Permit ,, CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
Ip
' ' 1 , : , COMM UNITY DEVELOPMENT k � i ` l '� „ v Permit #: FPS2009 -00025
131 25 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/15/2009
Ti A . g Parcel: 2S102CB03500
Jurisdiction:
Site address: 10050 SW GARRETT ST
Subdivision: Lot: 0
Project: GOOD SHEPHERD
Project Description: Install 13D fire sprinkler system.
Owner: FEES
GOOD SHEPHERD LUTHERAN HOME OF T Description Date Amount
831 SW 17TH AVE
PORTLAND, OR 97205 Permit Fee - RES 04/30/2009 $232.50
Tax - 12% State Surcharge 04/30/2009 $27.90
PHONE:
Contractor:
SIMPLEXGRINNELL LP
6305 SW ROSEWOOD ST.
LAKE OSWEGO, OR 97035
PHONE: 503 - 683 -9000
FAX: 503 - 675 -6521
Type of Use: SF
Class of Work: FPS Type of Const: VB
Occupancy Grp: R -2 Height: ft
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: No Sprinkler Type: Wet
Standpipe Required: No Hazard: UNK
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 $260.40
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 3010
Fire Alarm Valuation: 0
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 No�ti icatior Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir -t;t questions to OUN• • . cal ing 503.246.6699 or 1.800.332.2344.
Is ed By: / /A Permittee Signature:
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.
` st Sr
. Fire"Protection System 4 ,
Building Permit Application R,, 41) FOR OFFICE USE ONLY
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City of Tigard LE/Vr leeeiv Da te/Bv: ed
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Pennit No.: .,,,-: • 2 ,,e 41 7 --a29,23
.
2 . 13125 SW Hall Blvd., Tigard, OR 97223 A
: - -- Phone: 503.639.4171 Fax: 503.598.1960 AlPR 1 A
IIII PclaatileiRBeViAme,;„ireAMMI
.2. mi, Other Permit:
Inspection Line: 503.639.4175 u U 2009 Date Rea': ',._ -
TIGARD Mil El See Page 2 for
rn
Inteet: www.tigard-or.gov ern/
- OF n Notified/method: . , Supplemental Information
RUUD , GAR!)
TY ,---,,,,, P iiEOU111tikliATA: i '' Al■111' ' '24ViiEY' DWELLING
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0 New construction 0 Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
X ricidition/alteration/replacement 0 Other: equipment, materials, labor, overhead,-and-the-pro the
4:24i 6 ,:,-4/.12:;:lv,:,;: work
indicated on this application.
' ;‘3,, ,,,,,, kV _ `:•- ':::t '''';
NK - and 2-family dwelling 0 Commercial/industrial Valuation: $
Number of bedrooms:
El Accessory building 0 Multi-family
El Master builder 0 Other: Number of bathrooms:
1 1rlii,stg:-;1qp -§qNFoRmATIoN,rwcocATtcoN , r ;.,:-,,,,;,i4, Total number of floors:
Job site address: l006 0 SV1 exot44/240 Si: New dwelling area: square feet
City/State/Z1P: -7- 1 4 c re_ 9 7.2.2-s Garage/carport area: square feet
/
Suite/bldg./apt. no.: Project name: Ory)-- aggiliE7 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
I Rwjj,,ppAT,',A:,,,comm,..1 - 3.evii.,,,itsF,p.:,,,ECKIA$T.--or
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
' work indicated on this application.
iv,..., '-...,,, ' 6 P,*42,4' tAii; thin- t t,"
5ysli t..- Valuation: $
11USTA-L,l- 1 SII:) F (Ka_ 5 po 1 1 1.1 , 144.4F - 12._ t
Existing building area: square feet
t IV 6 -)(1577 t..) /.7i i-1.01.(1_ a._ P a_ 4_ 1..1 riabi t '3 D
2430 1 , New building area: square feet
:'
Pr , ':n40 7 ,:triak:if :4"-' ,::F.,„„1; , ..:, Number of stories:
'''''-'- ':,1,:vI.t.A. f3al
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( ) New:
rumotiietwief , iigiiRr s srr4 : ': , ,,,,„,,,,,, 4,,,,-- . emrir::,
",:'4Y'A.-4:' ....'',';'-- 14.04
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
Ci ty/State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:
E-mail:
11:131.11 ,, t i ar;:i4AV'ith likt :, : 4'4 e''''4 4 l'' ' 1'"'" '
, A , km, -,-,:: -, 1--- -- wk..- . . , , ,,, .....,,
.§.„ ,,maleiis'iifer,-hifeekekedidepn,,,:',1„ -., •,
Business name: ,..i,,,,...,
Si r.,ek 0 t_sk 1211.1 p EL
Permit fee:
..../
Address:
State surcharge (8% of permit fee):
City/State/ZIP: L_Ale_r 6 ( ist 0 1,4__ q 7 0 1 t FLS plan review (40% of permit fee):
Phone: (5 ) 4„ e, 3 ..--q ov Fax: (49S ) i„ 74' — 65'24 (Due upon application.)
CCB lie.: / Li q ci 2.._( Total permit fees: eig„,,--
Amount received: ea.,0.,, e t!)
Authorized signature: -
This permit application expires if a permit is not obtained
within 180 days
Print name: k044.6ft_4_ 47 g: 4s 4.y -.." Date: ii — after it has been accepted as complete.
9
* Fee methodology set by Tri-County Building Industry
Service Board.
I: \Building \PermitsTPS-PennitApp.doc 03/23/06 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
I,
r be.vvo�k�ty o er °,;
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
. System (Complete: C-or D:as applicable)
3 , .,
»31
� W E „
a:
a', " :'it ,,i
A. , Comme cial S. i ez:.. ,' :��::;
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B". u T:'; e.3:- : Hood Fire;''Suessxon S" "stetirii`;�
Hood Project Valuation: $
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3F ,,:
-Fir arm"
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Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
l
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3
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I
Square Footage: Permit Fee: ''
0 to 2,000 $187.50
2,001 to 3,600 $232.50`::,'' `'. ; .:fix ,; `. >:t ", :•013
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: 30 sq. ft.
Project valuation subtotal (see A, B & C above): $ 23 2. s�
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (8% of permit fee): $ 2 7 . —
FLS Plan Review (40% of permit fee): $ ?
TOTAL: $ 3S3
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
U \PERMIT APPS \ TIGARD_# 059427 \TIGARD.doc 2