Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
a ' COMMUNITY DEVELOPMENT Permit #: FPS2009 -00113
r,z Date Issued: 12/08/2009
T [ GAR b 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
rn . Parcel: 1S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 300
Subdivision: Lot: 0
Project: Forest City
Project Description: Add (5) heads and relocate (5) heads.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
Permit Fee - COM 12/08/2009 $102.20
CALIFORNIA ST 49TH FL 12% State Surcharge - Building 12/08/2009 $12.26
PHONE:
Contractor:
PACIFIC FIRE SYSTEMS LLC
6704 RIVERIA CT
WEST LINN, OR 97068
PHONE: 503 - 710 -6646
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: Design Area:
K Factor:
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $114.46
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation:
Residential Square Footage:
Fire Alarm Valuation:
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
Util' otificatioriGenter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
direct questions to OUN . ' ailing 503.246.6699 or 1.800.332.2344. /
Issued By: r / Permittee Signatur '
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
A ; Fire Protection System ED ; ...
B P ermit A'�a ` I k Fe w • �» ��r ""
City of Tigard 200 Received / l C 1, Permit No.: oo/ /,S
(� Received / — S BPS d�oo
13125 SW Hall Blvd., Tigard, OR 97 Plan Review
Phone: 503.639.4171 Fax: 503. 9 ' *r•t r p < ?. Date/By: Other Permit: �U pa� . 007
�� ,�' _
Inspection Line: 503.639.4175 F TIGA -'ll�� Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: 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: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
• JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / 0 25 0 5 1 , < -/ 6 I p J New dwelling area: square feet
City /State /ZIP: 49s271a., 4 .1. / (71e Garage /carport area: square feet
Suite Idg. /apt. no.: 30 v Project name: rog.e -5ii-'- et• Ty- Covered porch area: square feet
Cross street /directions to job site: j 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.
4/ 5 � ce` ds3 4 i e/ 19 C Ci Valuation: $ 2� /�, v e
/`-1
6 J l Existing building area: square feet
New building area: square feet
pi PROPERTY OWNER' ❑ TENANT Number of stories:
Name: S!/ ea �K 5 , - r e c, r,,,„_ Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::( ) .
E -mail:
CONTRACTOR
Business name: A ,Z �..e yS ----S BUILDING PERMIT FEES*
Address: 6 7 O q let) V t •� ! e '
/,/ / t � �� Please refer to fee schedule.
City /State /ZIP: (���f� S " )L4 ,,�
F pon application /D g • °4°
Phone: (5;05) 7/ 0 .. L 1/, Fax: ( ) A cerved /R alt?
CCB lic.: , ro/ v
°ems: //V •
Authorized signature: n
./... .. This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: e / s /`� �'_,,_ Date: �- 7 — [) • Fee methodology set by Tri-County Building Industry
YYT / Service Board.
is \Building\Permits \FPS- PermitApp.doc 12/03 440- 4613T(11 /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist 9
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or. D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Dens ity
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:
O to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Project Valuation Subtotal (A, B & C): $
Permit fee based on valuation (see attached chart): $
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $
FLS Plan Review 40% of Permit Fee: $
TOTAL: $
Plan review requires a completed application and 3 sets of plans at submittal. Plan review fees are required at
submittal.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
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