Permit III
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT COMMUNITY FPS2011 -00102
Date Issued: 08/12/2011
TIGARD. 13125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9627 SW WASHINGTON SQUARE RD FCO2
Project: Sonic Subdivision: WASHINGTON SQUARE MALL Lot:
Project Description: Hood fire suppression system.
Contractor: SANDERSON SAFETY SUPPLY CO. Owner: PPR WASHINGTON SQUARE LLC
1101 SE 3RD AVE BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97214 ATTN HILARY RAYMOND
CARLSBAD, CA 92008
PHONE: 503 - 889 -3110 PHONE:
FAX: 503 - 889 -3192
FEES
Description Date Amount
Specifics: Permit Fee - COM 08/12/2011 $102.20
12% State Surcharge - Building 08/12/2011 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 08/02/2011 $40.88
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Sm Sheet (up to 08/12/2011 $4.50
Occupancy Grp: A -2 Height: ft 11x17)
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required: '
Total $159.84
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $3,000.00
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 withi 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopte• b ' the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain . cop of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.
r /
Issued By: 40 0111111 1111...-- : • rmittee Signature:
Call 503.639. •iA: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 projec .
Approved plans are required on the job site at the time of each inspection.
c� .
' 'Bullding Permit Application
Fire Protection System (� \% . FOR OFFICE�.LSE ON•1_v
City of Tigard V �
' Received I ��, Permit No.: ,,/ -�
lig
• 13125 SW'Hall Blvd., Tigard, OR 9 Q Plan Review
J Phone: 503.639.4171 Fax: 503.598.1960 \§3. ��G Dat /By. �r fi � �'erPermit:C �� —UO
74,:i G ;n R D Inspection Line: 503.639.4175 Q D Ready/B
See Page 2 for
Internet: www.tigard- or.gov a Iti ficd/Mctliod : � 7 Supplemental Information
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n $ •" `�r,-. `mod'-' ..,-' y,,'.ssr.+ 'C's ® , .rit a+ ` • F ` ,,,- '� i i.r r,,.
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Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
=J, `' .:, •,.la.: , °^i ". W r,;.r t i Pdff a. at :,.nr,': " Kt 4 :67,0U err wt „ work indicated pp
.:� � 4 • VA . �, ; ATE60 CO b"T ,:i.C,TIONt•Q ;° ¢' k. ca ed on this application.
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El 1- and 2- family dwelling • Commercial/industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
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,� " `tai dUBt:S1T2W . J#W OC:'ATIQN P Total number of Moors:
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Job site address: `�' \ C`–
\ e)\ New dwelling area: square feet
City / State/ZIP: ii a r ('>k h I —7 Garage /carport area: square feet
Suite/bldg. /apt, no.: J Project name: , 5 A i Q OU r� <, r
Y Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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Subdivision: l Lot no.: Permit fees* are based on the value of the work performed.
•
fax map/parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the pro
4cy , ; z .,. .x,, b profit for the
a a: +r�: ` # r' ,d ,. rr k *Y.C:ss.:,+s?w•rra;;� ::aYy_' -. „. ,r^ "s .. .:n ”, , ,+'r"-... .... °ark..: ,.
°, i C 'st r ;. G A ) , t r, +e '; DESG'RIP'I`Idfro' ' WORI r )' ; P ", , d` ' ;' g work indicated on thi application.
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�a � Y � ��:5�/ C� r�� 5��� Valuation: $
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Existing building area: square feet
New building area: square feet
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� N �, r PRO P E RT] O�i' �%I vi , + ; y � apTENANT � ` Number of stories:
Name: type of construction:
Address: Occupancy groups:
City /State/ZIP: Existing:
Phone: ( ) Fax: ( )
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Business name: All contractors and subcontractors are required to be
Contact name: (Q 0 ..0 S n • �,� licensed with the Oregon Construction Contractors Board
'a under ORS 701 and may be required to be licensed in the
Address: . jurisdiction in which work is being performed. If the
City / State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: j Q t 3) Q S C ^� ✓ (1 D Fax: : ( )
E -mail \ [ )�c , +V � 1 ere, a 5ay.5cA e.,. c(
g . :r =a P I': ... :, • RAGTOR; : , . . : l r P. li , .
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ry a : ivR „ R . .: �� _= :5 , ," t , r , u, t - ,- mBL?ILDING;PER11%IIT FEES ` .a1 i, . u`• � ,r�',
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Business name: S '� L iss. « 61R leaser efettofieschedule).LAAk, ,-Al:
Sc��, d �v'Son r� --���� �J Vl'� � 1.
Address: ^ d Permit fee:
i
City/ State/ZIP:
State surcharge (12% of permit fee):
Phone>� l G• � FLS plan review (40% of permit fee): /� A v 7 ' J ) i I Fax ( ) (D ue upon application.) 1 (/ e 0
CCB lie.: (D- 9 6 Total permit fees:
Authorized signature: . �, /� Amount received:
)1'� T This permit application expires if a permit is not obtained
Print 11. - : j — ° D �
�� / r � - d * Fee methodology set by Tri- County Building Industry
•
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.
El Alteration ❑ 11+ heads: Plan review required.
El Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet El 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 El 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 three (3) sets of plans at submittal.
Plan review fees are required at submittal.
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