Permit a CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
,111N 0 ., COMMUNITY DEVELOPMENT Permit #: FPS2010 -00126
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/27/2010
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 120
Subdivision: Lot: 0
Project: Property Management Office
Project Description: Fire sprinkler modification of (8) heads for TI
Owner: FEES
G &S FC LLC Description Date Amount
16850 SW UPPER BOONES FERRY RD STE A
Permit Fee - COM 10/27/2010 $64.54
PORTLAND, OR 97224 12% State Surcharge - Building 10/27/2010 $7.74
PHONE: 503 - 639 -0108
Contractor:
WESTERN STATES FIRE PROTECTION
13896 FIR ST STE B
OREGON CITY, OR 97045
PHONE: 503 - 657 -5155
FAX: 503- 657 -5182
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: 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 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 t. • ■ C by calling 503.246.6699 or 1.800.332.2344.
Issued By I '/ Permittee Signature: /
CaII 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.
Buiilding Permit Application
Fire Protection System 1 � FoR t)rrlci: us': ()NI.,
City of Tigard Received / Permit p
131 Hall Blvd., Ti 0 C T 2 7 2010 Date/B : ! A9 47 I' . G -oo C
Tigard, OR 97223 Plan Review
: II Phone: Permit: Phone: 503.639.4171 Fax: 503.59 gc� Date/B : � U��v/O�n
Inspection Line: 503.639.4175 11 I (]I~ TjGA� am: P i ® See Page 2 for
- I - I G A 1: D Date Ready /By: J Oh Internet: www.tigard or.gov BUILDING DIVISION 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
® Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
dwelling Valuation: $
❑ 1- and 2-family g ®C ommercial /industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMAT1ON AND LOCATION Total number of floors:
Job site address: 16083 SW Upper Boones Ferry Rd. New dwelling area: square feet
City/State/ZIP: Tigard, Oregon Garage /carport area: square feet
Suite/bldg. /apt. no.: 120 I Project name: SPEC. SPACE T.I. 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: I 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.
fire sprinkler tenant improvement Valuation: $$1,000.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( ) New:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: Western States Fire Protection Co. All contractors and subcontractors are required to be
Contact name: Darrell Fluit licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 13896 Fir Street, Suite B jurisdiction in which work is being performed. If the
City/ State/ZIP: Oregon City, Oregon 97045 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 657 -5155 I Fax: : (503) 657 -5182
E -mail: darrell.fluit @wsfp.us
CONTRACTOR BUILDING PERMIT FEES*
(Pkase to fee
Business name: Western States Fire Protection Co. refer schedule)
Permit fee:
Address: 13896 Fir Street, Suite B
State surcharge (12% of permit fee):
City/State /ZIP: Oregon City, Oregon 97045 0
FLS plan review (40% of permit fee):
Phone: (503) 657 -5155 I Fax: (503) 657 -5182 (Due upon application.)
CCB lic.: 104570 Total permit fees:
Authorized signature:
/ / e Amount received:
This permit application expires if a permit is not obtained
Print name: Darrell Fluit I Date: 10 -27 -10 1 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
1:\Building\Pennits \FPS- PermitApp.doc 10 /01/09 440.4613T(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 ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 8
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 Light
Density 0.10
Design Area
K. Factor 5.6
Sprinkler Project Valuation: $ 1,000
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: 1 $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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): $ 1,000
Permit fee based on project valuation (see fee schedule): $ 64.54
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $ 7.74
FLS Plan Review (40% of permit fee): $
TOTAL: $ 72.28
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
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