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Permit
CITY OF TIGARD • FIRE PROTECTION SYSTEM PERMIT 1 COMMUNITY DEVELOPMENT Permit #: FPS2010 00103 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/29/2010 Parcel: 1S1260000300 Jurisdiction: TIGARD Site address: 9524 SW WASHINGTON SQUARE RD H08 Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project: H & M Project Description: Sprinklers for new mezzanine. Owner: FEES PPR WASHINGTON SQUARE LLC Description Date Amount 2235 FARADAY AVE STE #0 CARLSBAD, CA 92008 Permit Fee - COM 09/16/2010 $328.16 12% State Surcharge - Building 09/16/2010 $39.38 PHONE: Plan Review - Fire Life Safety - COM 09/16/2010 $131.26 Contractor: WYATT FIRE PROTECTION INC. 9095 SW BURNHAM TIGARD, OR 97223 PHONE: 503 - 684 -2928 FAX: 503- 684 -9657 Type of Use: SF Class of Work: ALT Type of Const: IIB Occupancy Grp: M Height: ft Stories: 2 Commercial Sprinkler System: Sprinkler Required: Yes Sprinkler Type: Wet Standpipe Required: Hazard: LT Density: .20 Design Area: 990 K Factor: 5.6 Commercial Fire Alarm System: Fire Alarm Required: Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $498.80 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: 23627 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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to • - C by calling 503.. • < = : • _ • 8'0 . . • 4. Issued By Permittee Signature: 0/ 47 � i Call 503.639.4175 by 7:00 a.m. for an inspection that busin .ss day. This permit card shall be kept in a conspicuous place on the job site until ompletion 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 c,,\ `J Da u Permit No.: -,� ,,� _ o 13125 SW Hall Blvd., Tigard, OR 97.' . ' Plan Review �l Phone: 503.639.4171 Fax: 503.598. `�-Q \� 1 Date/13 : Aila j►i Other Permit: \ O 10,E / / it )0— TIGARD Inspection Line: 503.639.4175 Da Rea dyB : Juris: s ee Page 2 for Internet: www.tigard- or.gov � K.,�0 Notified/Method: I / /0 ler U Supplemental Information \ ' N 1 G S � ■ 1 i! t }G/` ) A ( s,, (SLCt 6 - -t Air i TYPE OF WORhL Pk" REQUI D DvA 1- A 2 -F Y DWELLING ❑ New construction ❑ l 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 WGm pmercial /industrial Valuation: $ El 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: 958 S 51„,,i kJ, - 5/4 set , P vi-70 New dwelling area: square feet City/State/ZIP: 77a .4.-'7 1) / 1, 9 7 2_2- 3 Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: 4 M T = . ..511-5Z-1.__ 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: l 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 �j / DESCRIPTION N OF WORK � work indicated on this application. e P/ZD �/ / J) F// w `' 9K-I kj P l - C- - // ®) Valuation: $ 23 to Z7, °210 G if.i » ' 7 1 � 0 i � -X. Q Mkl Existing building area: square feet [� 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: PPLICANT ❑ 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* W y �7 / F M P2 Business name: , D -r C- 7 / (Please refer to fee schedule � 9 U,e_Aj sj / . Permit fee: Address: L City/State/ZIP: r/ 6, ._ ©/Z 9 7 Z Z State surcharge (12% of permit fee): / FLS plan review (40% of permit fee): Phone: (503) 6,54- _2.9 Z e., Fax: (S03) t 4 - 910s--7 (Due upon application.) CCB lic.: h 4 77 Total permit fees: Authorized signature: Amount received: This permit application expires if a permit is not obtained Print name: [ �/ - d - 6 i m- - j fJ r f 1..) Date: 9 - izp - b 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- 46I3T(I1/02/COI,1/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 l+ heads: Plan review required. El Repair Number of sprinkler heads: 6 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 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 CITY OF TIGARD FEE AND PAYMENT HISTORY a i • 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TI GA RD FPS2010 -00103 - 9524 SW WASHINGTON SQUARE RD H08, TIGARD, OR 97223 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due Permit Fee - COM 2300000 -43104 $328.16 $328.16 $328.16 9/16/10 Check 179486 $0.00 12% State Surcharge - Building 1003100 -24001 $39.38 $39.38 $39.38 9/16/10 Check 179486 $0.00 Plan Review - Fire Life Safety - COM 2300000 -43108 $131.26 $131.26 $131.26 9/16/10 Check 179486 $0.00 Totals for Fees $498.80 $498.80 $498.80 $0.00 Receipt # Payment Method Check # Pavor: Receipt Date Receipt Amount 179486 Check 14810 Wyatt Fire Protection, 09/16/2010 $498.80 Inc. Total Payments: 5498 8 Balance Due: / $0.00