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CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
•
COMMUNITY DEVELOPMENT Permit#: FPS2021 00092
Date Issued: 8/24/2021
T f C;A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S101AC01300
Jurisdiction: Tigard
Site address: 7105 SW HAMPTON ST
Project: KP Dental Subdivision: BEVELAND NO.2 Lot: 18-19,P
Project Description: Fire alarm permit-install fire alarm system as part of TI
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: KAISER FOUNDATION HEALTH
7324 SW DURHAM ROAD PLAN OF THE NORTHWEST#838
PORTLAND, OR 97224 ATTN PROPERTY ACCOUNTING
500 NE MULTNOMAH ST
PORTLAND, OR 97232
PHONE: 503-641-2222 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/23/2021 $435.64
12%State Surcharge-Building 08/23/2021 $52.28
Type of Use: COM Plan Review-Fire Life Safety-COM 08/23/2021 $174.26
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 08/23/2021 $12.00
Occupancy Grp: B Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 08/23/2021 $17.50
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 $691.68
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $36,746.00
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: Haw)/ Van/De/Wee Permittee Signature: OYV4pp
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.
ry Building Permit Ap licatio ECEIVED
Fire Protection System FOR OFFICE USE ONLY
City of Tigard Ue kG/ Received f o d3 202/ � 'e�n
" DateBy: � Permit No.:�v Lf��—�t.d/ /�...
11111 13125 SW Hall Blvd.,Tigard,OR 972 11Y OF TIGARD Plan RevinS, A
Phone: 503.718.2439 Fax: 503.59 60 Date/By: �( Other Permit:
TIGARD Inspection Line: 503.639.4175 31UILDING Date Ready/By: i uri• H See Page 2 for
Internet: www.tigard-or.gov ed/Method: Supplemental Information
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
®Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling KJ Commercial/industrial Valuation: $
❑Accessory building El Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 7105 SW Hampton Street New dwelling area: square feet
City/State/ZIP: Tigard OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: KP Dental-Tigard Covered porch area: square feet
Cross street/directions to job site: SW 72nd Ave 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.
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.
Install fire alarm system as part of a tenant improvement. Valuation: $ 36,746.31
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
•
Name: Type of construction:
Address: Occupancy groups: B
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
QCi APPLICANT in CONTACT PERSON
NOTICE
Business name: Performance Systems Integration All contractors and subcontractors are required to be
Contact name: Michael Baker 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:( ) 503-713-9856 Fax: :( ) 503-641-1464
E-mail: michael.baker@psintegrated.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: Performance Systems Integration Permit fee:
Address: 7324 SW Durham Rd
State surcharge(12%of permit fee):
City/State/ZIP: Portland OR 97224 FLS plan review(40%of permit fee):
Phone:( ) 503-641-2222 Fax:( )503-641-1464 (Due upon application submittal.)
CCB lic.: 227526 Total permit fees:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: Michael Baker 429LEA NICET 97902 Date:7-20-2021 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PermitApp_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: 75 devices &
appliances
❑ 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 In Yes
Cut Sheets
Fire Alarm Project Valuation: $ 36,746.31
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_Perm tApp_031016.doc 2