Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
0 • • COMMUNITY DEVELOPMENT Permit #: FPS2010 -00101
TIGARD 13125 SW HaII Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 1 S135BA00100
Jurisdiction: Tigard
Site address: 10205 SW WASHINGTON SQUARE RD
Subdivision: WASHINGTON SQUARE TOO Lot: 0
Project: Thirsty Lion
Project Description: Add smoke detector and pull staion to existing fire alarm for fire sprinkler monitoring.
Owner: FEES
PPR SQUARE TOO LLC Description Date Amount
BY THOMSON PROPERTY TAX SERVICES, Permit Fee COM 09/14/2010 $51.09
2235 FARADAY AVE STE #0 12% State Surcharge - Building 09/14/2010 $6.13
PHONE: Plan Review - Fire Life Safety - COM 09/14/2010 $20.44
Contractor:
GUARDIAN SYSTEMS
13500 SW PACIFIC HWY, STE 245
PORTLAND, OR 97223
PHONE: 503 - 639 -3723
FAX: 503 - 624 -8258
Type of Use:
Class of Work: 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 Catcs Provided: Cut Sheets Required:
Total $77.66
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
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 Oregon
Utility 'cation Cen - . ose rul -r; set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtai a copy of the rules
or rect questions to OUNC b ing 503.246.6699 or 1.800.332.2344.
I sued By: I /� / 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.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard RECEVE k 'eceIV eI Date /B
4. /4 J Permit No.: cis 2. f
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 SEP 1 4 2010 Pla Date /B n Rev : iew Other PcnniC
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris: El See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified /Method: Supplemental Information
TYPE OF WOR IBDILDING 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.
❑ I- and 2-family dwelling aluation: $
y g 'Si '� Commercial /industrial
❑ 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: \AaV 5 Si Qiis\-\r.tsr\ S / l Eci_ New dwelling area: square feet
City /State /ZIP: 11I W6. `'h- Ccl � �3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: - it z--/ LY 6N.% 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.
A4)+9 5nnok„F 1,F "r f— L J 7"1'L STA,r1m) Valuation: $ (. UO . (11S
r D ,--.?( I S 1 t' /OD 1=- 4/..f, A " 12 - 41 C..° A-- C: 1'0 f Existing building area: square feet
C 9- 1.. t/A tL t- t4L OVVilr 1T C1 ¢ ► l s4 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. lithe
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
' (Please refer to lee schedule)
Business name: GlA� 5V4e�MS (\k-) Permit fee:
Address: \3S 5 \ � (4, i V7 p -t e i... emit tee State surchar e l2% of
City /State /ZIP: 3 o�.A \� C� ce FLS plan review g ( P )
(40% of permit tee):
Phone: J t ) tiy‘ .1.3,a Fax: (13) 624 — ( 0,5`3 (Due upon application.)
CCB lic.: 5 7j uf6� Total permit fees: a�
v Amount received: T 77. '4
Authorized signature:
ay Amount
This permit application expires if a permit is not obtained
Print name: ��, m L L . ', ;<eK. Date:
within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
1:\Building\Permits\FPS- PermitApp.doc 10/01/09 440 -4613T(1I /02 /COMlWEB)
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: A n v 5 04t3 t V S. t t=`t t r i t P O 14- S , rAr l vN
j 0 - vft.G A t-p4 /In As R ►S p„ 12-(th f►�
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: $ 5 V 0
•
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
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.
http: / /www.tigard- or.t;oe/ city_ hall / departments /cd /dots /FPS- PermicApp.doc 10 /01 /l )