Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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COMMUNITY DEVELOPMENT Permit #: FPS2009 -00098
Date Issued: 10/21/2009
T I G NRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15875 SW 72ND AVE
Subdivision: OREGON BUSINESS PARK III Lot: 40
Project:
Project Description: Modify existing fire suppression system, less than 10 heads.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 Permit Fee - COM 10/21/2009 $91.44
12% State Surcharge - Building 10/21/2009 $10.97
PHONE: 503 - 624 -6300
Contractor:
FIRESTOP CO
3203 NE 65TH ST. #2
VANCOUVER, WA 98663
PHONE: 360 - 718 -8604
FAX: 360- 718 -8603
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: 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 $102.41
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 2000
Residential Square Footage: 0
Fire Alarm Valuation: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Special , Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is n• s arted within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow e rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. ou Ly obtain a copy of the rules
or direct que iori to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: n' 1 ^ n ,\ dt Perm ittee Signature:
\�1IA I Ai J
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.
BuQcling Permit Application , F z
am i Fire Protection System FOR OFFICE USE ONLY
Cl of Ti and J J Received
Date /B Permit No. A r �� � •
1111
- t} g OCT 0 C ✓ . q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Permit:
CITY OF YIGARD Date Ready/By: /By: Juris: ® See Page 2 for
TIGARD Inspection Line: 503.639.4175 B UILDING DIVISION } Supplemental Information
Internet: www.tigard- or.gov Notified/Method: PP
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.
r.�, Valuation: $
- c_
❑ 1- and 2- family dwelling .ommercial /industrial
Number of bedrooms: ,'
❑ Accessory building ❑ Multi- family,
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION. AND LOCATION
Total number of floors:/
Job site address: 15 S•-is (,J '1 2,�J ,Qt,e_ New dwelling area/ square feet
City /State /ZIP: Po v ....'- 1� 2 7 2_ 2q Garage /carportArea: square feet
Suite/bldg. /apt. no.: Project name: Covered uilch area: square feet
Cross street/directions to job site: Deck aa(a: square feet
Ottt6r structure area: square feet
REQUIREDDATAM- 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.
I � Valuation: on
y J Existing building area: square feet
New building area: square feet
• • ❑ PROPERTY OWNER TENANT Number of stories:
Name: C a 1 y I cyI- e., l ? 1 ` Q i " d , ' ( Type of construction:
Address: c---- 0. x� Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
APPI ICANT 0 CONTACT PERSON � NOTICE - -
Business name: E---Q ✓ e- s TO Co , All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: A (, i , r Z , i under ORS 701 and may be required to be licensed in the
Address: 5 7 O i/ j6 , Gs- s�-�, "ee-f- jurisdiction in which work is being performed. If the
( applicant is exempt from licensing, the following reasons
City /State /ZIP: G -J.J� ✓e- 2 / ^7 / / apply:
Phone: 66o) ) 1 8 - g& `( / Fax: : y6)0) ((C)-gtPo3
-
E -mail: A( r @ + [ ,e.S-F-tSpo • CC) -/-*s^ ..
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: 5
C� � Permit fee:
Address:
State surcharge (12 %of permit fee):
City /State /ZIP: FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.: Total permit fees:
Amount received: t 00_ (�
Authorized signature: 1
This permit applicat expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: A i L L 2 ✓ Date: ID " z_(....0 * Fee methodology set by Tri- County Building Industry
Service Board.
1 . \Building \Permits \FPS- PermitApp doc 10/01/09 440- 4613T(I I /02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Descnbe;work,to be ° '
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition' -10 heads: No plan review required.
Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work: ( �
I t oL � , S Pr-4J'
r 3IIJ� �� S -F q V ,e u> 1.J4.I 1 5
Type ofASystem (Complete A, B, C or D as applicable)
A) Commercial Sprinkler.
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B )r Type I„ 'Hood Fire,Suppression'Syste'in: 5 G ..
Hood Project Valuation: $
C) Fire Alanri ' }
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 f '�
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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
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