Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2011 -00077
TIGAR 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/06/2011
D
Parcel: 2S113AD01700
Jurisdiction: Tigard
Site address: 16850 SW 72ND AVE
Project: Bridal Exclusive Subdivision: ROSEWOOD ACRE TRACTS Lot: 30
Project Description: Relocating (68) existing sprinklers.
Contractor: DELTA FIRE INC Owner: BRIDGEPORT LAND LLC
14795 SW 72ND AVE 3939 NW ST HELENS RD
PORTLAND, OR 97224 PORTLAND, OR 97210
PHONE: 503 - 620 -4020 PHONE:
FAX: 503 - 620 -1058
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FEES
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Description Date Amount
Specifics: Permit Fee - COM 06/23/2011 $177.52
12% State Surcharge - Building • 06/23/2011 $21.30
Type of Use: COM Plan Review - Fire Life Safety - COM 06/23/2011 $71.01
Class of Work: ALT Type of Const: IIIB Info Process /Archiving - Lg Sheet (over 06/23/2011 $2.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm Sheet (up to 06/23/2011 $7.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .10 Design Area: 1500
K Factor: 5.62
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $278.83
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $9,931.00
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 copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: r •ermitteeSignature: jj
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Call '_''_` "•.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 CI ' of TI and Received
• Tigard �Q`` DaterBv r Permit No,: A, I 6 4,. �, v >rrR,w,'� 7 ay '
. • 13125 SW Hall Blvd., Tigard, OR 9 /___, p 3 Plan Re uJ�
Phone: 503.639.4171 Far: 503.598.19600 D O t DaieBv: A l figg � Other Permit: 1 / . • l
il
Inspection Line: 503 G D R;
T7GARD a te e adv:y: T 0 See Pa e_
Internet: v, w.tieard or.gov 1 (* � l s` ��ftsd thod: e� ' r Supplemental Information
TYPE OF W i , s 0 QUI D aT 1 AN . 2- - F M ILY DWELL
• ❑ New co El Demolition / Permit fees* are based on the value of the work performed.
Indicate the value ( rotded to the nearest dollar) of all
• Addition /alteration /replacement El Other: equipment, materials. labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1 - and 2- family dwelling tl(?\CommerciaUindustrial Valuation: S
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder 0 Other: Number of bathrooms:
JOB SITE. INFORMATION ,A ND: LOCATION Total number of floors:
Job site address: I � � F5 (j 7 (71n(/i, �"'�/C New dwelling area: square feet
City /State /ZIP: m rk , i � p, 9-7 � , ca.c[ V
- „ i ... Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name"' Covered porch area square feet
Cross street/directions to job site: sp T: I 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
t r� \1 tViii • t�1(, work indicated on this application.
n. 2I /`
/ c p X,L bkIna l `c��•1eI1T ) Valuation: j { , ?l
C Existing building area square feet
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
X APPLICANT ❑ CONTACT PERSON • . . . •
N.O,TICE.
Business name: r1) e,lJ. r r.9 "Tie All contractors and subcontractors are required to be
,
Contact name: �� � � �,� I licensed with the Oregon Construction Contractors Board
`" O under ORS 701 and may be required to be (tensed in the
Address: I Li 79 5 6i A) '7 ncA i0P . jurisdiction in which work is being performed. If the
In L ' ck
applicant is exempt from licensing, the following reasons
City /State. ZIP: / o f`. f(� 7 a a L' apply:
Phone: (O "10 I Fax: � M : (5(1, ( CYi J - (J5�
E -mail: k�; ,P,� i �Y`Q. -c �1 f I
CONTRACTOR
- BUILDING:PERNIT.FEES*
• ��� 4 (Pleai•`e re ild:(ee `schedule •
m
Business nae: f l f P. r C -
5 -.X.�-i + c Ave Permit fee:
Address: 114 ���
� � n P c� g-91-1 Statz surcharge (12% of permit fee):
City!State /ZIP: l
� FLS plan review (40% of permit fee):
r
Phone: 5 9 (o 9n _ /4 O () F ax: c `V Jf - �jl laB l) I (Due upon application.)
CCB lie.: /"n 4 7 ii `w b 4 Total permit fees:
Authorized /�,�j� nrt
Aount received: o $, ��
: S
� /" t. This permit application expires if a permit is not obtained
Print name: • r within 180 days after it has been accepted as complete. • .�' 4 . • - D a te: t I I * Fee methodolog' set by Tri- County Building Industry
Service Board.
C\Buildin \Permits \FPS- PermitApp.doc 03/23/06 440- 4613T(11 /02 /CO.1/WEB)
City of .- Tigard: Fire Protection Permit Checklist
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Page 2 - Supplemental Information •
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads' only:
❑ Addi tion ❑ 1-10 heads: No plan review required.
� �, Alteration . i g 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: (,4
Additional description of work:
Type of System (Complete A, B,.0 or D as applicable): .
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A.) Commercial Sprinkler
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• f 1:1, Wet ❑ Dry
Additional Standpipes /VA
Information: Hazard Group L'
Density , ( "
Design Area 1 '600
K. Factor 5.('6,_
Sprinkler Project Valuation: $ 9
B.) Type I - Hood Fire •Suppr System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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D.) Residential Sprinkler (Stand_Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50 .
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50 •
7,201 and greater $381.50
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: $
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Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
. "New ", fire protection sv stems require that plans bear the original seal of an Oregon licensed tare suppression
engineer, or NICET level "3" technicians.
i:\Building\Pennirs\FPS-PermitApp.doc 2