Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
2 COMMUNITY DEVELOPMENT Permit #: FPS2011 -00111
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Date Issued: 09/22/2011
Parcel: 2S113AB01201
Jurisdiction: Tigard
Site address: 16280 SW UPPER BOONES FERRY RD
Project: Spec Space Subdivision: Lot:
Project Description: Adding (4), removing (17) and relocating (2) sprinkler heads.
Contractor: FIRESTOP CO Owner: PACIFIC REALTY ASSOCIATES LP
3203 NE 65TH ST. #2 ATTN N PIVEN
VANCOUVER, WA 98663 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 360- 718 -8604 PHONE: 503 - 624 -6300
FAX: 360 -718 -8603
FEES
Description Date Amount
Specifics: Permit Fee - COM 09/22/2011 $86 06
12% State Surcharge - Building 09/15/2011 $10.33
Type of Use: COM Plan Review - Fire Life Safety - COM 09/15/2011 $34.42
Class of Work: ALT Type of Const: IIIB Info Process /Archiving - Lg Sheet (over 09/15/2011 $2 00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process /Archiving - Sm Sheet (up to 09/15/2011 $2 00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required Hazard LT
Density: 0 Design Area 0
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 $134.81
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,800 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 Notifi - -nter. 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 • •estions to O• NC by calf g 503 232 1987 or 1 800 332 2344
Issued y: f Permittee Signature:
Call 503.639.4175 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 OFFICICUSE' ONLY
. City of Tigard 6 � Date /B . / ' // Permit No
I II
11 ° 13125 SW Hall Blvd , Tigard, OR ' ;b11 �,�� Plan Review j S `� Jl /r �� /{
Phone: 503.718 2439 Fax' 503 598: '60 ` w` Date/By- Other Permit MGR
R
Inspection Ins Line• 503.639.4175 CD °Q J .„( � Q\` y � � r N le
T I G A R D p Date Ready/87 Tun ® See Page 2 for
. Internet' www.tigard- or.gov O� `� ` Notified/Method 1 // ��o Supplemental Information
('� \r, eh �, v� ' l i
TYPE OF WOR .\ ,O� REQUIRED DATA: 1- AND 2- FAMILY DWELLING
El New construction ❑ DeCbmolition Permit fees* are based on the value of the work performed.
X.... Addition/alteration/replacement ❑Other: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
CATEGORY OF C�ONSjTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling C,'ommercial /industrial Valuation: $
/
❑ Accessory building ❑ `Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / 6, ,-. U u-iz__ 3nb i1I re7, ?, New dwelling area: square feet
City /State /ZIP: 64 0 j _ C > > r C _ Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 6 77 a 'p L Covered porch area square feet
Cross street/directions to job site: pi-C`t- (¢r 4J-- 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 (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
4 --- 1) — L i TD (.-nrvi - i iZe:Gc.) elA / t" ' Z Valuation: $ !
Existing building area I ) in square feet
New building area: , square feet
gl. PROPERTY OWNER ❑ TENANT Number of stories: 1
Name:TA L — Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( )
New:
Y ,APPLICANT CONTACT PERSON NOTICE
Business name: l 7 5-ri-, ? Of) M n ek 1 ) All contractors and subcontractors are required to be
> licensed with the Oregon Construction Contractors Board
Contact name:
,L under ORS 701 and may be required to be licensed in the
Address i t T � r _. Z, jurisdiction in which work is being performed. If the
City /State /ZIP: U ti Lc) J J z .- ) Z L4) I � 1�a3 applicant is exempt from licensing, the following reasons
77 ,mil "� apply:
Phone: (51,,D) 1 % �Le O �) Fax ( 3a0 ) /� - s�.;iv')
E -mail: -- 1 4rsr Le f,?t_'Sic 1 ,to. (...C, /
CONTRACTOR BUILDING PERMIT FEES*
Business name: Y 1 ��ep p (L � „1
(Please refer t Permi schedule e:
TT �1 ll (�V Permit fee:
Address: 3 Z 0 - 3 /.. tr (e `
City /State /ZIP: ` J . o tr,`2 1� 5 r , y , „� State surcharge (12% of permit fee):
] � f/ �> FLS plan review (40% ofpermit fee):
Phone: ('3 -) e, - eir.e 04 Fax: ( 3 tv ) e _ 162 03 (Due upon application.)
CCB lic.: / c 3 7 `-.. Total permit fees:
Authorized signature: i - Amount received:
This permit application expires if a permit is not obtained
Print name: 1 3 � 1- �0 1--4:: Date: CI-- I c..(— 1 1 within 180 days after it has been accepted as complete.
* Fee methodology set by To- County Building Industry
Service Board.
I \BuildingWermits'FPS- PermiApp doc 02/01/2011 440- 4613T(1 I /02/COM/WEB)
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.
`�, Alteration j11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: n
Additional description of work:
Type of System (Complete A, B, C or D as .applicable):
A.) Commercial Sprinkler
Wet ❑ 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 ❑ Yes
include: Individual Component ❑ Yes
Cu Sheets
Fire Alarm Project Valuation: $
7
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.
L \Building \ Permits \FPS - PermitApp doc 02/01/2011 2