrust are ready to issue now. I have attached invoices above for you to reference, and the
fees due are as follows:
PacTrust
Permit# Fees Due
FPS2020-00133 $ 451.38
ELR2020-00140 $ 84.00
Total: $ 535.38
The above fees can be paid online through our website: https://aca.accela.com/tigard/Default.aspx. From there, click
on the Building tab, enter the permit numbers in the Record Number field, and click Search. Once paid, please notify us
at TigardBuildingPermits@tigard-or.gov, and we will place this permit and the approved site copy set of plans in our
open Permit Center conference room for you to pickup between the hours of 8:00 a.m. and 5:00 p.m., Monday through
Thursday. We are closed on Fridays. No appointment is necessary to pick up.
Thank you,
Branden Taggart
COph of Tigard
ffi Senior PermitTechnrcian
Community Development
13125 SW Hall Blvd
Tigard,OR 97223
(503}718-2449
brandent@tigard-or.gov
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