Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
2 ' • COMMUNITY DEVELOPMENT Permit #: FPS2010 -00161
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/29/2010
TIGARD Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16290 SW UPPER BOONES FERRY RD
Project: Dow Agrosciences Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Clean agent fire suppression system for computer room.
Contractor: SUPPRESSION SYSTEMS INC Owner: PACIFIC REALTY ASSOCIATES
4417 PACIFIC HWY EAST 15350 SW SEQUOIA PKWY #300
TACOMA, WA 98424 PORTLAND, OR 97224
PHONE: 253 - 926 -3300 PHONE: 503 - 624 -6300
FAX: 253 - 926 -3306
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/17/2010 $134.48
12% State Surcharge - Building 12/17/2010 $16.14
Type of Use: COM Plan Review - Fire Life Safety - COM 12/17/2010 $53.79
Class of Work: ALT Type of Const: IIIB
Occupancy Grp: B Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Unknown
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 $204.41
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $5,500.00
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 ork 's suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Nob. --:tion 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 direc • uestions to OUN • • c• i • • • 03.232.1987 or 1.800.332.2344.
Per mittee Sign. tssu = • By: 1111W
/ �
Call 503.639.4175 by 7:00 a.m. for the next available irtspotion 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.
Baildiag Permit Application
Fire Protection System FOR OFFICE LSE O\l.1
q � � ;
City of Tigard C, j Rlea aeived . I �� Permit No.: 4 ' , , ix) ,. 00 ,
• 13125 SW Hall Blvd., Tigard, OR 972 tan Review i .
C. Phone: 503.639.4171 Fax: 503.598.1 - �j 1 Y: 46��1 �m
Other Permit:
T I G A R U Inspection Line: 503.639.4 , ® � `� Date Ready : y: IM H See Page 2 for
Internet: www.t or.gov �1 Notified/Mdhod: i', Sup ple me otnllnfo rnt atlon
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 181 Other. equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling ffiComercialIindustrial Valuation: $
m
❑ 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: , t 0 54,) VppeQ. lborg S 2.Z9 izo New dwelling area: square feet
City/ State/ZIP: Q dc2, Garage /carport area: square feet
T •.4 I O �Z,
Suite/bldg. /apt. no.: Project name — — ^ — 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.
1 U b'T au- e.t. .c.u1 a►$c- T F ■ (L,� 5IA pptc a6 Valuation: $ 5,S00
S1i6T . i b.X. D(5W " a Ct e∎ V. r2 t2CX1nr1 Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I arTENANT Number of stories`— Q C)(V1pt_,C SE _
Name: Type of construction:, , „
Address: 1 Lo .7.&D ,1 Ls r- c . Q•i Q Occupancy groups:
City/State/ZIP: Poa. L.. h a u. ea_ d (L Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT `''ONTACT PERSON NOTICE
Business name: Q.p %cast Ito..1 "15-1 LAS 1 1 , 4 L. All contractors and subcontractors are required to be
Contact name: ki 11J1el. e.g. GA S.,1/4. licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 144 V1 Q ', c; C.� a` 1 E. jurisdiction in which work is being performed. If the
City/ State/ZIP: - rAzz, v \G� ` W p k. 't 2�
apply:
a
applicant is exempt from licensing, the following reasons
Phone: (5 eiv,„ szcp I Fax: : (7 - 5 56 C 7.ra 33C
E -mail: h , r■ •a S %A CV e ILCSj c.. ()t4 • C' [NM
CONTRACTOR BUILDING PERMIT FEES*
Business name: (Please refer Wee schedule
���� �^ v,1•1--
Permit fee:
Address:
City/ State/ZIP: State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: ( ) I Fax: ( ) (Due upon application.)
CCB tic.: 15Z — 10 t` Total permit fees: LA�0 K, t..' f
Authorized signature: I Amount received: l p l,, /, I
This permit application expires if a perminot obtained
Print name: 1i 1 w .,t 3 v Date: ‘21 `� 110 180 days after it has been accepted as complete.
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City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
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1.) 0 New 2.) Modification to sprinkler heads only:
0 Addition 0 1-10 heads: No plan review required.
El Alteration 0 11+ heads: Plan review required.
0 Repair
Number of sprinkler heads:
Additional description of work:
Y7 ?0'4:
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El Wet 0 DrY
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: . $
14,1k eryp
4::;,-,
Project Valuation: qs- i s-00 Corna e,L.C.A. Vo 'N E, Li
; ,,,r, :, - 7 , ;'- .•-:;,..--',,:, , -", '., ...-':' '1 1:' ,=,.',,',.::. ^:": , ;,_ '''— ,,,,, :,.-: ;.,, ' ::: '=",'? l ', ,-: :,',.;' ' , ,17 . . , '!: ''':' .;"':i
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Submittal shall ' Battery Calculations 0 Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: $
,. : .. , ,,k,c;,;:i, - --,, , .:1, - -„ - -'.f.. ":"- ! -,7 "' -', -...' 7 " ' T - ''- '' ' T:' ,i ': .C.- ' • j ' -': i. .,:.". ',-`_ k -'''- , :a -1:7 tr ‘ ,.Z. ` ,0tr'S
P*: Residential iiii.tiltjkc(Sfitirtt AICHI*Systeiii) ;.;::,.':F' .;f
Square Footage: Permit Fee:
0 to 2,000 $198.75 '3 ''''-;?'', ''''';',"',2-,:i:
2,001 to 3,600 $246.45 :.--:: '' --, -. --.='°--"-
3,601 to 7,200 $310.05 -•,,-.= ' 4.-- , ..= '-';',":-..."'''',. ':>''''
7,201 and greater $40439 ''',' , , : '", '':''''.. -„
Sprinkler Project Square Footage: sq. ft-
'' --. ". - ''' -- ' ': --- ' ''' 'FirilliotecikiniliiiiifFees' ,c ', ' ''''',;. '',.':',' ; --'';-'•, '',-• ',''' -,''-'':•
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.
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