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CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
114 . COMMUNITY DEVELOPMENT Permit#: FPS2021-00087
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/10/2021
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 200
Project: Casualty Insurance(CNA) Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: (51)sprinkler additions/relocations
Contractor: PATRIOT FIRE PROTECTION INC Owner: PACIFIC REALTY ASSOCIATES
4708 NE MINNEHAHA ST ATTN: N PIVEN
VANCOUVER,WA 98661 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 360-699-4403 PHONE:
FAX: 360-699-4485
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/09/2021 $166.76
12%State Surcharge-Building 08/09/2021 $20.01
Type of Use: COM Plan Review-Fire Life Safety-COM 08/09/2021 $66.70
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 08/09/2021 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 08/09/2021 $3.00
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Gales Provided: Cut Sheets Required:
Total $258.47
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $8,450.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
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
Issued By: Permittee Signature:
}Eouy Vari/fDe✓Were OwApplzatLan
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 ApplicatiOR ECEIVE - ZO
Fire Protection System FOR OFFICE USE ONLY
City of Tigard JUL 2 d 2021 Received
y -7\2(c`�1 4-\U PetmitNo.:FPwu_ 3il--1
13125 SW Hall Blvd.,Tigard,OR 972 f-ry�}C Plan Review CJ
' s Phone: 503.718.2439 Fax: 503.598.1960' I OF TIGARD Date/By: "� Z) J Other Permit:
T I i-A R D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready By: �"`��,. ® See Page 2 for
Internet: www.tigard-or.gov Notified/Meth r K.-r Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction ❑Demolition Pe • fees*are based on the value of the work perfo , ed.
Indicate e value(rounded to the nearest dollar)o : 1
®Addition/alteration/replacement 0 Other: equipment, . aterials,labor,overhead,and the p..fit for the
CATEGORY OF CONSTRUCTION work indicate. on this application.
❑ 1-and 2-family dwelling a Commercial/industrial Valuation: $
•
❑Accessory building 0 Multi-family Number of bedroom
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12 9 0 9 SW 6 8 th Pkwy New dwelling are. quare feet
City/State/ZIP: Tigard, OR 97223 Garage/cargo- area: squ. e feet
Suite/bldg./apt.no.: 200 Project name:Casualty Insurance (CNA) Covered .orch area: square f-<
Cross street/directions to job site: SW Hampton Street De 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
DESCRIPTION OF WORK work indicated on this application.
add, relocate & delete sprinklers to accommodate Valuation: $ 8,450
remodel Existing building area: same square feet
New building area: same square feet
g] PROPERTY OWNER 0 TENANT Number of stories: 4
Name: Pacific Realty Associates, LP Type of construction: 2B
Address: 15350 SW Sequoia Pkwy, suite 300
Occupancy groups:
City/State/ZIP: Portland, OR 97224 Existing: B
Phone:(503 ) 624 6300 Fax:( ) B
New:
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: Patriot Fire Protection, Inc
All contractors and subcontractors are required to be
Contact name: Ted Baker licensed with the Oregon Construction Contractors Board
4 7 0 8 NE Minnehaha Street under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: Vancouver, WA 98661 applicant is exempt from licensing,the following reasons
apply:
Phone:(360) 699 4403 Fax::(360 ) 699 4485
E-mail: ted.baker@patriotfire.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: same as above
Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: 7 0 8 2 2 Total permit fees:
Authorized signature: /Pol__---- Amount received:
^� This permit application expires if a permit is not obtained
Print name: Ted Baker Date: 7-19-21 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
• Service Board.
I:\Building\Permits\FPS-PermitApp_071514.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: 51 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
IN 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
® Wet ❑ Dry
Additional Standpipes no
Information: Hazard Group light
Density .10 (existing)
Design Area N/A
K. Factor 5.6
Sprinkler Project Valuation: $ 8,450
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: $
\\patriotfire.local\dfs\VAN Profiles\red.baker\Downloads\FPS_PermitApp.doc 2