Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
21 COMMUNITY DEVELOPMENT Permit #: FPS2011 -00114
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 09/22/2011
Parcel: 1 S 136C D01000
Jurisdiction: Tigard
Site address: 11745 SW PACIFIC HWY
Project: Cash and Carry Subdivision: Lot:
Project Description: Adding (4) dry sprinkler heads.
Contractor: FIRE EXTINGUISHER SERVICE CTR Owner: MONAGHAN FARMS, INC
3460 SW 209TH AVE 14120 EAST EVANS AVE
BEAVERTON, OR 97005 AURORA, CO 80014
PHONE: 503 - 643 -3309 PHONE.
FAX 503- 356 -1736
FEES
Description Date Amount
Specifics: Permit Fee - COM 09/22/2011 $64.54
12% State Surcharge - Building 09/22/2011 $7.74
Type of Use: COM Plan Review - Fire Life Safety - COM 09/22/2011 $25.82
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required. Yes Sprinkler Type' Dry
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 $98.10
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation $995 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 folio he rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 - 00900. of may obtain a copy of the rules
or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344
Issued By: _ Permittee Signature:
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C • • illTW.4175 by 7:00 a.m. for the next available insp do ;7
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 �� ` Date /B f
! Permit No (, (� 1 /
1 q 13125 SW Hall Blvd , Tigard, OR 97223 �O Plan Review li
Phone • 503 718.2439 Fax. 503.598 1960 Q „NO Nate/By Other Permit
TIGARD Inspection Line 503.639 � , \cjC'' �� ateRe adyBy Jnris [� See Page 2for
Internet. www.tigard- or.gov C` 41� V I e* 15 l Nottfied/Method - /D:62 Supplemental Information
TYPE OF WORK 8�1V REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (romded to the nearest dollar) of all
N6ddition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling ommercial /industrial Valuation: $
ID Accessory building 1:1 Multi-family Number of bedrooms:
I=1 Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATIO AND LOCATION Total number of floors:
Job site address: i r` iS (i '„ , 4 C V New dwelling area: square feet
City /State /ZIP: ) Garage /carport area: square feet
Suite/bldg. /apt. no.: Projec name: Cask c irlr.�/ Covered porch area square feet
Cross street/directions to job site: 0 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.
Tax map /parcel no.: Indicate the value (routded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application. / '
I P i I u ue ui f n Valuation: $ ,.
N Sm
1 x-06 % / � / / y
P 1 !J TAI-1 4cr AJ J C f✓() 1 e ! Existing building area square feet
/ New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: GN,'h a -. Gl rr Type of construction:
Address: I j L.ig ,3 W A -p--, )� Occupancy groups:
City /State /ZIP:.. Ti Existing:
Phone: (5i 9N) G 3 / .0 7 Fax: ( ) New:
,. - APPLICANT ❑ CONTACT PERSON NOTICE
Business name: CF/ r &X. 11 - �V i (,e Ce r All contractors and subcontractors are required to be
Contact name: I—� � licensed with the Oregon Construction Contractors Board
� � / -� under ORS 701 and may be required to be lensed in the
Address: 3 J �l� jurisdiction in which work is being performed. If the
City /State /ZIP: °` �' /7 applicant is exempt from licensing, the following reasons
,q U'' apply:
Phone: ( ) 'U1 l r ro c q S a x:: ( 60 yl. rtc
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: G l i/`t PJ �f Gf. r Permit fee:
Address: ; 0 , -� a,� .� °
/ State surcharge (12% of permit fee):
City /State /ZIP: - , e aril A
` FLS plan review (40 %ofpermit fee):
Phone: (533) 4L 33 2 - Fax: ) 3t.-`( / 173-6 (Due u pon application.)
CCB lie.: I ' Total permit fees: �g l (�
i � , Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: / r ( e C J , Date: 43 f i/i ] within 180 days after it has been accepted as complete.
/ * Fee methodology set by Tri -County Building Industry
Service Board.
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City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Mo ication to sprinkler heads only:
❑ dition El 1 -10 heads: No plan review required.
Alteration ) 1=1 - '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
El Wet j'Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Flood Project Valuation: $
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 $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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