Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11111 '' COMMUNITY DEVELOPMENT Permit #: FPS2010 -00164
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2010
Parcel: 2S 101 DA00104
Jurisdiction: Tigard •
Site address: 13333 SW 68TH PKWY, STE# 220
Project: ACS Subdivision: FARMERS INSURANCE Lot: 0
Project Description: Phase 2. Adding (1) horn strobe to existing circuit.
Contractor: COCHRAN INC Owner: TRIANGLE POINTE LLC
7550 SW TECH CENTER DR. #220 901 NE GLISAN ST #100
TIGARD, OR 97223 PORTLAND, OR 97232
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/21/2010 $56.47
12% State Surcharge - Building 12/21/2010 $6.78
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 $63.25
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $700.00
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. ou m o•lain a copy of the rules
or direct questions to OUN by calling 503.232.1987 or 1.800.332.2344.
Issued By: IIIII IIPermittee Signature: `
Call 13. • • 4 7:00 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.
•
Building Permit Application
Fire Protection System FOR OFFICE USE O;N l'
q $ Received •
City of
. agard l �0 ` Date/B : � � PermitNo.. . • no , 6
° 13125 S W Hall Blvd.. Tigard, OR 97223 , . ,.,
C Phone: 503.639.4171 Fax: 503.598.1960 ` G ■ ' P . Other Permit:
• TIGARD D inspection Line: 503.639.4175 � ` WOO''' ` ' eady/By: 0 See Page 2 for
' Internet www.tigard- or.gov Ct1 - %COI.' �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.
•
❑ 1- and 2- family dwelling .Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB.SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / 33 CA,- 4 -7f i) -`, New dwelling area: square feet
City/State/ZIP: - 2 A o GT4' ' 2 J Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name �1" — 7 (. lam' 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: 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.
4,4712.0 (/i /, �ti/ ,41.". 67t"i 4 Arx,c. Valuation: $ 7Q.o �l7
K'he -e�� �f. C�'e > i, //a �6.- '- G j �,-
0 Existing building area: square feet
d+' �. -,"-.0,e 9 / -• / 7 1 . /7 7V New building area: square feet
i iW
❑ PROPERTY OWNER /iz gre - TENANT G Number of stories:
Name: ,GS' Type of construction:
Address: / 3_33 _ „ ,..-7,-L,r/ Occupancy groups:
I 1 6��� ,,)e City /State /ZP: ,, ' /- Existing:
Phone:( ) Fax: ( ) New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name /. ,,QA/ ,. All contractors and subcontractors are required to be
Contact name :S j7l/ Z.� ,es�� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: z.7 �(f 7 •�' r 1 2 TjL- ��S? /Zc) jurisdiction in which work is being performed. If the
apply applicant is exempt from licensing, the following reasons
City /State /ZIP :� 4, ,,, e":"." 99Z-2,...r
Phone: �) f g.---z_6,/ ) 7 Fax:: (C� ig) 3� &2 %'
—
E- mail: - C / J� /1„VW CGS+/ x//sfi'G� - C er- 7 .
CONTRACTOR BUILDINGPERMIT FEES*
Business name: �^' (Please refer to fee. schedule
®e _eLx - Permit fee:
/ �
Address: 7�'��., s G✓ �GLii ce" ` . �C' a�,� e
�- State surcharge (12% of permit fee):
City/State /ZIP: " //6iQ� 9 ��
/ FLS plan review (40% of permit fee):
Phone: `Y 7 / ) Z s' x //070 Fax: 617?) efr -2.9,9r (Due upon application.)
CCB lic.: Z,re.. Total permit fees: %-$- " 1
Amount received: 6.3. j )->
Authorized signature
This permit application expires if a permit is not obtained
�� v Date: G" within 180 days after it has been accepted as complete.
Print name:
/���� /�'� � J �� * Fee methodology set by Tri -County Building Industry
Service Board.
1 :\Building\Permits \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:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinlder
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
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 Sprinler (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.
http : / /www.tigard- or.gov /city_hall /departments /cd /dots /FPS - PermitApp.doc 10 /01 /(J