Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111
° : COMMUNITY DEVELOPMENT Permit#: FPS2022-00057
Date Issued: 5/4/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136DD03400
Jurisdiction: Tigard
Site address: 11740 SW 68TH PKWY 200
Project: Mindful Therapy Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Fire Alarm Permit-modify existing addressable central station. Includes addition/relocation of horn and strobes.
Contractor: POINT MONITOR CORPORATION Owner: 11740 SW 68TH PARKWAY LLC
5863 LAKEVIEW BLVD STE 100 111 SW COLUMBIA ST STE 1380
LAKE OSWEGO, OR 97035 PORTLAND, OR 97201
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 04/21/2022 $123.72
12%State Surcharge-Building 04/21/2022 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 04/21/2022 $49.49
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 04/21/2022 $4.00
Occupancy Grp: B Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 04/21/2022 $3.00
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: Yes Alarm Type: Automatic
Pull Station Required: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $195.06
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,347.00
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: 'tee Signature:
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 ?tn' `EI /C D
Fire Protection System V FOR OFFICE USE ONLY
City of Tigard MAR 3 11012 Received 41sin 045 DateBy: re
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 1 I r''p DN Plan Revie
Lit- C 1r11 y: "4„ �� Other Permit:
Phone: 503.718.2439 Fax: 503.598.1964 DateB
Inspection Line: 503.639.4175 RUING DIVISION Date Ready/By: / t ® See Page 2 for
i I,,, \I,I) Notifi d/Metho� ,��.,_//�/ Supplemental Information
Internet: www.tigard-or.gov Y�,
:�§ `6.`A,7; :`L ',r .- 1 9 M£' J• *c,",, By ,rt.it .',.•,` i• v••elms s.B`, • ..
❑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
IN Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling $Commercial/industrial
Number of bedrooms:
❑Accessory building
El Multi-family
ElMaster builder ❑Other: Number of bathrooms:
ia; ,i . :.' 1.,.,;.: .,i. t.' 1 _ 1 1. Total number of floors:
Job site address: 17 90 5 W C$tt ? Kwi4y New dwelling area: square feet
City/State/ZIP: Ppp'(2.TI....Q11)7 O 9 7223 Garage/carport area: square feet
/
Suite/bldg./apt.no.: a Q O I Project name: )M;ylk I Th. pU Covered porch area: square feet
Cross street/directions to job site: i Deck area: square feet
Other structure area: square feet
Subdivision: I 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
ifirMirstIPM.r. is+ "4lV! work indicated on this application.
• t ��1 Valuation: S 4 �
�p�t eJCIS'tl Y1 c1df' -b I� ��4fa1Ct�t"101� Tire-
-1 inn/i�'dt!.C�t 1dh O� Existing building area: square feet
Ca.IC,t. NM SNStf.W1 • I1NL1U4165 a,Glat� t
r 5 JD-VMS 7 b New building area: square feet
Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
Business name: 0;r. t /\/\ y\ito . (p12?_ All contractors and subcontractors are required to be
tJ,.S$ e\1 1L D1 licensed with the Oregon Construction Contractors Board
Contact name: � -` under ORS 701 and may be required to be licensed in the
Address:5 SG3 Lo.1'evt Cw 'lvc\ ' /OO jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:LAvE Os lat�U 1 02-/ qF .7C 35 apply:
Phone:( j))6a7- _1O/OQ } Fax: :( y )
E-mail: ('(�u.�'O�y10'v Q'Pa 1 l 0 1 1 oit co Mh
Business name: p‘v rn 0Y11 tb f Cp r r• Permit fee:
Address:5 S b3 LA<G Vi CtW "Blvd. - r7 f°0 State surcharge(12%of permit fee):
City/State/ZIP: (q ke Qs e� / /o , ��,) 03 5 FLS plan review(40%of permit fee):
Phone:(5O3 ) 6a,7-Q I od Fax:( ) (Due upon application submittal.)
CCB lic.: 13590 I 1 I Total permit fees:
!/JI, l- d 4 2� Amount received:
Authorized signature. This permit application expires if a permit is not obtained
Print nam S G\\ 1 _ ML�``u,A Date: 3-30-2og 2. within 180 days after it has been accepted as complete.
e: t_ .�'"' * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PermilApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
Describe work to`be dont� ;
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:
0 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 6+ devices: Plan review re uired and
❑ 11+heads: Plan review required and ❑ q
(3)sets of plans. (3) sets of plans.
Additional description of work:
T r of S.s stern Cor fete B C or D as a livable 4".
mmerci C A.) o rinld
�gS•.ip M � ". .. Ic ,,, a�.� ,.n - ,.
Wet
Sprinkler Type 00 Dry
Additional Standpipes
Information: Sprinkler Supply Line D Yes D No
Hazard Group
Density
Design Area
K.Factor
Sprinkler Project Valuation: I $
L `./X.41
Hood Project Valuation: $
•
Submittal shall Batten,Calculations Yes
include: Individual Component ►T Yes
Cut Sheets Fire Alarm Project Valuation: $ t + 547
l7.
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 valuationjsee fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12%0 of permit fee): $
FLS Plan Review(40%0 of permit fee): $
"..__ TOTAL: $
I:\Budding\Peunitc\FPS PetmitApp 031016.duc 2