Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00120
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/19/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9619 SW WASHINGTON SQUARE RD
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: POTTERY BARN
Project Description: Add (1) new sprinkler head to new office in stockroom.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 Permit Fee - COM 10/19/2010 $51.09
12% State Surcharge - Building 10/19/2010 $6.13
PHONE:
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:
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 $57.22
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
Utili ification Center, Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
o irect questions to OUN • b 'n 503.246.6699 or 1.800.332.2344.
sued By: Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for an inspection that busine . 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.
!gilding Permit Applicat'
Fire Protection System y FOR OFFICE USE ONLY
1 City of Tigard OCT 19 2010 Date/By: 10 / 9 /� i PermitNo / 93,10/O -DD /
- q 13125 SW Hall Blvd., Tigard, OR 97223 • Plan Review q
Phone: 503.639.4171 Fax: 503.5 0171 ) 0F TIGARD Date/By: Other Permit: ,�u la90/O .-ex) .2
TIGARD Inspection Line: 503.639 BUILDING DIVISION Date Ready/By: Jura: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
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
UA .ddition/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 ❑ Other: Number of bathrooms:
96 /q JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: sk/ W A • D . New dwelling area: square feet
City/State/ZIP: f / aA - /an 0 2 7 -z-z_ 3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: FO QT Y BA/.L Covered porch area: square feet
Cross street/directions to job site: ISM. O [E., 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
ADD OF WORK work indicated on this application.
AD 0 1 , - 1 .P K M u>� � �TI /` i E' N w cFC . Valuation: $ S5 ,
/,j 51 gL7ZL� FPO , PtP . 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:
V- 4PPLICANT ❑ CONTACT PERSON NOTICE
Business name: 3 e.-0/4 - 7 - RA - __I - C , 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: vl y/1_7 f/, P$.OT- e_,--T2 ®I� (Please refer o e sc edule)
e
n � 57,6 7
Address: 0 ) ) �j 3 yV �j U th4 Y 1 ..-
Cit -`G n / t) /Z 9 '7 z_ 23 State surcharge (12% of permit fee): • ( 3
_ FLS plan review (40% of permit fee): , //—
Phone: (503) & F, 4_ - Z9 2 8 Fax: ($03) 6 S 4. - C) 6 � 7 (Due upon application.) /Wi 7
CCB Iic.: 6 et o 7 7 Total permit fees: 57 '
Amount received: s, ' a
Authorized signature: `� 7.
This permit application expires if a permit is not obtained
Print name: �i t i�jc- A) . -- f rhym) Date: 2 o - j 9 -/ within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
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