Permit CITY OF TIGARD
FIRE PROTECTION SYSTEM PERMIT
1 1 1 1 s COMMUNITY DEVELOPMENT Permit #: FPS2009-00099
T B GAR:D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/18/2009
Parcel: 2S110AC01700
Jurisdiction: Tigard
Site address: 11305 SW BULL MOUNTAIN RD
Subdivision: Lot: 0
Project: Christ the King Lutheran Church
Project Description: Install (1) panel, (1) annuciator, and (1) smoke detector.
Owner: FEES
CHRIST THE KING LUTHERAN CHURCH Description Date Amount
11305 SW BULL MTN RD
TIGARD, OR 97224 Permit Fee - COM 10/22/2009 $102.20
12% State Surcharge - Building 10/22/2009 $12.26
PHONE. Plan Review - Fire Life Safety - COM 10/22/2009 $40.88
Additional Plan Review 11/18/2009 $4.30
Contractor: Investigation Fee (Equals Permit Fee) 11/18/2009 $10.76
PROTECTION ONE ALARM MONITORING Investigation 12% State Surcharge 11/18/2009 $1.29
15500 SW 72ND AVE
PORTLAND, OR 97224
PHONE: 503 - 624 -0244
FAX:
Type of Use: COM
Class of Work: ALT Type of Const: VB
Occupancy Grp: A -3 Height: ft
Stories: 1
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: Yes
Battery Calcs Provided: Cut Sheets Required: Yes
Total $171.69
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 3328
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 -0100. You may obt. a copy of the rules
or direct questions to UNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: A n� p Permittee Signature: ` / /7
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 I' Eccl 1 i FOR OFFICE. USE'ONLY .
Mill Cl Of Tigard Re , �l d Permit No : A' u dad ty Da 9
13125 SW Hall Blvd., Tigard, OR 97223 ) s1 201 `plan Review ' "Alin .
Phone: 503.639.4171 Fax: 503.598.1960 0 C O CT T G 6' .bate /B : ' /t Other PermU.
Inspection Line: 503.639.4175 Date Ready ty (1 , 6J See Page 2 for
TIGARD ��
Internet: www.tigard- or.gov i3fi a Date �t , tf -, , t ,,; • • • � /, Supplemental Information
BUILDING ff i g1d'1I11 �,�u
..y. - �s -. ;. x:: '#!" x �"' t: A:' �." d' is"#- w,`da � �ni. "�`. °k�jx �.�k �: e " 1A �_ Y ���y� >,; ��.�s~:�� = �s��.;a�a:� t
° r A o - :, e , { x ' �,r , . �'.-. . r.., n.< nRE � iziali ii l-I ANAx2 -F , AMI LpYDWEI3`I iRaf : :
„�` ` �s .¢, ;: ,f ` <.g :, Tv s PE OF WORK: , , ' , ryJ .4. i `r' `s w i Q 3W7M ,V- :�,;�« .'t,2.Wd?..ar -a ., :jt.
:s�r�'t�z�c�,�� �. fe, .:a�� �'��:�:.� �� >�� ���t...�*�r ar�� ���.`� -�e,� `� s� sf fn . - ���� s�� �„=� ,� a? ,�,-
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
[4 Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
a =�;: -r + , :. ,k :m �:t, u.lzi r -:= _=<,: - �z -.6; �. _,:, : x
=F4� ;> s>.i-', "- -
w a, a. - 4 work indicated on this application.
