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Permit
J 4 , CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 11111 III COMMUNITY DEVELOPMENT Permit #: FPS2010 00148 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2011 Parcel: 1 S 133AD02200 Jurisdiction: Tigard Site address: 10730 SW 130TH AVE Project: Westgate Baptist Subdivision: Lot: 0 Project Description: Fire Alarm for kitchen and Fellowship Hall. Contractor: DUTTONS REMODELING Owner: WESTGATE BAPTIST CHURCH 16775 SW LAKE FOREST BLVD 12930 SW SCHOLLS FERRY RD LAKE OSWEGO, OR 97035 TIGARD, OR 97223 PHONE: 503 - 572 -7392 PHONE: FAX: FEES Description Date Amount Specifics:, Permit Fee - COM 12/02/2010 $77.99 12% State Surcharge - Building 12/02/2010 $9.36 Type of Use: COM Plan Review - Fire Life Safety - COM 12/02/2010 $31.20 Class of Work: ALT Type of Const: IIIB Occupancy Grp: E Height: ft Stories: 2 Commercial Sprinkler System: Sprinkler Required: Yes 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: Yes Smoke Detectors Req: Battery Calcs Provided: Yes Cut Sheets Required: Yes Total $118.55 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $1,450.00 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 "cation nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or rect questions to 0 C b lii 503.232.1987 or 1.800.332.2344. �� / / I ued By: Permittee Signature: 1 ,/J4 vi, 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 :} e A Fire Protection System Received FOR OFFICE USE ONLY City of Tigard cco\\15 — ) ti ermit No.. �i 'I _.t 1 " 13125 SW Hall Blvd., Tigard, OR 97223 . ( 1 cJ/W Phone: 503.639.4171 Fax: 503.598.19 C) vo'01 Pla Revre I Ir (6 Other Permit: T I G A R D Inspection Line: 503.639.4175 �C, � 'f j i�? �4 Date Ready : y: See Page 2 for Internet: www.tigard or.gov P otified/Method: /j I '�� w� r Supplemental Information TYPE OF WORK -,,,, r g REQUIRED DATA: 1- AND 2- FAMILY DWELLING f r� 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONS CTION work indicated on this application. ❑ 1- and 2- family dwelling Commercial/industrial Valuation: $ El 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: 10750 51,E (S0-t1'N New dwelling area: square feet City/State/ZIP: Tl ( ©Qdar 0f0 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: v3 '«M�c Covered porch area: square feet Cross street/directions to job site: S G ft6 LZ.j EttlYttLY p Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. ;l t � -112'1" / E LSZ Loi,� 5(h P n --� Valuation: $ /e/ SQ r dCS Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: IA) ` SS (6.sit Grip Cl S r c I t. Type of construction: Address: l 5W L eK E Poe tcs T SL,1lb Occupancy groups: City/State/ZIP: 1—( Cs X12 R f'� d? Z Z 3 Existing: Phone: (503) r j z cI - 3 S'GO Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/ State/ZIP: apply: Phone: ( ) Fax::( ) E -mail: CONTRACTOR BUILDING PERMIT FEES* Business name: -D u'(rom / $ (� [Fen.6 st, l of (Please refer to fee schedule) Permit fee: Address: +0 fits � r r•2.eV 1_v State surcharge (12% of permit fee): City/State/ZIP: 1, f 0.5tzer /Llf x FLS plan review (40% of permit fee): Phone: (S03 ) < ? Z '7 3 cl Z I Fax: ( ) (Due upon application.) CCB lic.: SS y Total permit fees: 11 55 Authorized signature // Amount received: C(,�� S� /(J rJ� This permit application expires if a perm t is not obtained Print name: M V no1/4) Date: / _, _ 0 within 180 days after it has been accepted as complete. * Fee methodology set by Tri- County Building Industry Service Board. I:\Building\Pennits\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.) ❑ New 2.) Modification to sprinkler heads only: ❑ Addition ❑ 1 -10 heads: No plan review required. ❑ Alteration ❑ 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: Additional description of work: Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler ❑ Wet ❑ Dry Additional Standpipes Information: Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B.) Type I - Hood Fire Suppression System Hood Project Valuation: $ C.) Fire Alarm Submittal shall Battery Calculations include: Individual Component 0"' Cut Sheets Fire Alarm Project Valuation: $ )l(3 '` 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. I: \Building \Permits \FPS- PemvtApp.doc 10/01/09 2