Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
y Permit #: FPS2011 -00045
I COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/13/2011
TIGARD Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 100
Project: Amedisys Subdivision: Lot: 0
Project Description: Fire alarm
Contractor: LEAR ELECTRIC CO INC Owner: G &S FC LLC
5140 SE CIRCLE AVE 516 SE MORRISON #100
PORTLAND, OR 97236 PORTLAND, OR 97214
PHONE: 503 - 849 -4723 PHONE:
FAX: 503 - 661 -6389
FEES
Description Date Amount
Specifics: Permit Fee - COM 03/31/2011 $51.09
12% State Surcharge - Building 03/31/2011 $6.13
Type of Use: COM Plan Review - Fire Life Safety - COM 03/31/2011 $20.44
Class of Work: ALT Type of Const: Info Process /Archiving - Sm Sheet (up to 03/31/2011 $5.00
Occupancy Grp: B Height: ft 11x17)
Stories:
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 $82.66
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $435.00
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 No' nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You o•tain a copy of the rules
or di questions to OUNC ing 3.232.1987 or 1.800.332.2344.
Issu d B y: Permittee Signature: , .
Call 503.639.4175 by 7:00 a.m. for the next availa • . inspectio • •ate.
permit card shall be kept in a conspicuous place on the' • site until c•mpletion of the project.
Approved plans are required on the job site at e time of each inspection.
03/31/2011 14:07 5036616389 LEAR ELECTRIC CO INC PAGE 02
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard Received / Permit No.: `' /l1C
41 13125 SW Hall Blvd., Tigard, OR 97223 p __ Mg, _ ��
Phone: 503.639.4171 Fax: 503.598,1960 D /By 4 ✓ (/ I , Other Permit:
) l t - \ i, i ., Inspection Line: 503.639.4175 Date Ready /By: , auri ® See Page 2 for
Internet: www.tigard- or.gov • Notified/Method: ethod: f /41ti Supplemental Information
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❑ 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
q `i, i 1 ` ,` r l r mffg��' I st I :,,1 ; d' z 1 i 4r ii1e. - work indicated on this application.
. . -,' .. . ....i1flHa9i .. I. i . r ..i..- r.. ..:r b -1, - P ..^-r r .I' t ' fi . I Ai� � u r r i 'a
❑ 1- and 2- family dwelling ® Comtnercial/mdustrial
Valuation: S
❑ Accessory building ❑ Multi4amily., Number of bedrooms:
❑ Master builder ❑ Other? Number of bathrooms:
r z tf r t ert unm �y' 'r.. :, i t�= V i� 1 4 , sn , r r r r
F ��' 'r {rr 1 i' "�y�` f t A '�aa f I' , j . l ,ti .ja - 5� l ai Total number of floors:
rimiss,6'_- '": i`miiilulwiri; iii+ lh: ap.. r9919sal €,µue /.., mzexear.'ew, 7'' ,IrIItei.a r ,rs, =V•4- .auauatthOili ell.R411
Job site address: 16083 SW Upper Boones Ferry Rd New dwelling area; square feet
City / State/ZIP: Tigard, OR 97224 Garage/carport area: square feet
Suite/bldg. /apt. no.: STE 100 Project name: Amedisys 'H Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
-
Other structure area: square feet
111: u }},� 1 , ,t, ' -,.. It „ . t qqyy ,
t 'affiIia A ;.:1•u 3 eia)ta.ti & .•I; 64t i iltsigiiiliiiltlllil� 0.
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
r e,. :gar I'i;l l'r1' a.;' r: j ^':q "�` l:li:; crn � : °t. <.r:4.. = z�s•cc:�: :3 ;; tty { lissiiiin:ii iFi:cy .tk4�i
! y lllq.'�� it �� f itlf r.ki� ii I; j Ikt l kry lli ''t E t a . . x � µ . work indicated on this application.
Extend Fire Alarm circuits for new tenant improvement Valuation: $5435 00
Existing building area: 23712 square feet
New building area: square feet
y } r R { ... �, ! i . T r,i t 1 it 11 1, .5It/AN 91.
lr , i ,� , r � ia, O #,e" �;stl !l 1 ,1"5 =+ 1 ! 1 0 :... .. I � fyyy ` ' l 1' 1t'i14 Number of stories: 3
3 iivrt. r ill! t . . y.. .! d9. «....e- . ry< 1t i !1�. i '. ! ... t Y'�. �. � ;1
Name: Amedisys _ Type of construction: office space
Address:
Occupancy groups:
City/ State/ZIP: Existing:
Phone:( ) Fax :( )
New:
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Business name: Lear Electric Inc. All contractors and subcontractors are required to be
Contact name: Oleg Primachenko licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 5140 SE Circle Ave. jurisdiction in which work is being performed. If the
City/ State/ZIP: Portland, OR 97236 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 849 -4723 Fax:: (503) 661 -6389
E -mail: op@learelecttric.com G
4 , 6
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Business name: SAME AS ABOVE `�li "l �i `., . ., j 2. 1 ..:' .1 i�! .,t lil: . :
Permit fee:
Address:
City/State /ZIP: State surcharge (12% of permit fee):
Phone: ( ) Fax: FLS plan review (40% of permit fee):
( ) (Due upon application.)
CCB lie,: 52278 - Amount received: Total permit fees:
. (p
Authorized signature: v
This permit application expires if a permit is not obtained
Print name: Oleg Prim the o Date: 03/31/11 within 180 days after it has been accepted as complete.
' * Fee methodology set by Tri- County Building Industry
Service Board.
1:03uilding \Permits \FPS•PcrmitApp.doe 10/01/09 440- 461rT(1 t n2/COM/Wsa)
03/31/2011 14:07 5036616389 LEAR ELECTRIC CO INC PAGE 03
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
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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
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❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
114 ( II - : I {1 f si a xs. , : n : yy+ "µ}my 1f � :z (Irs :Ih 0t } i l l F�t"��t7.5 .7,11.IS 11 f x4'0 ,Ti
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Hood Project Valuation: I $
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Submittal shall Battery C ® Yes
include: Individual Comp ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 435.00
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Square Footage: Permit Fee: „ nl� i' :'''l'
i�l I li” `�;' �-1 I, ilir ni!!'
0 to 2,000 $198.75 ' 'i Vi i'11� ;1'I 41'fl i1� j)n „. �ilillil I
'
t I I gii I l: i ( vl : it i I�� 4
2 001 to 3 600 $246.45 11 r< ay III: P1 II1: , ,i 1 11:1' llt� l'i`I �t l (
i
: .n, z a , t
3,601 to 7,200 i' I l o y li� lli t ii �I'i d �' l , l 0 , 1 R i I. •
$310.05 11�,I,:'1, ` i II', y 11+ li v,{ io ill} rpii'tiqi
7,200 - lil �I, a I7 , r i y 1 r {t
7,201 and greater $404.39 ';'' yi,•l Vl i ll�iiat to I : I i 1 i k t 4 III*: ; " t k
g 1 E i Il i l�riII =�t .
Sprinkler Project Square Footage: sq. ft.
j y4 , {Mil fl 1I 1 a-s 's°'` xs ,I :._ i W n , n 1 , 1 s w3 &I I 1 , i °1 . r ~!
,b '' hlll gi ii . • A �s s m ,1 x11 1II ' 1I :.., { . , 1 1ki., : r. , :
Project valuation subtotal (see A, B & C above): $ i k'3t,in
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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