Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
' !'- COMMUNITY DEVELOPMENT Permit #: FPS2010 -00172
TIG ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/13/2011
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9718 SW WASHINGTON SQUARE RD F05
Project: CATHY JEAN Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Modification of (19) fire sprinkler heads for TI
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR WASHINGTON SQUARE LLC
9095 SW BURNHAM 2235 FARADAY AVE STE #0
TIGARD, OR 97223 CARLSBAD, CA 92008
PHONE: 503 -684 -2928 PHONE:
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/30/2010 $112.96
12% State Surcharge - Building 12/30/2010 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 12/30/2010 $45.18
Class of Work: ALT Type of Const: IIB
Occupancy Grp: M Height: ft
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
Density: 0 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $171.70
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $3,072.00
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
Utilit 'oI!cation .- ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 0190. You may obtain a copy of the rules
or • rect questions to OU ' by c.Iling 503.232.1987 or 1.800.332.2344. i
Iss • ed By: A L / Permittee Signature:
A a 4
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.
- 13,uilding Permit Application
Fire Protection System CE� Received F OR.OFFICE,USE ONLY . 1
City of Tigard /0/ 2 /v _ i0 PermitNo.:/1 /
. a 1 B • 13125 SW Hal] Blvd., Tigard, OR 9722EC' 3 ® Plan Date Re iew .
1
Phone: 503.639.4171 Fax: 503.598.1960 2010 Date/By: C / e (1 Other Permit:6'.`4ye)'Dog55
TIGARD Inspection Line: 503.639.4175 C Date Ready/BY: Juris: 0 See Page 2 for
Internet: www.tigard- or.gov Di OFTIG'AQD Notified/Method: / /. I / 7 ¶� Supplemental Information
UU (,fJ �.�w
IVIRON r S O (Afek t (4`S .,
no' . ,.. .; ... ' TI'PE u F Woi i'e it # REQC JIRE DTDATA 1 AND Z F
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
'Indicate the value (rounded to the nearest dollar) of all
kAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
t t to work indicated on this application.
� . e ...�.. Ea_ CAT EGOfr Or+n CONS - e t w k d PP
❑ 1 -and 2- family dwelling Commercial /industrial
Valuation: $
111 Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
w %
,fit gar 1 ,I JOB SITE INFORMATION ND LOCATION * IS Total number of floors:
Job site address: 9�J S ( �� - , ( 2-? s� t RI) , New dwelling area: square feet
City/State /ZIP: ^ l 6,11--12_D t " % / Q 7 � 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: C k H- y J it) -,, r Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
R "',� U r . e a fi s9" e s r .d • rs
EQIRFi]? T ATA COM RCIAL CTS.EICT ECKL�IS '��I =
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
r equipment, materials, labor, overhead, and the profit for the
- d v,,et .a.
DESCRIPTION OFWOitK�- work indicated on this application. • ,y
d _F . ACi ,. n it n'- . . « . ,�F�ai, . .. N,, _ d 4x:41 3 ..,=.awe ae4* .3, 1,10.a - r
./4 J MA P /ag_ p - w Apiax � rn..r 7 J 1 9 5 ?/e_l}Jk1 Valuation: $ lz C7C/
t-i- E -O €? /v -- Existing building area: square feet
New building area: square feet
r ❑ I?ROPERT a WNER ` . ,} . tD TENANT } � Number of stories:
Name: Type of construction:
Address: • • Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
s ' l ii �T . < I P ::sz. �� ry -:, 0 V zf ..� .a: , a�" . s a c '�n' e t 4six* . r �s 0 1 4r, .,s,, 4 k
- t� LICANT Y r CONTACT PEI260N .. „ ' � i� t� a
yr 4 ,_
Business name: 4 c_OA,I -r/`-A� r op_ 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 /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) • Fax::( )
E -mail:
: '.. ,.. 3. v g , CON T RACT07t . ,. ..._, �a s k. ..., x y " f , BU NG PERMIT FEI S *y , y
_
Y> �6 p/� „ <..= :(Please,raferto!feeiscliedrrle r , , s
Business name: / `
Permit fee 7
Address: 90 6�(,)o�
State surcharge (12% of permit fee): . 6-- City/State /ZIP: 716 °R, L Z
/ 7 a 3 �
t FLS plan review (40% of permit fee): 4/,5":,1 a
Phone: (Sty'S) 1. 4 -.. 29 2 Fax: (fit 3) 54_ - 5 (Due upon application.) o
CCB lic.: l Total permit fees: / ,1 70
Amount received: ' 7 / Authorized signature: ��.
7d
This permit application expires if a permit is not obtained
Print name: / jA Date: I Z — Ze - 1 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- PernutApp.doc 03/23/06 440- 4613T(11 /02 /COMNdEB) e•Gl.
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
,Describe work to done � -
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
Alteration �' heads: Plan review required.
❑ Repair
Number of sprinkler heads: /9
Additional description of work: .
Type f S y tern (Complete A, B; C or Dimas app4cab M, , tAf VR IASK _g„S k
J' ; 9s " k f g E _ L 4 .-t k eig ez1 E \ 'i' m17+t .z„ i . , r e, y .�
!� s ''" E ? � . � ���`� x1 a ,� �s �r°i%5 rd� � -„^ J � v T ad � "�.
^` a i ° k" a a + aE g '.F =' _ � ' '.i+ E, eot t° si - 3� .E'R* �z
A)� o
Crn mer cr �Sprinklers 3 � �� �zE
i $W=�. �-.e ,<,. s �� fi u1�? ...... ,..4� '� � i4.o- _., E r.�� - �W , x !i� .n d , � .,� ., v .
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
•
Sprinkler Project Valuation: $
4 1� . ro � ^§ s
) T z H Fire S jon Systems : a . � _. s re r t o i w
Hood Project Valuation: $
ti
6 4 S �� NC `' U _ u it W i a t SAS � 13- r gn x a� �ys n a EV a
z r `o v R� a� `� na� t _
C �" c �" a ii t t be
Fire Alarm x
f�
Submittal shall Battery Calculations ❑ Yes •
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
s� a
a t , y i- a> 57 & : N i v F V : ^ ` Ar it>S ,�y u S z V i t' $ ,t ?k
D, Resiclentl Srinkler Al one Sy sem�� � Kk 5 %,
Square Footage: Permit Fee: re ft £ 'fir v
0 to 2,000 $187.50�� �"
2,001 to 3,600 $232.50 W x r to ati
3,601 to 7,200 $292.50 �f aP 4 �w �m ice'
7,201 and greater $381 .50 i 4 '
Sprinkler Project Square Footage: sq. ft.
.n. a...,... ._otai . got mrowdoii. Per F . ` ., IW N ._ _ l ..E
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 /docs /FPS- PermitApp.doc 2