Permit •
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
2 ;A- COMMUNITY DEVELOPMENT Permit #: FPS2010 -00150
T.IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2010
Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 202
Project: Scholls Ferry Rehab Subdivision: Lot: 0
Project Description: Fire Alarm.
Contractor: COCHRAN INC Owner: PROVIDENCE HEALTH SYSTEM
7550 SW TECH CENTER DR. #220 4400 NE HALSEY BLDG 1 SUITE 160
TIGARD, OR 97223 PORTLAND, OR 97213
PHONE: 503 - 234 -6564 PHONE: 503 - 215 -6282
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/03/2010 $166.76
12% State Surcharge - Building 12/03/2010 $20.01
Type of Use: COM Plan Review - Fire Life Safety - COM 12/03/2010 $66.70
Class of Work: ALT Type of Const:
Occupancy Grp: B Height: ft
Stories: 2
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: Yes Alarm Type: Automatic
Pull Station Required: Smoke Detectors Req: No
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $253.47
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $8,235.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other '
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility a ion Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir t questions to O C b •:Ili ! 503.232.1987 or 1.800.332.2344.
Iss ed By: / � L Permittee Signature:
Al/ _
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application ��jV`
Commercial
• ®®
FOR OFFICE LISE ONLY
r00
City of Tigard Received
7 .1:y Permit No.: F/05)01 t7 W ( SD
- • 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 Co$' l ® D : % '. Other Permit: g / � d s'A
TI G A R D Inspection Line: 503.639.4175 c, NG V � Date Ready /By: _ -. See Page 2 for
Internet www.tigard or.gov � No �. ethod: /% /(p /2 Supplemental Information
TYPE OF WORK ' r D DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Perini -es* 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: 12442 S.W. Scholls Ferry Rd New dwelling area: square feet
City/State/ZIP: Tigard Oregon 97223 Garage/carport area: square feet
Suite/bldg. /apt. no.: 220 Project name: Scholls Ferry Rehab 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 Alarm Valuation: $$8,235.00
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT • Number of stories:
Name: Providence Health System Type of construction:
Address: 4400 N.E. Halsey BLDG 1 Suite 160 Occupancy groups:
City/State /ZIP: Portland Oregon 97213 Existing:
Phone: (503)215-6282 Fax: (503)215 -6802 New:
® APPLICANT p CONTACT PERSON NOTICE
Business name: Cochran Inc All contractors and subcontractors are required to be
Contact name: John Vitro licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 7550 S W Tech Center Dr jurisdiction in which work is being performed. If the
City/State /ZIP: Tigard Oregon 97223 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 234-6564 Fax: : (503 -) 238 -2098
E -mail: J Vitro @cochraninc.com
CONTRACTOR
Business name: Same BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
City/State /ZIP: Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCBlic.:
Total fees due upon application:
Amount received:
Authorized signat _ (/r This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: J /war 0 Date: 127frAd * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building \Permits\BUP -COM PermitApp.doc 10 /01/09 440- 4613T(11 /02/COM/WEB)