Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11 COMMUNITY DEVELOPMENT Permit#: FPS2010 -00128
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2010
Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 100
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: Lincoln Heritage
Project Description: Fire sprinkler modification of (22) heads for TI
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Description Date Amount
BB# 73- 1771- GK1130, CBRE, PO BOX 2096
Permit Fee - COM 10/27/2010 $102.20
WARREN, MI 48090 12% State Surcharge - Building 10/27/2010 $12.26
PHONE: Plan Review - Fire Life Safety - COM 10/27/2010 $40.88
Contractor:
SIMPLEXGRINNELL LP
6305 SW ROSEWOOD ST.
LAKE OSWEGO, OR 97035
PHONE: 503 - 683 -9000
FAX: 503- 675 -6521
Type of Use: COM
Class of Work: ALT Type of Const: IIB
Occupancy Grp: B Height: ft
Stories: 2
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: 0 Design Area: 0
K Factor: 11.2
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $155.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 2316
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 503.246.64 • or 1.800.332: 344.
Issued By: Permittee Signature:
4.
Cal 03.639.4175 by 7:00 a.m. for an inspection that busi
This permit card shall be kept in a conspicuous place on the job site until co • -tion 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
RECEIVE C
City of Tig ard E+ � t ReceDat ived : O Air o ,/� PertnitNo.: r i g n 0 / O" DD� �gi
13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
. 2 Phone: 503.639.4171 Fax: 503.598.1960 7 Date/By: , ?� I 7 10 Other Pernut 4/00. �l
T I G n R D Inspection Line: 503.639.4175 OCT 2 7 2 010 Date Ready/By: tug: RI See Page 2 for
Internet: www.tigard- or.gov Notified/Method: II '3 K /4J / / Supplemental Information
CITY OFTIGARD et 50 wA1 V TO-)
tJ
TYPE OF wo �INQ DIVISION 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
lin Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling '® Commercial/industrial Valuation: $f:°
❑ Accessory building 1:1 Multi-family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 3221 S W 6vtd,- p <« l New dwelling area: square feet
City /State/ZIP: T1 cs fh > -ct 1 0 . • 47 ZZ3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: L jokvt, ReAri t "ke. Covered porch area: square feet
Cross street/directions to job site: 'e 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.
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.
Valuation: $ 2, 3 ` 6 , 0 U
i� exi`.- vt_ clue S`d'ivtk St.�„}e, •
cOr IAA v W C k i ( e jA1 r 0 in. S 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:
ir APPLICANT ❑ CONTACT PERSON NOTICE
Business name: S i vNJ. ` jz (-_-,vi- All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:
Sbv... ( Q i5�v‘ under ORS 701 and may be required to be licensed in the
Address: ( SOS- S W jurisdiction in which work is being performed. If the
O applicant is exempt from licensing, the following reasons
City / State/ZIP:
CA k2. 3taQ� 1 0 IZ.. ct 70.' S- apply:
Phone: (503) (, .B3 - o 06 G Fax:: ( <03) G7S- G S2J
E -mail re■-vV2-1 S0 t^p Si IM &QX,J e,t/Ltn,0.l l . Cow..
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Silt.sA_ OeX Gke ivttA Permit fee: ll'k °
Address: & 3 Q S .st esa acAriO Cl N+
State surcharge (12% of permit fee): /A . Are City / State/ZIP: QS 7 3
�—� t (� � ( d FLS plan review (40% of permit fee): ,/_ Q
Phone: (5- ) 6463 ' 1 00 Fax: (y) 6 S. 6 52• ( (Due upon application.) � 0
CCB lic.: 1 1.4 9 g 2 j Total permit fees: /5,0`... X1 t
Amount received: 155 , 3 _r
Authorized signature:
■ W' This permit application expires if a permit is not obtained
Print name:
Ov\ 14. Q A. S ok.,..._ Date: i .7,7• ` 0 * within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board.
1: \ Building \Perm nv \FPS- PcrmitApp.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 El 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: L 2
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 U. ID
Design Area (500
K. Factor ( \
Sprinkler Project Valuation: $ 2.3 k (� c 0
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
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): $
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.
hap" /www. Ligard-ongov/ci ty_hall /departments /cd/docs/ I 'I'S- PermitApp.doc 10/01/('0