Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit # FPS2011 -00120
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued 10/21/2011
Parcel 2S113AB00300
Jurisdiction Tigard
Site address 16037 SW UPPER BOONES FERRY RD 200
Project Oregon State Bar Subdivision FANNO CREEK ACRE TRACTS Lot 38
Project Description Add (12) fire sprinkler heads to existing system
Contractor FIRESTOP CO Owner OREGON STATE BAR, THE
3203 NE 65TH ST #2 16037 SW UPPER BOONES FERRY RD
VANCOUVER, WA 98663 TIGARD, OR 97224
PHONE 360 -718 -8604 PHONE 503- 620 -0222
FAX 360 - 718 -8603
FEES
Description Date Amount
Specifics: Permit Fee - COM 10/07/2011 $83 37
12% State Surcharge - Budding 10/07/2011 $10 00
Type of Use COM Plan Review - Fire Life Safety - COM 10/07/2011 $33 35
Class of Work ALT Type of Const IIB Info Process /Archiving - Lg Sheet (over 10/21/2011 $2 00
Occupancy Grp B Height ft 11x17)
Stories 3 Info Process /Archiving - Sm Sheet (up to 10/21/2011 $4 00
11x17)
Commercial Sprinkler System
Sprinkler Required Yes Sprinkler Type Wet
Standpipe Required Hazard LT
Density 0 Design Area 0
K Factor 11 2
Commercial Fire Alarm System
Fire Alarm Required Alarm Type
Pull Station Required Smoke Detectors Req
Battery Cats Provided Cut Sheets Required
Total $13272
Valuations Required Items and Reports (Conditions)
Sprinkler Valuation $1,700 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 Specially 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 .0 ay obtain a copy of the rules
or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issuetl By `�� Permittee Signature
Cal r 6 • 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 ONIX
RECEIVED Myr)�
City of Tigard �W�L� Received Date/By
/0 7 // • Penns No � 5�'o� / —L SAO E
III
13125 SW Hall Blvd, Tigard, OR 97223
I Phone 503 718 2439 Fax 503 598 ion W r eview k 1 / /1 _ / / f Other Permit haeot ( '0 0 /9(
T I GA RD Inspection Line 503 639 4175 / 2011 Date Ready /By 0�-/ l/ I 1 /urls ta See Page 2 for
Internet www ligard-or gov NouCe j ethod /o a/ Supplemental information
CITY OFTIGARD ar _ _ 0 •
TYPE i "in I ' SION REQUI'EDD - :l- ND 2- FAMILY DWELLING
❑ New construction 0 Demolition Permit fees* are bas- - the value of the work performed
Indicate the value Brooded to the nearest dollar) of all
>4ddition/alteration /replacement ❑ Other equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application
❑ l- and 2- family dwelling ommercial /industrial Valuation S
❑ 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 0 t °, • * t ir)-12 New dwelling area square feet
City/State /ZIP .— G A de- Garage /carport area square feet
Suite/bidg /apt no . Project name 4 a- •7r\T Covered porch area square feet
Cross street/directions to job site adet) ory f} 60 � Deck area square feet
Othce stmcture area square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision I Lot no Permit fees* are based on the value of the work performed
Tax map /parcel no Indicate the value (roinded to the nearest dollar) of all
equipment, materials, labor, overhead. and the profit for the
DESCRIPTION OF WORK work indicated on this application
Valuation S / C9e?
' A. I Z Zi nl ✓_t�t lZS 6 r r,17-�
` 5 '1 r ) /_ C 1 e r (—pin__
building area square feet
e
C `F-1 "\ J New building area square feet
❑ PROPERTY OWNER ❑ TENANT Number of stones
Name Type of construction
Address Occupancy groups
City/State/ZIP Existing
g
Phone ( ) Fax ( ) New
/ APPLICANT CONTACT PERSON NOTICE
Business name tr 7. K -. >7 �
Te-D All contractors and subcontractors are required to be -
Contact name l `7 t n L� licensed with the Oregon Construction Contractors Board
1-1 /` ) under ORS 701 and may be required to be Irensed in the
Address 'Z� `� �) �n �� -- I " 5 t jurisdiction in which work is being performed If the
City/State/ZIP _-� I applicant is exempt from licensing, the following reasons
Qt
y �QNI /�h x.: ', `. / apply
Phone (MC /C>„to 1 Fax (2ipp)�,Ie.A- C'��0-5
E -mail 1
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule) Business name — s ✓ l^- ^� ? 3- I / i
rl K L5 / !> IJ Ai fee
Address 3 %ro� to E, L0 57�, „ 3. 2.
e xy t- State surcharge (12% of permit fee)
City /State /ZIP
�- 0 ��- / FLS plan review (40% ofpermit fee)
Phone (i ) -9 ( ` ` z6L 00 eJ Fax ( ,,(PCB - 3 4 55 i -A 19o3 (Due upon application)
CCB he r ,c2,3 � Total permit fees
Authorized signature / I /` / Amount received f g
This permit application expires if a permit is not obtained
T71 � L Date -- 1 within 180 days after it has been accepted as complete.
Print name
/ * Fee methodology set by Tn- County Building Industry
Service Board
I \Building \PermiisWFPS- PermiApp doe 02101/2011 440-4613T(11 /02/CO,WWEB)
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 ❑ i l+ heads Plan review required
❑ Repair
Number of sprinkler heads:
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 ❑ Ycs
include: Individual Component ❑ Yes
Cut Sheets
Fire Mann 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
I \ Building VPcrnvtsVI.PS-PcnmtApp doe 02 /01/2011 2