Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11 • COMMUNITY DEVELOPMENT Permit #: FPS2010 -00122
T 1 G.A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/19/2010
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 120
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: ETHICS POINT
Project Description: Adding (1) sprinkler head to server room.
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Description Date Amount
BB# 73- 1771- GK1130, CBRE, PO BOX 2096
WARREN, MI 48090 Permit Fee - COM 10/19/2010 $64.54
12% State Surcharge - Building 10/19/2010 $7.74
PHONE:
Contractor:
DELTA FIRE INC
14795 SW 72ND AVE
PORTLAND, OR 97224
PHONE: 503 - 620 -4020
FAX: 503 - 620 -1058
Type of Use: COM
Class of Work: ALT 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 Calcs Provided: Cut Sheets Required:
Total $72.28
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1000.00
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: gon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of thy' rules
or direct questions to OUNC by calling 503.246.6699 or 1.800 ,
111111111.11111411 —
Issued By: - tore: Able
Call 503.639.4175 by :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 [ISE ON1
City of Tigard VS Received P er mit No.:
w� Date,Bv: 1 1 q 0 J 1 _ - 1(,
13125 SW Hall Blvd., Tigard, OR 97223 0� (ACC++'' 0 01 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �1S Date/By: Other Permit:
T I G n k U Inspection Line: 503.639.41 75 G9 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov C, ` � V Notified/Iviet
TT& Supplemental Information
nNA
V
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: S
Accessory building Number of bedrooms:
❑ g ❑ Multi - family
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: • `�il� A' i 1 0 1 ` New dwelling area: square feet
�Pttl� �% �.
Garage /carport area: square feet
Suite/bldg. /apt. no.: ' , Project name:CTh ;ra sealef n Covered porch area square feet
Cross street/directions to job site: p - j Iy t0n 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. / � / �
Arta 1 Vt.fe. ` 1ni"n Valuation: $ ' I 0W D
f l \ c� PrVPx f f nAC ka 1- Existing building area square feet
1 �.i.i" cF ` 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:
Y'+, APPLICANT ❑ CONTACT PERSON
NOTICE
Business name:' lk-fA - rice, r.nC. All contractors and subcontractors are required to be
Contact name: �+ _ licensed with the Oregon Construction Contractors Board
�9 1 c + tt under ORS 701 and may be required to be 'tensed in the
Address: I/4 5 v \ C ro 7lr�r1 e , jurisdiction in which work is being performed. If the
f-l�n ..I t 0n ot 7^ Ot applicant is exempt from licensing, the following reasons
City /State /ZIP: � (� I ' 1 C7•
apply:
Phone: c.�.t� � „ //�� La, Fax: � : / ( { �5 (COO _ (O6
E -mail: ht� ce: 1 Lre .(06f l
CONTRACTOR BUILDING PERMIT FEES*
Business name: �t - (Please refer to fee schubile)
t � ^w � Cla f'IC ^ Q. fw_ 01C.
Address: ILI --/ 15 s( 1 \ 7(1I d AVe . Permit fee:
�/`' n^ State surcharge (12% of permit fee):
City /State /ZIP: `l3r ai' O9 oil aat
1 1 I Qa ( FLS plan review (40% of permit fee):
Phone: (8Z n^ �,) _ 1 / I Fax: ( 9.0_ 105 ' (Due upon application.)
CCB lic.: ( 17(4 vV �s Total permit fees:
i � /
Amount received:
Authorized signature:
_ This permit application expires if a permit is not obtained
Print name: Ne `t CZ+n'” ' ��// Hort,k)8 Date: I0/ ICI //6 within 180 days after it has been accepted as complete.
■ ►lam "'°° ' Fee methodology set by Tri- County Building Industry
Service Board.
I Building PermitsiFPS- PennitApp 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:
MAddition g 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 •
• zi Wet ❑ Dry
Additional Standpipes ,kJA.
Information: Hazard Group
Density , ( C
Design Area 1 F `O
K. Factor 5. C
Sprinkler Project Valuation: $ O)( J , 00
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 Syste
kl ) . •
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): $ 1 000.00
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): I $
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.
L \ Buiiding\ Permits\ FPS- PermitApp.doc 2
RECEIVED
OCT 1 9 2010
Hanger No. CO5
CITY OF TIGARD Snake+ Anchor
BUILDING DIVISION
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DROP DETAIL
SCALE - NTS
•
SYM. TYPE MFG./MODEL TEMP. SIZE FINISH CANOPY FINISH QTY
ETHICS NT I • SSP REUABLE MODEL F1FR 200 1/2- cm GF1 CH 1
SERVER ROOM DELTA
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87ee-eao-ERE4(elee7 TIGARD, OR FIRE, INC.
TITLE FIRE SPRINKLER PLAN
DATE 10-18-10 SCALE 1/4- 1.—o- SHEET 1 OF 1 FIRE PROTECTION CONTRACTORS
CONT. 10 DRWN. C.S. SYSTEM WET 14795 S W. 72n0. PORTLAND. OR 97220 (503) 620-4020
s.
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
I1
•
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January 6, 2011
Delta Fire, Inc.
14795 SW 72n Ave.
Portland, OR 97224
Attn: Heidi Scarbrough
Re: Permit No. FPS2010 -00122
Dear Heidi:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 13221 SW 68 Pkwy, Ste. 120
Project Name: Ethics Point - Server Room
Job No.: N/A
Refund: ® Check #200408 in the amount of $57.82.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as submitted for wrong address; refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
I: \Building\ Refunds\ Administration \LtrRefund- CancelPemutdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 , • www.tigard - or.gov • TTY Relay: 503.684.2772
,
IIIII a . " City of Tigard
r ► c n R D Accela Refund Request
This form is used for refund requests of land use, development engineering and building application
fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached
to this request. Refund requests are due to Accela System Administrator by Wednesday at
5:00 PM for processing by the following Wednesday. Accounts Payable will route refund
checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing.
