Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
'! COMMUNITY DEVELOPMENT Permit #: FPS2010 -00141
131 25 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2010
T i .C"r, Parcel: 1 S 134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 202
Project: Scholls Ferry Rehab Subdivision: Lot: 0
Project Description: Fire sprinkler modification: add (3) heads and relocate (11) heads. Change all existing heads to F -1 /FR.
Contractor: DELTA FIRE INC Owner: PROVIDENCE HEALTH SYSTEM
14795 SW 72ND AVE 4400 NE HALSEY BLDG 1, STE 160
PORTLAND, OR 97224 PORTLAND, OR 97213
PHONE: 503 - 620 -4020 PHONE:
FAX: 503 - 620 -1058
FEES
Description Date Amount
Specifics: Permit Fee - COM 11/18/2010 $102.20
12% State Surcharge - Building 11/18/2010 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 11/18/2010 $40.88
Class of Work: ALT Type of Const:
Occupancy Grp: B Height: ft
Stories:
•
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 $155.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,914.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or .:00.332.234
Issued By: 'ernflttee-Signature:
Call 503.6 • :00 a.m. for the next available inspection date.
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.
11/12/2010 12:53 FAX 5032970811 ANDERSEN CONST al001
Building Permit Application
Fire Protection System RECEIVE
City of Tigard NOV 12 2010 Reeeiv ed
/f�' / .
Date
• 13125 SW Hall Blvd., Tigard, OR 9723
e 0 Permit No.: ' 0S o�� fj0/
Phone: 503,639.4171 Fax: 503.598.1960 Plan Review �,
I ll
CITY OF - FIG Daie /B : % 1 Other r Permit:
T' I(' \ R D Inspection Line: 503.639 4175 Date Read 47- l urks; ® See Pa e 2 for
Internet: www.tigard- or.gov BUILDING D ' t NISIO , Notifie. thud: e
� Supplemental Information
ilAYAll I
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 (rotnded to the nearest dollar) of all
; A dditionlalteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
• CATEGORY OF CONSTRUCTION • work indicated on this application,
❑ 1- and 2- family dwelling lit Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
/2, 4/4/ JOB' SITE. INFORMATION .AND; LOCATION Total number of floors:
Iob site address: 1 NA t f _ . New dwelling area: square feet
City /Slate /ZIP: 1 �_ d V • • • r`(j[ Q Garage /carport area: square feet
. eitooldglapt. no.:ae Project name: m o-ce H ., s -R b Covered porch area square feet
Cross street/directions to job site: rep ocka R .,
area: square feet
Other structure area: square feet
R0.10I1D.4fA COMMERCIAL U.S CEECKL ST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK n work indicated on this application.
3 +• A ♦ • , 0 - .1 .1t _ I I' L + , I'er Vk c cn-L -1{ Valuation: $ ►. • q
reline s sang al( ex isfi rtt� V ► i l ti..0-►r Existing building area square feet
re40-Ce‘j TO F 1 it-( r -(octe New building area: square feet
N PROPERTY OWNER ❑. TENANT Number of stories:
Name: p v
(.levlbe, _ Type of construction:
Address: q me (- t ' `B
l 1 5t . ( Co o Occupancy groups:
City /State /ZIP: fel X 0 R. "t -- I 2 L ' 3
t Existing:
Phone: ( ) Fax: ( )
New:
X APPLICANT ❑ CONTACT PERSON
NOTICE. • .
Business name: � (€ 1 "(�n All contractors and subcontractors are required to be
Contact name: 1 • i t f , X 1 J - i �.v t" ..... _ licensed with the Oregon Construction Contractors Board
1 ^ Ir ' under ORS 701 and may be required to be !tensed in the
Address: 1 t'f J
L •
jurisdiction in which work is being performed. If the
Cit /State /ZIP: ',f�fl OR o -72r f applicant is exempt from licensing, the following reasons
t _1 apply:
Phone: A .• 9-0 - „II Fax:: �` .-o - 106t."
E- mail: b� c ' lc re.l (ivy) -
CONTRACTOR
f D)(IY,GTERMIT FEES*
�/ BUII, .
Business n ' a 1 7 name: r ,\\ Ffeaseree to'eeschedule
A � `,�) i y �r U e. Permit fee: 7t 0 2, ,
Address: !
City/State/ZIP: r #- /`Ind OR c �u State
FLS plan rev iew (12% of permit fee): 72 . / ` '�` ` t/�" ` plan review (40% fee): o p_ Phone: /�G , _ O Fax: ) v �n _ 1 B t' (Due upon application.) '7 0 - gp �/
CCB lie.: ' • � l Total permit fees: /53 39 1
Authorized signature: Amount received:
W 4
r 4 This permit application expires it a permit is not obtained
Print name: 1-kt a - bib( TI/L_ l / Date: I 1 within t80 days after it has been accepted as complete.
1 t J ��' o * Fee methodology set by Tri- County Building Industry
Service Board.
i: \PconitaPS- Permit,gpp_doc 03/2 '3/06 440.4613T(1 L02 ;COM/wEB)
City. of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 24 Modification to sprinkler heads only:
Addition ❑ 1 -10 heads: No plan review required.
Alteration 11+ heads: Plan review required.
0 Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete. A, B, C or D as applicable):
A.) Commercial Sprinkler
tg Wet ❑ Dry
Additional Standpipes j u f
Information: Hazard Group
Density 1O '
Design Area C)
K. Factor n.(0
Sprinkler Project Valuation: s a9i t i3O0
13.) 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 Sy •
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 Eire suppression
engineer, or NICET level "3" technicians.
l \Building \Permits \ FPS- PermiiApp.doc 2
TOO /T00 ISNOD NdSHIQNV TTSOL6ZEOS XVd SS:ZT OTOZ /ZT /TT -