Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
ill
illq = COMMUNITY DEVELOPMENT Permit#: FPS2021-00111
T I C i A II.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/29/2021
Parcel: 2S102CB02300
Jurisdiction: Tigard
Site address: 13240 SW PACIFIC HWY
Project: Westside Surgery Center Subdivision: FREWING'S ORCHARD TRACTS Lot: 8
Project Description: Fire alarm notification devices.
Contractor: POINT MONITOR CORPORATION Owner: WESTSIDE BUILDING PROPERTIES LLC
5863 LAKEVIEW BLVD STE 100 BY VALLABHANATH, PRASHANTH
LAKE OSWEGO,OR 97035 11086 SE OAK ST
MILWAUKIE,OR 97222
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/29/2021 $188.28
12%State Surcharge-Building 09/29/2021 $22.59
Type of Use: COM Plan Review-Fire Life Safety-COM 09/29/2021 $75.31
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 09/29/2021 $4.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 09/29/2021 $12.50
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 $302.68
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $10,425.00
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: How., vcuA,De.,Wee€ Permittee Signature: Ow A
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. i
Approved plans are required on the job site at the time of each inspection.
Building Permit Application 13-'9I 1512
Fire Protection System RECEIVED 1.OR ohrl( 1. USI,oyl.Y
}yTigard E!12/hh/2
�,%f Permit N13125 W Ha 1 BllvdTigard,OR 97223 / decJS 20 Li„c iiSEP 152021 Pl Q Other Permit:
= Phone: 503.718.2439 Fax: 503.598.1960 Date/By: g'a T'a, l!
i-I lZ l) Inspection Line: 503.639.4175 CITY OF i i GAR D Date Ready/By: `� J ® See Page 2 for
Internet: www.tigard-or.gov I .ified/Method: ��%I Supplemental Information
BUILDING DIVISION ,/' .` -_ LL�•
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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 El Other: equipment,materials,labor,overhead,and the profit for the
,: """` "` "°" "-' " 'Y OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ElCommercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION 7
Total number of floors:
Job site address:13240 SW Pacific Hwy New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: 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
[TIRED DATA COMMERCIAL-USE QIECI,LIST
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
- .
iAyalt • equipment,materials,labor,overhead,and the profit for the
start" DESCRIPTION OF WORK work indicated on this application.
Fire Alarm Notification Devices Valuation: $10,425
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ® TENANT Number of stories:
Name:Westside Surgery Center Type of construction:
Address:13240 SW Pacific Hwy Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
® APPLICANT 0 CONTACT PERSON ;tW o:' tt it
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
City/State/ZIP:Lake Oswego,OR 97035 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)627-0100 Fax::( )
E-mail:bwilliams@pointroonitor.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Point Monitor Corp. (Please refer to fee schedule
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:
Authorized signature:
Amount received:
This permit application expires if a permit is not obtained
Print name:Ben Breit Date:9/15/2021 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
Iesc a done: rig r M .
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: 19
® 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 Devices
Type of System (Complete A,B,C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I —Hood Fire Suppression System
Hood Project Valuation:j $
C.) F E m z _
Submittal shall. Battery Calculations E Yes
include: Individual Component Z Yes
Cut Sheets
Fire Alarm Project Valuation: $ 10,425
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: $
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