e;::� t ���`.rirv" - �_y, _,��� -` �`, .CATEG,ORY�OE�''`,CONS...- a �•� a:� ��':. °r' "".fs':`
C Js .. � .,..'.f�a-= , xv��,. `��: ,� � ?,r�,r,���.�;��', r, � �G..,�,
:. i».. �N. r; Fa� r,.4+;G� c:..,:;;�c„,�.s�.t.��i#.a _ _�
• Valuation: $
❑ 1- and 2- family dwelling (I Commercial /industrial
Number of bedrooms:
❑ Accessory building ❑ Multi - family
❑ Master builder Number of bathrooms:
❑ Other:
t„ 'M . b :;, :: cairif s :i loss a: sera; re��,::°,I u=r�r i +rs,* a hrz..� .;; r ,,:'�, -; s ;.;. - 'rt
`�"u 5� "��'.-�";�-�; -:� � �, �' _ t °x" H n LO. ATION =.�'� �� �' t"� >� .`� . Total number of floors:
! -a " a-� _ =S E INFORMeCTIO ?►'ND C ,,,. a�. i "`
�; JOB, IT r , ;� �- . 8, 1,, �.,�.��:�;h_.������k;�.::;a'
j.,. rs.` xx,• �:= „, Y' �, Y: S..-; r�F, i, Jr[.~<< P?'-' S�:��x51+ tt' a- sK*� ?f;#'"'A�cz:;.a
Job site address: 1 13 (0 S Sin.) by I. \ y v>,. u m gyy New dwelling area: square feet
City /State /ZIP: 0 Ott OA — 1 22.14 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: ewe r Ilit kt n,ee, Covered porch area: square feet
Cross street/directions to job site: f t e*-111...QJ . 14' Deck area: square feet
Other structure area: square feet
, -t� rei..§-�a� x ” : =:�v: ; `���-�c_ •*�.: ��,'
t I EQUIREb DATA COM;MERCIAE=„ SE.iHEGKi ST' 't
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
ems, - �ci il .,�1 'tt ;�;.r ,.?°. -:,i- 4'
;;;;:` < {t . >`t € se'. -,c:- «. » -ktt - z t¢'i. =,r : °'` ° ° <rf work indicated on this a
.. , 4aTg;' 4 3 DESCRIPTIONa.OF,::ROR -e —Afi r rstt , „,., Via, application.
��;�`�,�'�'sf���..�� . ���3' �" � ��= �r�k '�'� ^,- i�.�.;:�.::�;:��,. -.� a� r. �r.`.'' ��='`. ec�. a- �. c�..�`�^,�,s���.`:r': =� +�.. -
V. ation: $ 3 3a C'•010
p1Ct,e_e.. p rue l 1 cLAYklk 0 4AO( 1
l ' I
11 0 ` Q M `4i ICS x tC 0 U ,� C A-Ot Existing building area: square feet
• (� New building area: square feet
`s''tT c mi � `x •,°TEN NT tze= . r y s Number of stories:
a, . 0 .. g ®: I'ROEERTY OWNER , � t' V 4 r ® : °� ` -- 1
Name: Type of construction:
Address: Occupancy groups: k?
City /State /Z1P: t Existing:
Phone: ( ) Fax: ( ) New: •
:sr eB . ,�: , ni e - a i < fg' : 1 iN ,; "" ,' ' :,... ''�z:ay *' ?':.:'> ,,,, ,,,,, �. •-,,, .Ss.:,' ,r., ,,,,,w •ate=•'° 5 ,:1°.' sti -,
., . '14 , s _ - , , ':x ' ; ® ,,.CO tTACT ERSO N�,:} r g; . i ; i iiP `.-t141, *:.: Xt i v
1 �^ ® rPPL ' t ` N,QTIGE� '.` £ r
�*�.��'Lt .s.a � sz ��.� -�'✓. .�e,.. $- 5:'�'•. r, "'Kin 4 '• v�,` aw.:.' �.,; �Ya �d3; sr >i .«»�'�tS.U54= .».n',a. -t'O ;'*t"�` ��`?�.aa" � ,�, ^"� »a�s wu�.�::7R �"�"* w''�u"'�.�*1",k;.. ^^. i
Business name: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: apply:
Phone: ( ) Fax:: ( )
E -mail:
=. 363.0 `: -:w: -W° :f.4' •� c *i;,1;. ;, 3�N.:Met.trya' ds;:r- ;,e.: YS ;�`�Ir3;R 3' WW' .,"h s = - - - - - - - -
��'€` =� �', . �, iF�. ��"_ N '� , -� ,�'* : wr',� �- ,?ate �-� tc'�. y , *�o- , ,, : - i t s+ { � �„"`". -
>:�'� L, =. .,�;�� :,: w .�. „��: �, ,,� - ,, ; ..�s -,. �;.<:°� �.. , -�, x - �, �,.�b�:I�Bi7I�;DI " G�I'ER'1� f I'1:� FEES '"�;;
�; ,:. ; _^ x.. { CONTRACTOR i - ,� ''i*r t.4il';i !1 > - 4, =,. ,.,:;p.- =.
