Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00162
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TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9530 SW WASHINGTON SQUARE RD H10
Project: Apple Store Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Modification of (5) sprinkler heads for TI.
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR WASHINGTON SQUARE LLC
9095 SW BURNHAM 2235 FARADAY AVE STE #O
TIGARD, OR 97223 CARLSBAD, CA 92008
PHONE: 503 - 684 -2928 PHONE:
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/21/2010 $61.85
12% State Surcharge - Building 12/21/2010 $7.42
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 $69.27
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $826.00
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 . • a is enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtai a copy of the rules
or d -ct questions to • NC t ailing 503.232.1987 or 1.800.332.2344.
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By: 1- ued B � / Permittee Signature: / /
Call 503.639.4175 by 7:00 a.m. for the next available inspectio date.
This permit card shall be kept in a conspicuous place on the job site until c'.mpletion 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
City of Tigard DEC 21 2010 Re eiv ed /z Z/ 1 ( Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 e
Plan Review
„ ao�0 — O!� llp
Phone: 503.639.4171 Fax: 503.598.1960 Date Other Permit:
' TIGARD Inspection Line: 503.639.4175 CITY OF TIGIRD Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
�.' .._ g .11 _ : : a,.. . , .rM,r .a ,w_ a*.:..... g. ` 4 . _ ... �A , REQCITI2ED DAT & ? D�2'EL1.1N
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
9.. 144dition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
st PP work indicated on this application.
r t I;A , CATEGORY : OF CONSTRU lbekaif ,. ` o _
— V 1uation:
❑ 1- and 2- family dwelling VCemmercial/industnal
❑ Accessory building ❑ Multi- family Number of bedrooms: •
El Master builder ❑ Other: Number of bathrooms:
t y J S INFORIIIATI y AND LOC ATION g t
Total number of floors:
Job site address: 9 5" 0 5 / . , s 9 New dwelling area: square feet
City/State /ZIP: /)D / 9 2 97 2.2._ Garage /carport area: square feet
Suite/bldg. /apt. no.: N/ D Project name: PL. 602.E., :R C IW Covered porch area: • square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
' II191L TA° CTM14fEi2C ,'�,ZfS rein Ci, TST't "
,
Subdivision: • Lot no.: Perrnit 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
E *t I "t g DESCRIPTION OF ` ORK to - work indicated on this a lication
")P,r) i r 0 I) /-1=1--i) 5 c' NCi-tJ wit-I-___.5 � Valuation: $ g , •
R te vE A-0 q>J,- , � t , P . V -Q - t5H0S l Existing building area: square feet
/ / New building area: square feet
• d'ROPERTYLOWNEI2 ems# r TENANT t y ' Number of stories:
Name: Type of construction:
Address: • Occupancy groups:
City/State /ZIP:
Existing:
Phone: ( ) Fax: ( )
New:
. , . :,„ , PLIC N T ,0, i L�'C'QNT4'C„ PETISOIY }e pp ,_ Ato � v N � � u x ivr
Business name: G(` -f, A C _ 7 'Z;2 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/Z)P: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) I Fax: : ( )
E -mail:
� r ror , ; . z�,,..... � o .,,. �.. CONTRACTOR a , sa , ..&f B�111LDING P : 4!, FEES* in
�^ f.'r.fei ,. <. ti
ebease.reje74 feeschednle) A,,,,., r
Business Warne: 6/ 1/ 73,,,-,--,---7,A.,, Permit fee: �/ O / j
Address: 909 5 6y 1 &1.)p_ v /� a State surcharge (12% of permit fee): 7 , y9,
City/State /ZIP: 7? 6 R-D n1 9 7 �z3
FLS plan review (40% of permit fee):
Phone: (50 &g4 _ 29 Fax: (5 6 - 9 &57 (Due upon application.)
CCB lic.: (,4_0 7 7 Total permit fees: ( . 2
Authorized signature: Amount received:
` /e---1 — e-- This permit application expires if a permit is not obtained
Print name: (� /A Date: 1 Z — ZC5 — t D within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\ Building \Permits\FPS- PermitApp.doc 03/23/06 440- 4613T(1I /02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
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Descr>be work to be done 4 1 `� :
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1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition -10 heads: No plan review required.
a lteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
•
Type o£ Syst t etili ilete AB keljt D agra pplxcable) a w, Y
WW 2204 A ) Commercial Sprinkler it ' i W e w' �; 3 ~�
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
3 TSfia . H88 giffiessxon 5 .., t lit K z� 01 s. M i fi r ;
Hood Project Valuation: $
e? � f�m tr a{ � 4 t,. tam" 1 i 4100:4 PM t� i�.'s VINAI �" � •s 1 , s' ,,,s,
O itdA1a rm 0 4 •K t I t o f i t
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
• Cut Sheets
• Fire Alarm Project Valuation: $
gil ,� A1 M rs tr iM M U IN IM g r t ta ar V Ica ,
*ti )' Restdentlal Spr ikler {Stand Alone System) 10 ,4WW, RR� x� ��
Square Footage: Permit Fee: . i � ; st � r w
0 to 2,000 $187.50
ok
2 001 to 3,600 $232.50 �' ��;
3,601 to 7,200 $292.50 p
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Ni116101111.011411MiliAlltaWARMOtaagraCiEtIVAMIUMMONItialgi
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 fire suppression
engineer, or NICET level "3" technicians.
http: / /www.ci.tigard.or.us /city_ hall /departments /cd /dots /FPS- PermitApp.doc 2