Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
- COMMUNITY DEVELOPMENT Permit#: FPS2021-00149
Date Issued: 1/20/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134AD06200
Jurisdiction: Tigard
Site address: 10565 SW NIMBUS AVE 110
Project: Big leaf Networks Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: A
Project Description: Fire sprinkler permit:Adding and relocating(35)sprinkler heads.
Contractor: FIRE SYSTEMS WEST INC Owner: DIETRICH, NANCY BISHOP
600 SE MARITIME AVE#300 ROBINSON, JERRY CHRISTOPHER TRUST
VANCOUVER,WA 98661 ROBINSON, LYNN ET AL
9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/17/2022 $199.04
12%State Surcharge-Building 01/17/2022 $23.88
Type of Use: COM Plan Review-Fire Life Safety-COM 01/17/2022 $79.62
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 01/17/2022 $2.00
Occupancy Grp: B Height: 25 ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 01/17/2022 $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: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $317.04
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $11,489.00
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: Eotgardo-Ma.4.4.4-ma4o- Permittee Signature: yze,
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 Applicatid `'EIVEV ��,�
Fire Protection System DEC 1 4 2021 FOR OFFICE USE ONLY�=�
City of Tigard -)I G/�pry Received 'J i22i // p
UFTIGARd Date/By: �"' �/ LtJL/ , Permit No:�pS202/`OD1�/
s n 13125 SW Hall Blvd.,Tigard,OR Plan Review I
Phone: 503.7I8.2439 Fax: 503. � NG DIVISION Date/By: Ja. (0 - Other Permit:
lit,A 1t I) Inspection Line: 503.639 4175 Date Ready/By: /� r ® Sc,Page 2 for
Internet wtvw.ligard-OC.gov Notified/Method: / �1l' Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND'2-FAMILY DWELLING
❑New construction 0 Demolition Permit fees*arc based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
gi Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-faintly dwelling 14 Commercial/industrial
Accesso buildin Number of bedrooms:
❑ ry g ❑Multi-family
❑Master builder ElOther: Number of bathrooms:
T JOB SITE INFORMATION AND LOCATION 'Iota]number of floors:
Job site address: fb 5(0,S ,s $ AJ111-11.3,,CA,S /q V e- Sr e- 110 New dwelling area: square feet
City/State/ZIP: IPOfJ,,TL.V' t' ) [,,y a, 9-41,a,3 Garage/carport area: square feet
Suite/bldg./apt.no.. Project name: (6)Le.:161, N'.t,.t,..0 ft4!_14 2r,' Covered porch area: square feet
Cross street/directions to job site: Deck area square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECELISI'
Subdivision: lot no.: Permit fees*arc 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.
.FK,Bn. '.,� �+,i5filk*6'4..C1C t Q'1'/ at-,l ; /?5 7-0 T Valuation: $ {, f-'�� .
_
Existing building area: square feet
Y';\CG.csvkt vt-r(VI wr~t.:-:.; cc11.-1(1 t - ---- -- - _
New building area: square feet
Q-PROPERTY OWNER ',TENANT Number of stories:
Name: git's ( 14:-N 14C-rtoC>Q — Type of construction:
Address: Occupancy groups: 1
City/State/ZIP: Existing: 1
Phone:( ) Fax ( )
1
New:
'APPLICANT
{4I'�Q�'ACT PERSON —
.
Business name: /,E- 5 v.c'f'',y-i S C.A.)ES 7'.." _ All contractors and subcontractors are required to be
Contact Warne: co4 licensed with the Oregon Construction Contractors Board
�� N�� f tt under ORS 701 and may be required to be licensed in the
Address:CDC e"`- pr Are,1-1-,,,A.,,,,tir 84.1.0 err s-j' 300 jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
/1A� i�C".C�t�.Ve---, _ k l.N40 H'`(t 6pI apply:
Phone:(560)(0,a3.. gc9(..,0 Fax::( )
1
E-mail. 8taiPt [_DOf\ 1w �`�CVS` -e:-/-`t''1.� .. 7- c_c)Yl.,_ 1
CONTRACTOR )3.IJII. 0.102'TICI.MI 'I rrPf
Business name: f f i 5 `/(,7,e'I l i j o a s,9 I^ (Pfeara riyEl fale�i asrJka%rtiej:
��yy — Permit fee: ;
Address:(o(7C.9 Se' 1 el Thvw hf AVE: 7 6, %6l — i
`��� State surcharge(12%of permit fee):
City/State/ZIP: U t �k ei u _ i
/ FLS plan review(40/a of permit fee):
Phone:(�G d 1 (fg,(% Cit.?I:J k,4j Fax:( ) _(Due upon application submittal.)
CCB lie.: €- 7842,,a Total permit fees: x./, try
e' Amount received:
Authorized signature:
a - h *f^^' `"" This permit application expires if a permit Is not obtained
Print name: Date: / within 180 days after it has been accepted as complete.
gp iG\NQCa{� {h� r7"^d'Fe t� < ,,( Z2.. z!
// 4 Fee methodology set by'Fri-County Building Industry
Service Board.
t\Building0Permits\[BPS-PerndtApp.0310I6.doc 440-4613T(11/02/COM/lt'EB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
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: 35
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes
Information: Hazard Group LIGHT
Density
Design Area
K. Factor 5.6k
Sprinkler Project Valuation: $ 11,489.00
B.) Type I - Hood Fire Suppression System
Flood 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 Pee:
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: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
\\Adams\Special Project\CITY\Tigard\Tigard-PermitApp.doc Rev 01/05/2012 2