a
;r.. ,,^ = ;r s sc:,: fps *....;..: a�.;;iC. -,. ,.° $>.:.x. +t's t ;,
M - ����,...a„ - �: °>�, .ate: e��,t',_�" - t>r _�$:a �.., '- ''��°� ,,:�.w"4; �. r =ec :�, t � � a s s „ e , e �
?(-54..e P ��� l�N ti ,� ��.- _,�.a� �^�.,� ( P,leasetrejer`toafee,•sehedulel J:�'�;i:,�;..'��` -��:
B usiness name: Permit fee:
Address: / t e : : : ) 0 , (�,,) —j ( 9 . )40 d ' - / 00
State surcharge (12% of permit fee):
City /State /ZIP: ?, f .-4-1 (),"! f ,( / 0 C(7 2. L 41 FLS plan review (40% of permit fee):
Phone: (SC j ) tit 3 2.4 2. Fax: ( 9_,S)/.04.3 Z9 a l (Due upon application.)
CCB lie.: 11 t(0 3 Z,S"---- Total permit fees:
Amount received: /46, () CJ
Authorized sig •
�_ This permit application expires if a permit is not obtained
Date: // within 180 days after it has been accepted as complete.
Print name: f /d u'09 * Fee methodology set by Tri- County Building Industry
Service Board. //�) �� �/ /�
I \Budd,ng \Permits \FPS- PermnApp,doc 10/01/09 440- 4613T(11/02 /COM/WEB) - e../�/ `�V `ice
•
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
.�,. „�,,. .r �.:: ; "r A u._. :•,Yw..: �x °..�; `.'i* :'� '=.f;:,��. -= , .i�.'£x.= '� = =�b�T - ����..x'?i -' ?w; zn .
,q
D es c rib k e worktob e <.done _ .., b , ' ; ... fs .. ;;.
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:
,,,- - :•� :sr- '%s;,i rt_�:;��5 . }.z,.�» ^F::'ic�a� �, "�,:,�.t.- .'�zu?'':�„��� ' °�'° F�w' '�`� "'#"�' =rx
st.'•°v _ y .. S' _ ...� � .., - <._;- �,`�"." �� �.fr.^., ,d _ y+'sr;� day �K:.r ;ev``, >." -%.i:' �'�Pdi44,� vv .Y"? ' �m- 'u
�� ; i„ R =. r,:. F , riM I. €.T:;3 4'i 5 ;5s }t a t* $ { ',z ,#=4` i ,r,*,: �3° �+s- d
9;.,Ia�` .+'.�� ir � ' _*t•3 s` , �. r' . � ;� (},`:. �, 5 ��.<;�", i`''� s �M��'•_* � - .gi,� � a, ' ?- •� c i K :�'�' .� y zk � Y'#�� '3�" , ,.�"�" - '"s= �'�
a�� � s:
E.•�3 a„ 3. `;; v�•;1' �?a,«'� sr �'�'as = °�;;�" � � � ' ' � T ` ti ��, ,��i:, •-
A �� ; ommercia' bprintu'.r 4 ; it ,,t .,:, '.
.. ' * h"ai' a.,„...'° e,'+ . �>x� ,�.'�..„,,ate *few 5: s o'ti `. , .�,.Mi i +'•a a , r.,. .. s ems..
