Permit p CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
€ �'! l e ' ' COMMUNITY DEVELOPMENT Permit #: FPS2011 00035
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/01/2011
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 100
Project: Amedisys Subdivision: Lot: 0
Project Description: Modification of fire sprinklers for new tenant.
Contractor: FIRESTOP CO Owner: G &S FC LLC
3203 NE 65TH ST. #2 516 SE MORRISON #100
VANCOUVER, WA 98663 PORTLAND, OR 97214
PHONE: 360- 718 -8604 PHONE:
FAX: 360 - 718 -8603
FEES 1
Description Date Amount
Specifics: Permit Fee - COM 03/18/2011 $91.44
12% State Surcharge - Building 03/18/2011 $10.97
Type of Use: COM Plan Review - Fire Life Safety - COM 03/18/2011 $36.58
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg Sheet (over 04/01/2011 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process /Archiving - Sm Sheet (up to 04/01/2011 $1.50
11x17)
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $142.49
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,000.00
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
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You iay obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: A I)-- - T;2)Z er .. iex ....z <_ Permittee Signature:
de r°.
)0 0/AP-
Call 503.639.4175 by 7:00 a.m. for the next available ins. -ction 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
Fire Protection System RECEIVE FOR OFFICE USE ONLY
City of Tigard 18 DateB -, r� I �,0 Permit No.: /2S, r/ �• �3
.. 13125 SW Hall Blvd., Tigard, OR 97223 L 0 f Plan Review
-
Phone: 50 Fax: 503.55!8 " �T OF TI DateB : 3 - 3/- l� Other Permit:
TIGARD Inspection Line: 503.639 C DateReadyBy: .orris: ® See Page 2for
Internet: www.tigard- or.gov B UI LDIN G DIV Notified/Method: Supplemental Information
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
i gf Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwellingCommercial/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: 1( Q i :> S ( U � ES / .A New dwelling area: square feet
City /State /ZIP: - 6 p J O p.._. ell 2-2,1 -- Garage /carport area: square feet
44:1111,,ldg. /apt. no.: ) Project name: 4$4 et) / y6 Covered porch area: square feet
Cross street/directions to job site: / /� Deck area: square feet
5W. - 72- " 4 5; W . thq £)Q. VA/ S 7-0°4A-1 tf). Other structure area: square feet
REQUIRED 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
A DESCRIPTION OF WORK work indicated on this application.
A t b F 11" SP 12-J IQ K G 1-S -T AMMO M-TE Valuation: $ Zoo a�
TE Existing building area: '3 3A 3 square feet
iv/�jJ 141 pJ� V EM E Al i
New building area: square feet
❑ PROPERTY OWNER TENANT Number of stories: '
Name: A Al & t) ISI1S T, . Type of construction: •' 3 _ g,
Address: I 66 a 'S SIA) V Pa & E 5 FT-P'1 /L .-s'J . /CD Occupancy groups: 6
City /State /ZIP: TI &A t...4) o , 1- L2, 4 1' Existing: 13
Phone: ( ) Fax: ( ) New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: FIl,_E STO p t_ t All contractors and subcontractors are required to be
Contact name: 66 13 O I`yAN Go (..-6-. licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: t \i e ; S T b ST. , SPACE Z jurisdiction in which work is being performed. If the
City /State /ZIP: VAN 6.0()V El-, WA • 9 9 6 6 3 applicant is exempt from licensing, the following reasons
apply:
Phone: (3) 71 S - c?) 6o4- Fax: : (36.0 ) 7 - 6o 3
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: jA M.E. A S A 6 d ar t":- Permit fee:
Address:
State surcharge (12% of permit fee):
City /State /ZIP: - FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
,CB lic.: i $ 3 2....-7 1 Total permit fees:
• Authorized signature: 4 PAg"2-3-- Amount received: / 9 '�y
/
This permit application expires if a permit is not obtained
Print name: 11.4 PE r.:- b t ft-t E,Ai Date: .1, r ` I - a j I 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 don e:
1.) ❑ New 2.) Modification to sprinkler heads only:
ig Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
El Repair
Number of sprinkler heads: ? 3
Additional description of work: A b b 5 P/L-i roc C. J S A- S N EGESS" f- 7
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
2 ❑ . Dry
Additional Standpipes -- • ' "
Information: Hazard Group LI H T
Density N /fit
Design Area
K. Factor ( 5 6 )
Sprinkler Project Valuation: $ 'L OM) , ° M-
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ 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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