Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
_ COMMUNITY DEVELOPMENT Permit#: FPS2021-00081
Date Issued: 9/15/2021
T f G A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S102G602300
Jurisdiction: Tigard
Site address: 13240 SW PACIFIC HWY
Project: Westside Surgery Center Subdivision: FREWING'S ORCHARD TRACTS Lot: 8
Project Description: Add/relocate 61 sprinklers
Contractor: VIKING AUTOMATIC SPRINKLER CO Owner: INLINE PROPERTIES LLC
3245 NW FRONT AVE 13200 SW PACIFIC HWY
PORTLAND,OR 97210 TIGARD,OR 97223
PHONE. 503-227-1171 PHONE:
FAX: 503-227-1552
•
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/05/2021 $188.28
12%State Surcharge-Building 08/05/2021 $22.59
Type of Use: COM Plan Review-Fire Life Safety-COM 08/05/2021 $75.31
Class of Work: ALT Type of Const: VA Info Process/Archiving-Lg$2.00(over 08/05/2021 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 08/05/2021 $6.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: 0.1 Design Area: 1500
K Factor: 5.6
Commercial Fire Alarm System:
• Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $294.18
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation. $10,585.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Slate 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:
hollyOVI/Abblicatan
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.
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' - Fire Protection System RECEIVED ,3-7I 12,1 1
Building Permit Annlication FOR OFFICE USE ONLY
JUL 1 2 7021
City of Tigard Received I \3'Z1 Permit Na.:F?S2OZI-000'6\
lig • 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGARD Plan/Review
t � . Other Permit:
Phone: 503.639.4171 Fax: 503.598.1 I Date 7� OC 1
Inspection Line: 503.639.4175111LDING DIVISION Date ReadylBy: J H See Page 2 for
TI G ARD (((///
Internet: www.tigard-or.gov Notified/Method�/J/Z/ I Supplemental Information
Pint-r 4- ,,' .97/ -
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
El 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.
LI1-and 2-family dwelling Valuation: $
®Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:13240 SW Pacific Hwy New dwelling area: square feet
City/State/ZIP:97223 Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:Westside Surgery Center 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: 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 61 sprinklers as needed for tenant improvement. Valuation: $10,585
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER I ® TENANT Number of stories:
Name:Westside Surgery Center Type of construction:
Address: 13240 SW Pacific Hwy I Occupancy groups:
City/State/ZIP:Portland,OR 97223 Existing:
Phone:(970)493-8747 Fax:( ) New:
f...„,„..,... ® APPLICANT ® CONTACT PERSON f ' ' NOTICE
Business name:Viking Automatic Sprinkler All contractors and subcontractors are required to be
Contact name:Dave Bateman licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:3245 NW Front Ave jurisdiction in which work is being performed.If the
City/State/ZIP:97210 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)227-1171 I Fax::(503)227-1552 I
E-mail:dave.bateman@vikingsprinkler.net
CONTRACTOR I BUILDING PERMIT FEES*
Business name:Viking Automatic Sprinkler (Please refer mfee schedule
Permit fee:
Address:3245 NW Front Ave
City/State/ZIP:Portland,OR 97210 State surcharge(8%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)227-1171 I Fax:(503)227-1552 (Due upon application.)
CCB lic.:64837 Total permit fees:
Authorized signatu / Amount received:
�.4�..� �^ �_ This permit application expires if a permit is not obtained
Print name:Dave Bate n Date:6/25/2021 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
l BuildwgsPemits\FPS-PermitApp doe 0323/06 440.46131(11/02/COM/WEB) . (7i V' /
• .
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done: 1
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1-10 heads: No plan review required.
® Alteration ® 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 62
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Wet ❑ Dry
Additional Standpipes N/A
Information: Hazard Group Tip-ht Hazard
Density .10
Design Area N/A
K. Factor 5.6
Sprinkler Project Valuation: $ 10,585
I I
B.) Type I - Hood Fire Suppression System w , ; :
Hood Project Valuation: $
I I
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 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 I $292.50
7,201 and greater I $381.50
Sprinkler Project Square Footage: sq. ft.
I I
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 (8%of permit fee): $
FLS Plan Review(40% of permit fee): $
TOTAL: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
"New"fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer,or NICET level"3" technicians.
hugs://vilangsprinIder-my.sharepoint.com/personal/love_bateman_vilungsprinkler_netToeuments/Jobs/Westside Surgery Center(OPC-1058)/Submittal/City of Tigard Permit
App.doc