Permit ;
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;; COMMUNITY DEVELOPMENT Permit #: FPS2009-00046
T[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 2S113AA01100
Jurisdiction: Tigard
Site address: 16596 SW 72ND AVE, BLDG# B11
Subdivision: OREGON BUSINESS PARK I Lot: 0
Project: Spec Space
Project Description: TI relocate less than (10) heads.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
Permit Fee - COM 06/04/2009 $62.50
#300 12% State Surcharge - Building 06/04/2009 $7.50
PHONE:
Contractor:
CROSSFIRE SPRINKLER CO
17400 SE 82ND DR
CLACKAMAS, OR 97015
PHONE: 503 - 210 -5506
FAX: 503- 210 -5538
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
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 $70.00
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1000
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. 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 with'. :0 da of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules . i • p -d by the •regon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You m. . .ta a •y of e rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. \
Issued By: \ / / /J Permittee Signature: _�!
_•
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.
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Building Pert it Application l k '
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Fire Protection System al ' .
l y; �, . , FOR OFFICE ONLl z ,. „ "+ rp
' 'e.,:; '"..,:'' - JUN Received
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Iii:'''' City of Tigard N 0 4 20Q9 DateB : , Permit No.. 0 Q - a twin,
® 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C ? Phone: 503.639.4171 Fax: 503.598.19600 1 r TI GARD Date/By: Other Permit:2)� P can, ', - 1
1 an
T I G A R D' Inspection Line: 503.639.4175 BUILDING UI tf �� Date Ready /By: Juris• ® See Page 2 for
.. 6 Internet: www.tigard or.gov , ®N Notified/Method: 1 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.
❑ I- 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: I l 1p -7 2 n d New dwelling area: square feet
City /State /ZIP: Garage /carport area: square feet
Suite/bldg. /apt. no.: l) k, Project name: & e i z _ 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: I 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.
2 t to e c l2 r l.LrtC'i A (. 1 Valuation: $ 1000.00
\ -P S I k Q r> t O Existing building area: square feet
"[ V 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:
❑ 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 BUILDING PERMIT FEES* •
Business name: e V ' g > 6 L0,k C tRleoserefermjeesehedule)
Permit fee:
Address: t 7 14 0 0 Se 7 rnct Or
Cit /State /ZIP: ,/ Q State surcharge (12% of permit fee):
y `,Q c ` -(' r ` 7o tS FLS plan review (40% of permit fee):
Phone: ( 2 I 0 ss aa Fax: 431 2 G S s! 4 (Due upon application.)
CCB Iic.: (7 `T 7 L4 (2 3 • - 1 1 �' Total permit fees:
X Authorized signature: Amount received: 10.0C)
This permit application expires if a permit is not obtained
Date: / 4 within 180 days after it has been accepted as complete.
Print name:
C i irvx n A _ p S hy ` * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits 'FPS- PermitApp.doc 03/23/06 440- 46I3T(1I/02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
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
Density
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:
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 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.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
I: \Building \Pem»ts \FPS- PemtitApp.doc 2