Permit in,h „ � FIRE PROTECTION SYSTEM PERMIT
CITY OF TIGARD
R ' f COMMUNITY DEVELOPMENT Permit #: FPS2010 -00015
ii, Date Issued: 02/26/2010
416Aka 13125 SW Hall Bivd., Tigard OR 97223 503.639.4171 Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9483 SW WASHINGTON SQUARE DR AO6B
Subdivision: Lot: 0
Project: Pac Sun
Project Description: Add /relocate approximately (48) sprinkler heads at TI.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Permit Fee - COM 02/11/2010 $145.24
CARLSBAD, CA 92008 12% State Surcharge - Building 02/11/2010 $17.43
PHONE: Plan Review - Fire Life Safety - COM 02/11/2010 $58.10
Contractor:
WYATT FIRE PROTECTION INC.
9095 SW BURNHAM
TIGARD, OR 97223
PHONE: 503 - 684 -2928
FAX: 503 - 684 -9657
Type of Use: COM
Class of Work: ALT Type of Const: IIB
Occupancy Grp: M Height: ft
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard:
Density: Design Area:
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $220.77
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 6300
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
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: - • / Permittee Signature: 'N 117',P/ C � / 7p /
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.
Building Permit Application
Fire Protection System RECF FOR OFFICE USE ONLY •
City of Tigard Received
gqi
. Perna[ No.: •
1 11 q ,�sC�lO 0
13125 SW Hall Blvd., Tigard, OR 97223 FEB 1 1 2010 Plan Review _I� �
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : i Other Permit:,t , , . a zaa
TIGARD Inspection Line: 503.639 C ! Y OF T IGAR Date Read /B a See Page 2 for
Internet: www.tigard- or.gov + 1 1Il D0��'a DIVISION Notified/Method: I h 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
=pi-Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling Commercial /industrial
❑ Accessory building El Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 95b5 ii, 14).A „ sp. KA-a_ DR___‘ New dwelling area: square feet
City /State /ZIP: I l6f -/2 D ` 7 /2.. 7 2-z Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: ?AC SUS 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.
574*-.-- Valuation: $ 62 -tJ `AO
/ 5 �) A � -t � 1 — 7 2 Existing building area: square feet
" �i / 1— New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
taAPPLICANT ❑ CONTACT PERSON NOTICE
Business name: S�� LV 4 / 7 / L 127/e.-- 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 BUILDING PERMIT FEES*
,�/ ,-/ R � T � `-2 ` (Please refer to fee schedule)
Business name: l�✓ 7/ 'O ^f
'- / 1 7� u n Permit fee:
Address: 9095 .5{,-/ 2 L)R /h4 6
State surcharge (12% of permit fee):
City /State /ZIP: 1 , a , 4 - !2 . L a4_ C 7ZJZ 3
FLS plan review (40% of permit fee):
Phone: (rja5) &i —2 / Z Fax: ( 6134 - 9& 6.7 (Due upon application.)
CCB lic.:
0/0 7 . 7 Total permit fees:
Amount received: '� n , 77
Authorized signature: / /
.te
/ This permit application expires if a permi is not obtained
Print name: _FAA E 7 9L,4� Date: DZ - // -/0 This
180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
r:\Building \Permits \FPS - PermitApp.doc 03/23/06 440- 4613T(11/02/COM /WEB)
/ '. -. : ' ' - :' ' e'j OA -00
4- Q52oto- (D00 t5
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
D,escribewo`rk "' to" be`done, =:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
- Iteration •11+ heads: Plan review required.
❑ Repair a gg ��
Number of sprinkler heads: 4-ZJ
Additional description of work:
T" e of5 stem Com lete =A B` C or _':D a hcable
A ) Commercial Sprinkler ��
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
`B.) Type. L...Hood; F><re ,Suppre`s,sibp System r �' . ,
Hood Project Valuation: $
C )'; Fire, Alarm
�N
Y °s
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D )' Residential Sprinkler (StandAlone Sys ten)__
Square Footage: Permit Fee:
0 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.
Fire,Protc"` ,
`� ction,'Permit FeesS, "° z � ��
.t .
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: $
Plan review requires a completed application and 2 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.
http: / /www.ci.tigard.or.us/ city_ hall / departments /cd /dots /FPS- PermitApp.doc 2
CITY OF TIGARD §oG� _ 006/
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 4171 u , '� 4��;;p /,„; ��
Inspection Requests (24 Hrs.): (503) 639 -4175 412. / � -
3/ v
INSPECTION WORKSHEET FOR DATE: T PAGE:
SITE ADDRESS: q 7 P3 A L OT CLASS OF WORK:
SUBDIVISION: #: TYPE OF USE:
PROJECT NAME: 7 �
DESCRIPTION: /� c _ '� _ ^^���
OWNER: PHONE #: duo
CONTRACTOR: PHONE #: 3 / _ ("SZ
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
5 i (3 Lc Ire"- ii^ —�
Correcti. ns /Comments/ Instructions:
/ I 6 4...„.. . / f L
._. . W.— ■..- A ; I/ ,-0—... o' _ ...
r
AG 40 _ Lam_ .. A / t��� ,g u��.
❑ PASS b4P-AR-T-IAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: C/ d Date: 3 / Z 1 " Phone #: (503) 718- 2