Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
a COMMUNITY DEVELOPMENT Permit#: FPS2021-00136
T f GA R f-j 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/15/2021
Parcel: 1 S 135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 500
Project: Lifestance Health Subdivision: ASHBROOK FARM Lot: 5
Project Description: Fire sprinkler permit:Adding and relocating(39)sprinklers for TI.
Contractor: WESTERN STATES FIRE PROTECTION Owner: KING CAPITAL INVESTMENTS LLC
17500 SW 65TH AVE ATTN KING, THOM
LAKE OSWEGO, OR 97035 19250 NE PORTAL WAY
PORTLAND, OR 97230
PHONE: 503-657-5155 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/07/2021 $274.36
12%State Surcharge-Building 12/07/2021 $32.92
Type of Use: COM Plan Review-Fire Life Safety-COM 12/07/2021 $109.74
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 12/07/2021 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 12/07/2021 $12.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: 0.1 Design Area: 1500
K Factor: 05.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $431.52
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $18,983.00
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: Hotly Va.w De Wege Permittee Signature: Or\ G 1 C_' • �
1�P � 1O
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 Application //
Fire Protection System FOR OFFICE USE ONLY
City of Tigard Received _
g — Permit No.:
Date/By: �� rt� � p1
13125 SW Hall Blvd.,Tigard,OR 97223 � i
g (RECEIVE Plan Review �a
Phone: 503.718.2439 Fax: 503.598.196 y. 1 1 Other Permit:A/9?0674...e.zot,eiIIGARDInspection Line: 503.639.4175 Date Ready/By: J /� Juris: Page 2 for
Internet: www.tigard-or.gov NOVj gtly9 Notified/M o T/1% /1/ i,� L�''LO Supplemental Information
Y f G8L , '
TYPE OF WORK ,f. fy c t ,; REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑De01.91 tipn . , .,,. 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.
El1-and 2-family dwelling ❑Commercial industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
I Job site address: 9600 SW Oak Street New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: 500 Project name: Life Stance Health TI Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW 95th Ave 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.: 1 S 1 35BD001 00 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 and Relocate (39) Fire Sprinkler Heads for TI Valuation: $18,983
Existing building area: 381 5 square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Pacific Crest Structures, Inc. Type of construction:Tenant Improvement
Address: 17750 SW Upper Boones Ferry Rd., Suite 190 Occupancy groups: Light Hazard
City/State/ZIP: Durham, OR 97224 Existing: 37 Heads
Phone:( ) Fax:( ) New: 6 Heads
El APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: Western States Fire Protection All contractors and subcontractors are required to be
Contact name: Alexander Funk licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1 7500 SW 65th Ave. 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)305-3018 Fax: :( )
E-mail: Alexander.Funk@wsfp.l.ls
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: Western States Fire Protection
Permit fee:
Address: 17500 SW 65th Ave.
State surcharge(12%of permit fee):
City/State/ZIP: Lake Oswego, OR 97035
FLS plan review(40%of permit fee):
Phone:(503)305-301 8 Fax:( ) (Due upon application submittal.)
CCB lic.: 104570 Total permit fees:
aa°F ,, o=w,,,, s,,a,r,a
Amount received:
Authorized signature: (14 * � o E�Desg,E,,..MAN..,,,Fu0
050 iS "1015i5S.36 This permit application expires if a permit is not obtained
Print name: Alexander Funk Date:11/10/2021 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_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
I Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
El New system Number of sprinkler heads: 39 Number of alarm devices: 0
X❑ Addition or El 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
❑X 11+ heads: Plan review required and El 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 ❑X Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes El No
Hazard Group Light Hazard
Density 0.10 gpm/ft2
Design Area 1500ft2
K. Factor 5.6
Sprinkler Project Valuation: $18;983
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: 3815 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): $ 310.05
State Surcharge (12% of permit fee): $
FLS Plan Review (40% of permit fee): $
TOTAL: $
I:\Building\Permits\FPS_PermitApp_031016.doc 2