Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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COMMUNITY DEVELOPMENT Permit #: FPS2010 -00030
4 t cA Rte 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/09/2010
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 460
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: AM Trust North America
Project Description:
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - COM 04/07/2010 $64.54
PORTLAND, OR 97224 12% State Surcharge - Building 04/07/2010 $7.74
PHONE: 503 - 624 -6300 Plan Review - Fire Life Safety - COM 04/07/2010 $25.82
Contractor:
STANLEY CONVERGENT SECURITY
SOLUTIONS INC
15495 SW SEQUOIA PKWY STE 100
PHONE: 503 - 968 -3353
FAX: 503- 968 -3398
Type of Use: COM
Class of Work: ALT Type of Const: IIB
Occupancy Grp: B Height: ft
Stories: 4
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type:
Standpipe Required: No Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Yes Alarm Type: Automatic
Pull Station Required: No Smoke Detectors Req: No
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $98.10
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 1000
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. k will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuanc , r if work is suspe ded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Center. Those - ar- et forth in OAR 952 - 001 -0010 through OAR 952 - 001 -010 ou may obtain a copy of the rules
or erect questions to OUNC calling 503 •.6699 or 1.800.332.2344.
I sued By: � � jrj / P' rmittee Signature:
Cali 503.639.4175 by 7:00 a.m. for an inspection that mess day.
This permit card shall be kept in a conspicuous place on the job completion of the project.
Approved plans are required on the job site at the time of each inspection.
3ui'4ing Permit Application
Fire Protection System ' v Jl 4,.) FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 - • w Plan Review' I • Q 3�
Phone: 503.639.4171 Fax: 503.598.1960 DateBy: k� r !0 Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By: /�� O (/ luris: El See Page 2 for
Internet: www.tigard- or.gov YY r 'r; <v' 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: 12909 SW 68 PARKWAY #460 New dwelling area: square feet
City /State /ZIP: PORTLAND, OREGON 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: AMTRUST NORTH AMERICA 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.
INSTALL TWO (2) HORN STROBES AND TWO (2) STROBES TO EXISTING FIRE Valuation: $$1000.00
SYSTEM BOOSTER
Existing building area: square feet
New building area: 3512 square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: PACIFIC REALITY ASSOCIATES Type of construction:
Address: 15350 SW SEQUIOA PARKWAY Occupancy groups:
City /State /ZIP: PORTLAND, OREGON 97224 Existing:
Phone: ( ) Fax: ( ) New:
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: STANLEY SECURITY SOLUTIONS All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: GARY TAUSCHER under ORS 701 and may be required to be licensed in the
Address: 15495 SW SEQUOIA PARKWAY jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: PORTLAND, OREGON 97224 apply:
Phone: (503) 968 -3355 Fax: : (503) 968-3398
E -mail: GTAUSCHER @STANLEYWORKS.COM
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: STANLEY SECURITY SOLUTIONS Permit fee:
Address: 15495 SW SEQUOIA PARKWAY State surcharge (12% of permit fee):
City /State /ZIP: PORTLAND, OREGON 97224 FLS plan review (40% of permit fee):
Phone: (503) 968 -3355 Fax: (503) 968 -3398 (Due upon application.)
CCB lie.: 161567 Total permit fees:
f ` Amount received: 9 8 .I 0
Authorized signature: -7" -• } A � - This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: GARY TAUSCHER Date: 4/6/2010 * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building'Permits \FPS - PermitApp.doc 03/23/06 440- 4613T(11/02 /COM/WEB)