Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 a ' COMMUNITY DEVELOPMENT Permit #: FPS2010 -00170
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/29/2010
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15951 SW 72ND AVE
Project: Miller Paint Subdivision: OREGON BUSINESS PARK III Lot: 38
Project Description: Extend & modify (10) sprinkler heads.
Contractor: FIRESTOP CO Owner: PACIFIC REALTY ASSOCIATES
3203 NE 65TH ST. #2 15350 SW SEQUOIA PKWY #300
VANCOUVER, WA 98663 PORTLAND, OR 97224
PHONE: 360 - 718 -8604 PHONE: 503 - 624 -6300
FAX: 360 - 718 -8603
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/29/2010 $102.20
12% State Surcharge - Building 12/29/2010 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 12/29/2010 $40.88
Class of Work: FPS Type of Const:
Occupancy Grp: M Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
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 $155.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,600.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code Stat- of 0 Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit wil expire. if w.rk is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requir: s you to f. ow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 9%2-001-0190 , You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / .may • Permittee Signature:
���-- ���--- CCCCCC 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 Annlicatkim CEWED
Fire Protection System hoR ohrlcl.: IISI•: ONLY
City of Tigard DEC 2 9 2010
•J g Received Permit Nos
DateB „� " 1 0141 �Y/�/ ,--it / / ��
• 13125 SW Hall Blvd., Tigard, OIlS97nF TIGARD Plan Review
11111 ti aaoo OD.
Phone: 503.639.4171 Fax: 503. l�ljj66'00'' Date/B Other Permi
TI A IL 1) Inspection Line: 503.639.4175BUILDING DIVISION Date Ready/By: ® See Page 2 for I
Internet: www.tigard - or.gov Notified/Method: �® Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING/
El New construction ❑ Demolition Permit fees* are based on the value of the work perfo. r ed.
Indicate the value (rounded to the nearest dollar) o . l
ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the r ofit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El I- and 2- family dwelling Commercial/industrial Valuation: $
El Accessory building ID Multi-family Number of bedrooms:
ID Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 495 l S t/O-12kAA Ave_
1 New dwelling area: square feet
_
City /State /ZIP: d r-�-- tom t..)Tl( D i 2 _ L( Garage /carport .. ea: square feet
Suite/bldg. /apt. no.: Project name: ill A ( PA,■ at t "-rt Covered po area: square feet
Cross street/directions to job site: Deck ar .: square feet
Oth - structure area: square feet
R ' 1 UIRED 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 Q RK I work indicated on this application.
X /v6t 'VI Del l V C /'p `r C et✓+ O,,_.) Valuation: $ �j(G �
C /C) .S'' /Al/G s Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Na- L T.,-,..,_ , 4- Type of construction:
Address: d S rj 6 5 (,) 5€c/o l'oL P k / . J Occupancy groups:
City /State /ZIP: . c„..._ ma oa 2 72-2-4 Existing:
Phone: boa ( 6 306 Fax: 66) 4 ZI ` 65 New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
A (Q-(- �'� under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) n Fax:: ( )
4
E-mail: ( a) P. `r'e s" l oo C.k.> co - '-L,
CONTRACTOR BUILDING PERMIT FEES*
Business name: r ��
(Please refer to fee schedule)
�i !mss �Cp Permit fee:
Address: SZ /v t 625-C 51-,
City/State/ZIP: ✓� State surcharge (12% of permit fee):
Ci
ty tick h , c4 9(...„.,„ 4 2_,,_,- / G A 98 FLS plan review (40% of permit fee):
Phone: -6) 7 (g - g Fax: (30)) 1 I g 86 7 '3 (Due upon application.)
CCB lic.: is `J Z'? Total permit fees: c /L______ Amount received: /55 3 y
Authorized signature:
This permit application expires if a permit is not obtained
Print name: /1_ j .e f Date: / Z Z9 /0 * 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 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.) El New 2.) Modification to sprinkler heads only:
❑ Addition Igt 1 -10 heads: No plan review required.
❑ Alteration El 11 + heads: Plan review required.
❑ Repair '
Number of sprinkler heads:
Additional description of work:,—, $4-Cd■ (j 1 _ ' 1 ^ y `'- G *'
Type of System (Complete A, B, C or D as applicable): Pro-Fe
A.) Commercial Sprinkler `L
)J Wet El Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $ 2 , Co 00
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations El Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (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.
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