PAYABLE TO: Delta Fire, Inc. DATE: 12/28/2010
Attn: Heidi Scarbrough .
14795 SW 72n Ave. REQUESTED BY: Dianna Howse
Portland, OR 97124
•
TRANSACTION INFORMATION:
Receipt #: 179970 Case #: FPS2010 -00122
Date: 10/19/2010 Address /Parcel: 13221 SW 68th Pkwy, Ste 120
Pay Method: Check Project Name: Ethics Point - Server Room
EXPLANATION: Per applicant's request as submitted for wrong site address.
j11%ljf,�'!:` *■'ryyF�/�■ �' // T � F � :... 'P ii is �� Js �'_ ``G " ✓ :1•. .:}-• . h�' � .L_... f
j ." t. �Y ..a. ^ a � . ri ir�' "h - :�1 \F. ...1:T.' :'. •:..• � h• � S.. ..Y(xA'� : �' 1s '
; ? _ .jA;ncu.ti�. ?F:,, ° •. ems.. •, ."�, ,T; :x .,his:, 'sn "'c.•4Jf�.r.... � :K`'^..
:e , ; ' ,,..; ; =�::K�:`:� - :�..�;r`z:''.< '�' • u , : x� ::ry; its. .,�• � ..
. . :it's • A '� E'� 11 � 41 0 �.,.. • . 4, 41i " a c, Y ount . o � ;_ , �, , , , I e' alt. ;>
.:1. c t . r ��?s is,:t � .. C ! -. : t . . 1: ,- .� : ,, alii y . ns 4 -6, M ,�' . ti .� n x, 1; i . y`. : ,4 r.
t-fi `lel $u 1n iii •iE � :.. ' K '. - - ;. : , . r � a= : ' �F;x l e0:_ : 0 000..= 431; t
Permit Fee 2300000 -43104 $51.63
12% State Surcharge 1003100 -24001 6.19
•
TOTAL REFUND: $57.82
APPROVALS:
If under $5,000 Professional Staff .
If under $12,500 Division Manager 104 / 0-, J.—
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
.g,;4::Fw...4,. ;FOR-14D:EMag;SYSTEiViIAD11%I• ; IS'rRAT30N.US - :`', :-.".,..:P.:7:::.'-.:. Case Refund Processed: Date: I /10 / 1// I By: r
1: \Building \ Refunds \RefundRequest.doc x 09/01/2010
lig CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
I WGit A6
Receipt Number: 181001 - 01/06/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
FPS2010-00122 $ -57.82
Total: $ -57.82
•
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 200408 DHOWSE 01/06/2011 $ -57.82
Payor. Delta Fire, Inc.
Total Payments: $ -57.82
Balance Due: $57.82
Tidemark
ih ' System Administration
1 i Finance Department Request
Date: /gyp ///
To: ✓ Liz Lutz
Angela McCoy
From: Dianna Howse/
Re: Receipt #: /9 / `e /O D /
Please process this request as follows:
Journal Entry (route copy of JE to
Dianna Howse).
Reversal (fees have been reversed on
Revenue Account Report).
Credit Card Return (fees have been
reversed on Revenue Account Report).
Other /Explanation:
,--EF NJ) AErti i r 'S ,
Thank you!
-0 15 C 14---
I: \Building \Forms \RteSGp-FinanceReq.doc
Page 1 of 1
IN CITY OF TIGARD RECEIPT
= 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
T [GA kID
OR" ctAl L-.
Receipt Number: 179970 - 10/19/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
FPS2010 -00122 Permit Fee - COM 2300000 -43104 $64.54
FPS2010 -00122 12% State Surcharge - Building 1003100 -24001 $7.74
Total: $72.28
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check • . 26950 BTAGGART 10/19/2010 $72.28
Payor: Delta Fire, Inc.
Total Payments: $72.28
Balance Due: - $0.00
•
Page 1 of 1
DEC / -08 /2010 /WED 03:12 PM FAX No. P. 002
� _a y � `�
rREC�.I i.VED
Ili . ' ' Community Development DEC 0 2010
T i GA r Request for Permit Action Cm( OF TIGARD
BUILDING DIVISION
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www. tigard- or.gov
FROM: 0 Owner [] Applicant ® Contractor ❑ City Staff
(cheek one)
REFUND OR Name: Delta Fire, Inc.
INVOICE TO: (Business or Individual)
Mailing Address: 14795 SW 7T' Ave.
City/State /Zip: Portland, OR 97124
Phone No.: 503 - 620-4020
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
1 , CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
El REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: FPS2010 -00122
Site Address or Parcel #: 13221 SW 68 Parkway Suite 120
Project Name: Ethics Point - Server Room
Subdivision Name: Triangle Corporate Park Lot #:
EXPLANATION: Permit Pulled in wrong City
Signature: , / , / J y /
ilia 1 L ALA Date: 12/8/2010
Hei• Scarbrough '
Print Name:
1. The Dimes: or Building Official may authorise the refund of
a) any fee which was etsoneovsly paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended
e) Ant more than 80% of the building permit fee for issued pemrib prior to any inspection requesb.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
F 0 R. OFFICE USE ONLY
Rte to S • Admin: Date - tylwarmina Rte to B .: Admin: Date "Ariall.QK :=
Refund Processed Date / 97// .• Invoice Processed Date By
Permit Canceled: Date % 024r / U ffAll Parcel T.: Added: Date B
Receipt # / V99 :GS Date re) /9 /t Method C.' _ Amount $
I: \Buikting \Forms \RegPeanitAcdon.d • • 07/26/07