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CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I7 COMMUNITY DEVELOPMENT Permit#: FPS2021-00143
Date Issued: 1/3/2022
T f Cl Ali T-) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 180
Project: Gold's Gym Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Fire sprinkler permit-add(1), relocate(18)and remove(4).
Contractor: AFP SYSTEMS INC Owner: PACIFIC REALTY ASSOCIATES
19435 SW 129TH AVE ATTN: N PIVEN
TUALATIN, OR 97062 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-692-9284 PHONE:
FAX: 503-692-1186
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/29/2021 $134.48
12%State Surcharge-Building 12/29/2021 $16.14
Type of Use: COM Plan Review-Fire Life Safety-COM 12/29/2021 $53.79
Class of Work: ALT Type of Const: IIIB Info Process/Archiving-Lg$2.00(over 12/29/2021 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 12/29/2021 $6.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
Density: 0.1 Design Area: 0
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 $212.41
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $5,475.00
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: Ed.garoto-P1aL ,on.aal.o- Permittee Signature: SU,arptiCACulieleti
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 ApplicatioiEEIVED f3
Fire Protection System DEC 6 2021 I OR OI l I( I' I Sr ONl.\
City of Tigard RecO1ved / Oq 202/ / PerlaitNo.:F7CS'202/'00/43
" 13125 SW Hall Blvd.,Tigard,OR 97223(I TY OF TIGARD PlanDate/By:
Review ^
• Phone. 503.718.2439 Fax: 503.598.1, DIVISION Date/By: la'oQ 3 �, Other Permit:
Inspection Line: 503.639.4175 3�91l.DING Date Ready/By: / Ians H See Page 2 for
TIGARD {
Internet: www.tigard-or.gov Notified/Method: to Iz 6�2 11 Supplemental Information
��� LA Ate
TYPE OF WORK REQ ' D 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 El Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling Commercial/industrial
IDAccessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ' 5 515 Sw 5E0Q U 0=A e kv•t y New dwelling area: square feet
City/State/ZIP: TI( AT-1R I Q R.. c 1 229 Garage/carport area: square feet
Suite/bldg./apt.no.: I ao Project name: C�0 1 a 45 G►`I M TT. Covered porch area: square feet
Cross street/directions to job site: 1 Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHISCKLIST
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_
Add, , Valuation: $ 541 5
e 1 o c a e 18 Existing building area: "1 A n 0 square feet
Remove. 4 New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Type of construction: e6 — 3
Address: Occupancy groups: , 7
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New.
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: ttF? Sy sket S N C • All contractors and subcontractors are required to be
' licensed with the Oregon Construction Contractors Board
Contact name: .(AN` �1 Gft 01 c,�1(1 S O Yl ( under ORS 701 and may be required to be licensed in the
Address: ( q I.{5 G S\ 1 l Z Gt c\te jurisdiction in which work is being performed.If the
City/State/ZIP: T ` ekA.;,..‘, O t ` a,�6 2_ applicant is exempt from licensing,the following reasons
lia apply:
Phone:(503) (9? 928y Fax::( )
E-mail: perr'1 -S l? o c?si s . C o r-,
CONTRACTOR BUILDING PERMIT FEES*
Business name: pt F¶ S 1 S i_Q-m s --IN 'N C (Please refsanfaschedule)
Permit fee:
Address: °t 3 5 S W \-7 v.{ piN
State surcharge(12%of permit tee):
City/State/ZIP: —1—kia1 p.. 1, ( O( C)'.p Z. FLS plan review(40%of permit fee):
Phone:(5O S) at 2 —q 7 g y Fax:( ) (Due upon application submittal.)
CCB lic.: (0-1 N1 Total permit fees:
',' Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: kmi l A t0 has r1 Date: 1ir -Z 1 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I\Building\Permrts\FPS•PermitApp_031016 doe 440-4613T(I 1/ObCOM/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:
0 New system Number of sprinkler heads: 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
A.-]1+ heads: Plan review required and 0 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 0 Yes ❑ No
Hazard Group L. hk
Density 0 . k
Design Area
K.Factor
Sprinkler Project Valuation: $ 69 i 5
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component 0 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: J 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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