Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2022-00053
Date Issued: 4/6/2022
Tt(aARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1S126CD00100
Jurisdiction: Tigard
Site address: 9985 SW GREENBURG RD
Project: Crescent Grove Cemetery Subdivision: None Lot: None
Project Description: Fire supply line.
Contractor: DON TANKERSLEY CONSTRUCTION LTD Owner: CRESCENT GROVE CEMETERY ASSOCIATION
1628 NW EVERETT ST STE 1 9925 SW GREENBURG RD
PORTLAND, OR 97209 TIGARD,OR 97223
PHONE: 503-232-0918 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/31/2022 $723.34
12%State Surcharge-Building 03/31/2022 $86.80
Type of Use: COM Plan Review-Fire Life Safety-COM 03/31/2022 $289.34
Class of Work: ALT Type of Const: Other Info Process/Archiving-Lg$2.00(over 03/31/2022 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: No 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: Cut Sheets Required:
Total $1,101.48
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $83,355.00
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: Permittee Signature:
Ca 50 .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 ApplicatiaE C E I V E[
Fire Protection System BAR .i , 2022
Received . eaf 2z' 2`M tote;
City of Tigard Receive ✓✓ ( Permit [uG(, ( �>
13125 S W Hall Blvd.,Tigard,OR 97321 I Plan Review
Phone: 503.718.2439 Fax: 503.59 {{�QQ Date/By: 3) i other Permit
ilGnRn Inspection Line: 503.639.4175 bILUING DIVISIDh ,Otte Ready/By: 7 see Page2for
Internet: www.tigard-or.gov ifred/Method: i�// �� Supplemental Information
TYPE OF WORK REQUIRED D 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/alterationreplacemant ❑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: $ f / "
❑Accessory building ❑Multi-family
Number of bedrooms:
❑Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9985 SW Greenburg Rd. New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Cres it Grove Cemetery Covered porch area: square feet
Cross street/directions to job site: From HWY 217,north on SW Greenburg Rd., Deck area: square feet
on west side of road between SW Washing Square Rd.and SW Lehman St. 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.: WCTM 1 S 126CD,Tax Lots 100 and 500 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.
`7�QLr o t.Tl r� 14�� Valuation: $ g3�355
r ! / �� Existing building area: square feet
New building area: 2,776 square feet
El PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Type of construction: VB
Address: 9925 SW Greenburg Re. Occupancy groups: B
City/State/ZIP: Tigard, OR 97223 Existing: B
Phone:(503) 639-5347 Fax:( ) New: B
❑ APPLICANT 121 CONTACT PERSON NOTICE
Business name: Don Tankersley Construction LTD All contractors and subcontractors are required to be
Contact name: Ashley Anderson licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1628 NW Everett St.,Suite 1 jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: Portland,OR 97209 apply:
Phone:( ) 352-0383 Fax::( )
E-mail:
CONTRACTOR BUILDING PERMIT FEES'
Business name: (Please refer so fee schedule
,.._.. Permit fee:
Address: 1628 NW Everett St.,Suite 1
City/State/ZIP: Portland,OR 97209 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone(503) 223-0918 Fax:( ) (Due upon application submittal.)
CCB lie.: 88663 Total permit fees:
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: Date:/13:4 30
r247..,2within 180 days after it has been accepted as complete.
• Fee methodology set by Tri-County Building Industry
Service Board.
1-16uilding Pan°itaP3-Pmn/App_031o16.d°° 44046t31(t1/0]JCOM/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:
O 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
0 11+heads: Plan review required and ❑ 6+devices: Plan review required and
(3) sets of plans. (3)sets of plans.
Additional description of work: Project only consists of a 6" pipe ii
.:re fire hydrant and ociate
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 0 No
Hazard Group
Density
Design Area
K.Factor
Sprinkler Project Valuation: $
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: sq.ft.
Fire Protection Permit Fees
Project valuation subtotal (sec 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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