Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• - COMMUNITY DEVELOPMENT Permit #: FPS2011 -00068
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/09/2011
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 140
Project: OMEP Subdivision: TIGARD TRIANGLE CENTER Lot:
Project Description: Adding (1) and relocating (9) sprinkler heads.
Contractor: DELTA FIRE INC Owner: PACIFIC REALTY ASSOCIATES
14795 SW 72ND AVE ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 620 -4020 PHONE: 503 - 624 - 6300
FAX: 503 -620 -1058
FEES
Description Date Amount
Specifics: Permit Fee - COM 06/09/2011 $112.96
12% State Surcharge - Building 06/09/2011 $13.56
Type of Use: COM Plan Review - Fire Life Safety - MF 06/09/2011 $45.18
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .10 Design Area: 1500
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: $3,050.00
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 may obtain a coo of t rules
or direct questions to 0 . by calling 503.2 • s or 1.800.332.2344. /
Issued By: d
Permittee Signature: ,
J
• . - .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
Fire Protection System FOR 'OFFICE USE ONLY
City of Tigard Received ��
i ,!...5 u �IIII �a
r' Pn Re Permit No
° 13125 SW Hall Blvd. Tigard, OR 97223 a
4:401) Plan Review Phone: X03.639.4171 Fax: 503598.1960 Dafe /By: Other Permit: y e / ,2074 l'' /r,
TIGARD Inspection Line: 503.639.4175 DateReadyiBy: Sufis: ( e e I
Internet: w wvv.tigard - or,gov � N See Pen Supplemental Information
�` '(l S upplemenalnformation
CIS •
TYPE ,ORK° . - ..)." ` REQUIRED DATA: I,: AND 2 F • -. %IILY DWELLING
❑ New construction I ❑ aemo i Permit fees* are based on the value of the work performed.
Indicate the value (rotnded to the nearest dollar) of all
Addition/alteration/replacement ❑ O �
,� equipment, materials, labor, overhead, and the profit for the
. . CATEGORY OF CONSTIWIION work indicated on this application.
❑ 1- and 2- family dwelling ` %Commercial/industrial Valuation: S
❑ Accessory building I ❑ Multi- family Number of bedrooms:
❑ Master builder ❑Other: I Number of bathrooms:
JOB SITE IN ; N
FORMATIOND LOCATION Total number of floors:
Job site address: a9 Oq ,' t1 C n Q om ' ?a„•1, 1 1/� New dwelling area: square feet
City /State /ZIP: Po fAcnd I �pp 9/ vn �� ^ Garage /carport area: square feet Project name: WC #( E p _ O) Covered porch area square feet •
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
• - REQUIREDDATA :? COMIIIERCIA -..... „�......... .
L,- U ,..
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application. �\
•
Ill (7,10c ir7in t-- e heock Valuation: S Z, O5. CO
t ldAn 1 5 ein1h 1 1{ er Existing building area square feet
v heed.
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
XAPPLICANT ❑ CONTACT PERSON . .
NOTICE
Business name: l,, � � - -
�e , 1 re. Eric All contractors and subcontractors are required to be
I licensed with the Oregon Construction Contractors Board
Contact name: �ke orbf N 4 • . under ORS 701 and may be required to be lensed in the
Address: 4 a /l . jurisdiction in which work is being performed. If the
City /State /ZIP: Or a f t f 0Q v 7 /1 t] / I a is exempt from licensing, the following reasons
Phone. '4 , i 0 • •,... Fax:: • r — • 1
E -m ail. he ;tc1: 5 (w cA -. Wee. COM
CONTRACTOR UPNG_:PERD.Irr FEES*
� et- , fire Inc. BILD Y :..-
Business name: 1 Y . 41edse refer to jee schielnie
I L - p 5 G in n a • Pzrmit fee:
Address: `? p( Ave /"CVG
City /State /ZIP: r +A an ( 'Q 9 (f State surcharge (12% of permit fee):
` "1 ELS plan review (40% of permit fee):
Phone: 6 _ p • _ $ — + Fax Fax' e • • • u e upon application.)
CCB lic.: '(,I 1 71.1 Total permit fees:
—
Authorized signature: , • / Amount received:
•
/ ,, ' �j _'1. I �tlk This permit application expires if a permit is not obtained
Print name: : '1 ` �,� • / ` within l80 days after it has been accepted as complete.
�J "1 6
* Fee methodology set by Tri- County Building Industry
Service Board.
1 1 Buildine/Permits/FPS•PermtApp doc 0323,06 :40- 4613 J02 /COAIrWFB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be 'done: . _
1.) y��� New 2.) Modification to sprinkler heads only:
Addition itio 1 1 n heads: J_, w r 1
lul.LiLLV11 X 1 -10 heads. :Vo plan Ieview required.
Z , Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 10
Additional description of work: -
Type of System (Complete. A, B,:C or.D as applic
A.) Commercial Sprinkler •
St Wet [7] ' D ry • .
Additional I Standpipes A) k
Information: Hazard Group l.•�h�—
Density
Design Area j 500
1 K. Factor 5, Co
Sprinkler Project Valuation: $ 7'j 0(3 . 04
B.) Type I - Hood Fire Suppression System .
Hood Project Valuation: 1 $
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 $187.50 . "• . .
2,001 to 3,600 $232.30 .
3,601 to 7,200 $292.50 -
t 7,201 and greater I $381.50
Sprinkler Project Square Footage: sq. ft.
.. i
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $ .
Permit fee based on project valuation (see fee schedule): I $ I
Permit fee based on square footage (see D above): I $
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.
I ,Building \Per:n,Cs \FPS -Perr itApp.doc 2