Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
to . COMMUNITY DEVELOPMENT Permit #: FPS2010 -00083
Tr GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2010
Parcel: 1 S 133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Subdivision: Lot: 0
Project: Westgate Baptist
Project Description: Fire sprinkler alteration
Owner: FEES
WESTGATE BAPTIST CHURCH Description Date Amount
12930 SW SCHOLLS FERRY RD
TIGARD, OR 97223 Permit Fee - COM 08/04/2010 $102.20
12% State Surcharge - Building 08/04/2010 $12.26
PHONE: Plan Review - Fire Life Safety - COM 08/04/2010 $40.88
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: IIIB
Occupancy Grp: A -3 Height: ft
Stories: ' 2
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 $155.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 2522
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 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 Or- • •n
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 Itt.
or direct questions • ' UNC by calling 503.246.6699 or 1.800.332.2
Issued By: rmittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that bu ess day.
This permit card shall be kept in a conspicuous place on the job site u it completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
E CE�VE� Date13: T A �yy+Q3
71 City of Tigard Date/13 : i �V / PermitNo.: M5ggao_ 0983
° 13125 SW Hall Blvd., Tigard, OR 97 Plan Revie s D
1 11 .. Phone: 503.639.4171 Fax: 503.598.1960 DateB : P, A I/ �( I O Other Permit: A ll / • 4 OA
TIGARD BP= Inspection Line: 503.639.4175 AUG 0 4 rrti" Date Ready :y: El See Page 2 for
Internet: www.tigard- or.gov L J ! O Notilied/Method: . y Supplemental Information
CITY OF TIGARD 61/4 ✓iry i,5,r1
TYPE °& MNG DIVISION 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.
Valuation: $
❑ 1- and 2- family dwelling commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder iJ• ❑ Other: Number of bathrooms:
/ Au) oJ O B S E INFORMATION AND LOCATION Total number of floors:
Job site address: 41 - Ab „yf _ ' . • New dwelling area: square feet
City/State /ZIP:
- 7J, 4 72_/2 j ®VE 97 7---7-- Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: 7 bil,P77.5 ! 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 may, N �/ f work indicated on this application.
4L /) :%-1� % /D2R O e�4 re 1' — 4/ • 83 Valuation: $ z 522-. cent)
rk 6X-15 T/A/ CC 907 co,c_ etovom.6c Existing building area: square feet
Et. -e,t-c) ,(1 (/ e Z ,// Ll /. - New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: IA-! .` 4- --r -p os 4' ) ('_ Type of construction:
Address: /7_930 ,.5i,,/ 6ej-{fr(,L 5 P D : Occupancy groups:
City/State/ZIP: �i e_ D , pie._ f 7 z_ -- Existing:
Phone: ( ) Fax: ( ) New:
fig- APPLICANT
� ❑ CONTACT PERSON NOTICE
Business name: a 7Ar l�/ 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: w y,. -TT Fji. p 7----721)/t/ (Please refer to fee schedule)
,� / �/J Permit fee:
Address: 91)95 514/ BUf,/i/14 ! I 5 l State surcharge (12% of permit fee):
City /State /ZIP: -r;6 Q C, 97 Z Z 3
FLS plan review (40% of permit fee):
Phone: (3) b 23¢ , z4Z B Fax: ( E53) 6 ,6¢ - 9657 (Due upon application.)
CCB lic.: & 407 7 Total permit fees:
Authorized signature: Amount received: if`ss• 3
�� This permit application expires if a permit is not obtained
LPrint name: .a���� 1 ( A - Date: S — 4 -/o within 180 days after it has been accepted as complete.
• 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)
,
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.
'4.1teration J1+ heads: Plan review required.
El Repair
Number of sprinkler heads:
Additional description of work:
R166 1
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 El 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.
http: / /www.ci.tigard.or.us /city_ hall /departments /cd /docs /FPS- PermitApp.doc 2