Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
o • COMMUNITY DEVELOPMENT Permit #: FPS2010 -00105
T (G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/30/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9669 SW WASHINGTON SQUARE DR CO3
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Express
Project Description: (99) sprinkler heads for TI
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 Permit Fee - COM 09/17/2010 $209.80
12% State Surcharge - Building 09/17/2010 $25.18
PHONE: Plan Review - Fire Life Safety - COM 09/17/2010 $83.92
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: FPS Type of Const: IIB
Occupancy Grp: M Height: ft
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 0
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 $318.90
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 12137
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 OUNC by calling 503.246.6699 or 1.800.332.2344. -
Issued By: / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that busin:=s day.
This permit card shall be kept in a conspicuous place on the job site unti ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
. Building
System RECEIVED FOR OFFICE USE ONLY
. DateB :
City of Tigard Received ' PermitNo.: = 0 190 5 2
13125 SW Hall Blvd., Tigard, Dan Review : 9 /7 /e � e� - SoQzQ / � t7 vo /
g OR 97223 S EP 1 7 20 10 C J %!1 �i1�•U
Phone: 503.639.4171 Fax: 503.598.1960 �•_ � �� Other Permit• eu
TIGARD
Inspection Line: 503.639 Date Read fB 0 See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: / d ��� I �� Supplemental Information
BUILDING DIVISION
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
Oddition /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 m iniercial/industrial Valuation: $
El Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
9669 JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: g.:0314./ �� 141,46/4. se D New dwelling area: square feet
City/State/ZIP: � / �J'V ` Y Z / Z-j Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: 6``13/. 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.
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.
Valuation: $
, D 400/ dcA — c= t� ai • 9 1 /Z I37
sP f � y a ,-04. »!�) /GJ ` � s A,i - rl, / f� 7 Existing building area: square feet
` in 7 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:
[a *PPLICANT ❑ CONTACT PERSON NOTICE
Business name:
�� ea(f l T-04— 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: / (Please refer to fee schedule1
Address: 9095 .5 i 13 C) ) /4/41) ""7—. Permit fee: ‘ ,10 ,0
- L-V O ,- (9` 0 3 State surcharge (12% of permit fee): p � 5 t�
( ` 6 4 - 0_9 Z Fax: ( / @ // 7J't' - Q 7 FLS plan review (40% of permit fen): , ?3 F.2_ Phone: 5 D� 5L% 3 (r ,
) 7 � � j (Due e upon application.)
CCB lic.: 10 1z> 7 7 Total permit fees: p
•
Amount received: 3//
Authorized signature: „� /fe I 0
v` G This permit application expires if a permit is not obtained
Print name: 116,t � ,i b■3 Date: 9 —) 7 - l 0 * 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.
❑ Alteration 51_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 Sprinlder
❑ 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 Sprinlder (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
a CITY OF TIGARD FEE AND PAYMENT HISTORY
i p 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
FPS2010 -00105 - 9669 SW WASHINGTON SQUARE DR CO3, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Permit Fee - COM 2300000-43104 $209.80 $209.80 $209.80 9/17/10 Check 179499 $0.00
12% State Surcharge - Building 1003100 -24001 $25.18 $25.18 $25.18 9/17/10 Check 179499 $0.00
Plan Review - Fire Life Safety - COM 2300000 -43108 $83.92 $83.92 $83.92 9/17/10 Check 179499 $0.00
Totals for Fees $318.90 $318.90 $318.90 $0.00
Receipt # Payment Method Check # Pavor: Receipt Date Receipt Amount
179499 Check 14814 Wyatt Fire Protection, 09/17/2010 $318.90
Inc.
Total Payments: $318.90
Balance Due: $0.00
C.