Permit Building Permit Application Fire Protection System RECEIVED I t)I(OFFICE l-SE ONL,
Received i
11111 City of Tigard ,UG 2 8 2023 DateBy: ti$I'1AZ3• rip PermitNo.:`"pSZQ23,Qb104
• 13125 SW Hall Blvd.,Tigard,OR 9722PlanRevieee��Phone: 503.718.2439 Fax: 503.598.1960 DateBy: "Olt 2.3Other Permit:
TIGARD Inspection Line: 503.639 4175 CITY OF TIGARD Date Ready/By: /. Sufis: gi See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method:���(�3 /QJ I Supplemental Information
TYPE OF WORK REQUIRED DATA: 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-family dwelling ®Commercial/industrial Valuation: $
ElAccessory 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: 12230 SW MAIN ST New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: STE 100 Project name:ipadellt laic" 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.
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.
Valuation: $ 2700
Move Fire Alarm System from Combo panel to New Dedicated Panel,with Cell Communicator
Existing building area: square feet
AU existing devices and cable to remain.
New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories:
Name: PADDLE PALACE TABLE Type of construction:
Address: 12230 SW MAIN ST STE 100
Occupancy groups:
City/State/ZIP: Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT 12 CONTACT PERSON NOTICE
Business name: Johnson Controls Security Solutions All contractors and subcontractors arc required to be
Contact name: Tjy Helms licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6305 SW Rosewood St jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: Lake Oswego,OR.97035
Phone:( ) 971-294-1320 Fax::( )
E-mail: Tjy.Helms@JCLcom
CONTRACTOR BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule
Johnson Controls Security Solutions Permit fee:
Address: 6305 SW Rosewood St
City/State/ZIP: State surcharge(12%of permit fee):
Lake Oswego,OR.97035 FLS plan review(40%of permit fee):
Phone:( ) 971-294-1320 Fax:( ) (Due upon application submittal.)
CCB lie.: 197010 Total permit fees:
Authorized signature: "(/ 7 Amount received:
This permit application expires if a permit is not obtained
Print name: Tjy Helms Date: 7/24/23 * within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board.
LEI uilding\Permits\FPS-PermitApp_031016.doc 44046132(11/02JCOM/WEI3)
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:
Addition or El 1-10 heads: Affidavit required and IN 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
❑ 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 El Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinlder 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% of permit fee): $
FLS Plan Review(40%of permit fee): $
TOTAL: $
I:\Building\Permits\FPS_PerndtApp_031016.doc 2