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III CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
i Ill
COMMUNITY DEVELOPMENT Permit#: FPS2021-00142
Date Issued: 1/4/2022
T I[;Ai.L} 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 500
Project: Lifestance Health Subdivision: ASHBROOK FARM Lot: 5
Project Description: Fire alarm permit-adding(10)alarm devices.
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 01/04/2022 $166.76
12%State Surcharge-Building 01/04/2022 $20.01
Type of Use: COM Plan Review-Fire Life Safety-COM 01/04/2022 $66.70
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 01/04/2022 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 01/04/2022 $6.00
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $261.47
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $8,500.00
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 rule re set fort 'n OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Permittee Signature: (:c 1 4:P14 7r‘l"
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. Y
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 8_12_ (012..
E EIVE
Fire
Protection System Ftl►z 01,rlc,l: I til:O,l.,
111 City of Tigard DEC 6 2021 DateBReceiv�l z�U7 �� �r PermitNo.:/S2OZI.-a) 1 �
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review _ I
Phone: 503.718.2439 Fax: 503.598.1 OF TIGAFtU Date/B : 1•- di Other Permit:
1 I G A RI) Inspection Line: 503.639.4175 /� i� �. Date Ready/By: r ® See Page 2 for
Internet: www.tigard-or.gov Pii_JILDING DiVISIOb Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
J 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 ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9600 SW Oak St 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 Greenburg Rd and SW Oak Other structure area: square feet
vt E .tI , 1:F iY 4 t , io;,! ,,i d k P r'e } J _F,!,,
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Notification additions for tenant improvement in 5 story Valuation: $8,500.00
B-Occupancy fully sprinkled building Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:5
Name: Type of construction:
Address: Occupancy groups: B
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT ® CONTACT PERSON NOTICE
Business name:Western States Fire Protection All contractors and subcontractors are required to be
Contact name:Mike Teague licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:17500 SW 6th Ave jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: Lake Oswego/OR/97035
apply:
Phone:(503) -657-5155 Fax: :( )
E-mail: mike.teague@wsfp.us
CONTRACTOR BUILDING PERMIT FEES*
Business name:Western States Fire Protection (Please refer tn fee schedule)
Permit fee:
Address:17500 SW 6th Ave
City/State/ZIP:Lake Oswe o/OR/97035 State surcharge(12%a of permit fee):
g FLS plan review(40%of permit fee):
Phone:(503) -657-5155 Fax:( ) (Due upon application submittal.)
CCB lic.: 104570 Total permit fees:
_ Amount received:
Authorized signature: Mike Tea a "; ,s„A„� ° ""`""'W"'
.,a a.o
9 This permit application expires if a permit is not obtained
Print name: Mike Teague Date; 12/6/2021 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building,Permits`FPS-Permit App_031016.doc 440-4613T(1 I/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: 10
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
❑ 11+ heads: Plan review required and ❑X 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 appli„,
A.) Commercial Sprinkler
Sprinkler Type Q Wet ❑ Dr\
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: $
afire Alarm
Submittal shall Battery Calculations ❑X Yes
include: Individual Component ❑X Yes
Cut Sheets
Fire Alarm Project Valuation: $ 8,500.00
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 itApp_031016.doc 2