Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1 . COMMUNITY DEVELOPMENT Permit#: FPS2022-00116
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/7/2022
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15600 SW RIVER TERRACE BLVD
Project: Art Rutkin Elementary School Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Hood fire suppression system.
Contractor: ALEXANDER GOW FIRE Owner: PACIFIC REALTY ASSOCIATES
1436 NW 53RD ST ATTN: N PIVEN
SEATTLE,WA 98107 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 206-632-2810 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Info Process/Archiving-Lg$2.00(over 09/06/2022 $2.00
11x17)
Type of Use: COM Info Process/Archiving-Sm$0.50(up to 09/06/2022 $9.00
Class of Work: NEW Type of Const: VA 11x17)
Occupancy Grp: E Height: ft Permit Fee-COM 09/06/2022 $123.72
Stories: 12%State Surcharge-Building 09/06/2022 $14.85
Plan Review-Fire Life Safety-COM 09/06/2022 $49.49
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: Cut Sheets Required:
Total $199.06
Valuations:
Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
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 co rules
Issued By: s4y�� � / Permittee Signature:
Xf1503.639.4175 by 7:00 a.m.for the next available insp ti date.
This permit card shall be kept in a conspicuous place on the job site unti mpletion of the project.
Approved plans are required on the job site at the time of e h inspection.
4
if
Suildina Permit Application
Fire Protection System FOR OFFICE I,SE ONLY
rrCity of Tigard Dule/B a '/�
4 DalcBy f�' q"��/a;.i Permit No.: j a�'C i���
13125 SW FIa31 Blvd.,Tigard,OR 97223 `�' . : �;
ill
Phone: 503.718.2439 Fax: 503. Plan k°vlcyr>, ���
ECEIUED Dale By. Olprrprnt:
TiOAhA Inspection Line: 503.639.4175 Date lteady/by: JUAN ® See Page 2 for —
Internet: www.tigard-or.gov Notifod/Method: ' t. ... ;, Lelia
Supplemental lnfortaation
TYPE OP WORK
TI( _. REQUIRED DATA:1-AND NAMILYDWEhLING
iy Permit fees*are based on the value of the work performed.
New construction
�U���Q�GARD Indicate the value(rounded to the nearest dollar)of all
LI �l t7 Addition/alteration/replacement Ot er: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
• ❑ l-and 2-family dwelling Commercial/industrial Valuation: $
CIAccessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other; Number of bathrooms:
/ -6,6„) ,Jolt SITE D,YFORMATJONT AND LOCATION Total number of floors:
Job site address:e� _ 2 • MQn n New dwelling area: square feet
City/State/ZIP: Q 7?. /ulJSQ s�!Oara ca ort area:
l t�� rp square feet
Suite/bldg./apt.no.: !' Project name: t �j ,ry�.N,�Cy Covered porch area: square feet
Cross street/directions to job site: 7 1 vt(w 0 Deck area: square feet
aYto IC Llr s( Art I �/% � Other stntehue area: square feet
fb plea.<�'�-a. r.tC p E b7 S, 7 ; .REQII L
tED DATA:COMMERCIAUSI{C}IECKLIST
Subdivision: •' � Lot no.: 4S4 I, 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.: 1 i5 SGC0Qe�aO
equipment,materials,labor,overhead,and the profit for the
DESCRIPBIoN OF'ywoRK work indicated on this application.
/ fleti(et ' o•F 41,1 S v I �'lao2. A-f?GH7%/l� Valuation: $ _!/'oo• OD
t 1>r Y jy�gyy� , Existing building area: square feet
New building area: square feet
❑�IPROPE�TY OWNER . ..:;lit TENANT Number of stories:
Name: �a
)
groups: C
1 "I`CJe � rTA.f�/ Type of construction: ��
Address: / St'1� &-}'for Li • Occupancy
IOM,,,nGt"Ge II,
City/State/ZIP: 7-lri®,,dt/c ®/L 197 4
Existing:
Phone:( ) Fax:( ) L
��,rf New:
C;0.4PPLICANT C�CONTACT' PERSON Note
Business name: A'�K y„�� 600-1 Eft_ 6,9,(...if All contractors and subcontractors arc required to be
Contact name: k f D -4,,„ 6 VIidre v l' licensed with the Oregon Construction Contractors Board
1 y3 6 ke1 w 5 3� Sfi• under ORS 701 and may be being to be licensed in the
Address: jurisdiction in which work is being
performed.If the
City/State/ZIP: s�i,1.� WA WiD7 applicant is exempt from licensing,the following reasons
Phone:/7/)„4//7r, 114 6nFax::( ) aPPIYE-mail: `A1 Alc oOw4ti'e-. c 4
` .I
". CONTRACTOR BU ,DING`PERMII°TEES■
Business name: I e re. �A i'Plearare/er fofeasch ..
Address: J� d ,i w 53 ,S !J v�' Permit fee:
City/State/ZIP: Sjf aa�ra WA 8i/r7 f State surcharge{12%of permit fee):
•/ V FLS plan review(40%of permit fee
Phone:( ) Fax:( ) (Due upon application submittal /4i9 tko
CCB tic.:�+3�61S' Total permit fees:
Authorized signature: Amount received:
Tills permit application expires if a permit is not obtained
Print name: iipS1,,u4,/, V GilettG 0 Date. 7/2f/n„q Z within 180 days after it has been accepted as complete.
IN[/ * Fee methodology set by Tri-County Building Industry
Service Board.
ilBuikting\Pamil WPS-Permithpp aJIOT6.iI 440-4613fli l/e7.mOMlwatt)
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:
I, New system Number of sprinkler head Number of alarm devices:
❑ Addition or ❑ 1-10 heads: Affidavit required and
q ❑ 1-5 devices: Affidavit requited 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 ❑ 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: Sprinker Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K.Factor
Sprinter Project Valuation: I $
B.) Type t- Hood Fire Suppression System
Hood Project Valuation:] $ `?r/00
C.) Fite Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fite Alarm Project Valuation: I $
D.) Residential Sprinkler(Stand Alone System)
I 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.
6
Fire Protection Perna Fees
Project valuation subtotal(see A,B & C above): $
Permit fee based on project valuation (sec 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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