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density •
Design Area
K. Factor •
Sprinkler Project Valuation: $
-- 'ww`t�" ;e' '�W ':' - : syyy - ^ f; , :�"'a5:.t:g• ,_ • • 5 . a�:t3S 5�`�i " - w'N +�?k`?�,t= vA " z: x, �" �, pr" ��', �`; �^', r<• �. Tjwr' i' i3,:' � � �� �:,' �:; �". �s= a :: = 'n`r.' •. n? "�I:�'" �'% 'Y
B ); T,-YPe I vd Ate Sysfe"m , z iihe c _ ` V 1.
Hood Project Valuation: $
€ #
1004"744 a < t 'M •R • y ua� .x ' "� ., :$3 . =i?,'" _, ; tt k "��i i tea: " ` r +h 1 ``
> , ; ,�, r � # v ,� �"ss? r <: ,+�d"�a " *'. " fit ' , y P,4^''^s, r '�' a �' i ''''§"' r ' "�a .� a �•� ..�
C w ;
ry A . i`S #t;�r s M1`' '' s � ; ' * " f t - 4 �''�'" c-",..., 8*', 4 - • t f` - , l , „ ". "� I •= + :. , q
. pT fi } ° � ��� �A � `�� �s � - �
. �. vr �.... a�s : ° ad...u�inv�.�`.�::,e`" 1 . � dz�i}Y�,�m..''.`s�`��.�. -a.. �� ,eC -s�n
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
.. ^s: °T� :" 'rr��;�". `t' °r"�' ^., �a•� .;��� r,ap =+�. .A +. r Ia.�. ,,,. ,, -3<i`r,:"Y#�'e,�"�`i�` P •dd �°� x
z#' `..'*i •..,yam . , s� �. m, , F.,; xFry. '' }° . { N .tea; f�� } ,lx.!_� '• `?.;•`" ;a � A a S 4 , '� }r .?,,' `�E.�s , „� '` 'r`�,..' . 1
�S ';�,',�°}. e ' * .�'..�i.3��'iYb � . d ^it��4 ty,�y S:” y ��' ° �� " - "�"�'., f �Y t%i'�'�• �. y ,�= � �A "S � � 1� 'X iY,+�S f ,.,'� `,t+���� °'. ;'�
,�, ' '�.' * ,r,Jr °, '" t �. ° '. ' .;� •, 4 5'' £:5, • , z i, ' ... 1 tf X.. t ;s - L.,. i'- ; ta 4 ,
� �• ,�� �- s�. � � va'. b ,� t�c`, ,.< 3 `n.� rs�ik��'. », �'
x D esidential Spfinkle AStarid;�Aliin Sy stem) gam§ W ` �P t'.
uA? �� fi 1 ,i.' � ''� ' $
� i�" , PWiS+ ��; �:^ �4 , .�"k'".:u�:��?r"a£ix,�;`�; -�- '�. .� �' a�f' -."L`, r s"". ':'re ��' a �:�,4r�a•c�`. "�tlt fr�'����,.K ..gat #" �'a � : '`'���
� "ii fad S �+'�g�t}Yr &'A•u y "�. '^�
Square Footage: Permit Fee:
0 to 2,000 $198.75 * ,k
246.45 + w tk $' , 4
2 001 to 3 600 $ :
3,601 to 7,200 $310.05 ` - z ° ` � ` , ,> • 7,201 and greater $404.39 „ Si .xrt•, `sv,. : ` t 4,,isV s ;r4 ?
Sprinkler Project Square Footage: sq. ft.
•
. - - - „ -,�..T 'aa - - - :;��f�:.. rx;t��- ;�+s:: rr� °�'; ^;,'� °a, . r �' +:r,: .�.x �..� " . "����.�.i?;. ;u��,��°.:.zK. ��czr,;
,. h � U .t •£ "?'skS��=�•
��,��,� >,$��u��R• ..��4 t: �� ��0�ire Protc_ tionz�P�ermitbF z� .:,;°��.,s��- �����������::�_4:r;4a
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.
I: \Building \Permits \Permit Forms 10 -01 -09 \FPS - PermitApp.doc 10/01/09 2