Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2022-00047
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/26/2022
Parcel: 1 S126CC00200
Jurisdiction: Tigard
Site address: 10065 SW CASCADE AVE
Project: Tesla Subdivision: None Lot: None
Project Description: Fire sprinkler permit-add(35)sprinkler heads to provide coverage for TI work.
Contractor: EXPRESS FIRE SYSTEMS INC Owner: 10065 SWC LLC
670 S 28TH ST BY ALSTON &BIRD LLP
WASHOUGAL, WA 98671 BANK OF AMERICA PLAZA
101 SOUTH TRYON ST STE 4000
CHARLOTTE, NC 28280
PHONE: 360-356-8105 PHONE:
FAX: 360-953-8394
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/25/2022 $188.28
12%State Surcharge-Building 03/25/2022 $22.59
Type of Use: COM Plan Review-Fire Life Safety-COM 03/25/2022 $75.31
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 03/25/2022 $6.00
Occupancy Grp: B Height: 25 ft 11x17)
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0.1 Design Area: 1500
K Factor: 05.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $292.18
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $10,400.00
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: a12"� ` ��
Call 503.639.4175 by7:00 a.m.for the next available inspection date. C `
p
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 ECEIVEC` GO
Fire Protection System 7 ZO22 FOR OFFICE USE ONLY
/Ji
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Cl of Tigard Received
Date/By: Oa/5 0�- r Permit No.:F�ou�MO
111 a 13125 SW Hall Blvd.,Tigard,OR 97223GI I Y OF I IUMt-I[ Plan Review u
g Phone: 503.718.2439 Fax: 503.598.1 /�h Date/By: 7 Other Permit:
T tC AK D Inspection Line: 503.639.4175 `G + ��Z ILDING DIVISION' D to Ready/By: Jana VISee Page 2 for
Internet: www.tigard-or.gov otified/Metho ' Supplemental Information
TYPE OF WORK QUIRE ATA: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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1-and 2-familydwellingValuation: $
❑ Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10065 SW Cascade Blvd. New dwelling area: square feet
City/State/Z1P: Tigard, OR Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Tesla TI Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
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.
Add sprinkler heads to provide coverage for TI work Valuation: $ 10,400
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Tesla Inc. Type of construction:
Address:901 Page Avenue Occupancy groups:
City/State/ZIP: Freemont, CA 94538 Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON
NOTICE
Business name: Express Fire Systems All contractors and subcontractors are required to be
Contact name: Tiffany Bell licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 670 S 28th St. jurisdiction in which work is being performed.If the
City/State/ZIP: Washougal, WA 98671 applicant is exempt from licensing,the following reasons
apply:
Phone:(360)583 - 8624 Fax: :( )
[-mail: Design@expressfiresystems.corn
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to jee schedule
Business name: Express Fire Systems
Permit fee:
Address:670 S 28th St.
State surcharge(12%of permit fee):
City/State/ZIP:Washougal WA 98671
FLS plan review(40%of permit fee):
Phone:(360 )953 - 8432 Fax:( ) (Due upon application submittal.)
CCB lic.: 193272 Total permit fees:
' Amount received:
Authorized signature: / g
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Tiffany Bell Date: 3/7/22
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_03I 016.doc 440-4613T(11/02/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: 35 Number of alarm devices:
j 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
II11+ heads: Plan review required and ❑ 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 ❑ Yes ❑ 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(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%ofpermit fee): $
FLS Plan Review (40%of permit fee): $
TOTAL: $
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