Permit gi CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
II COMMUNITY DEVELOPMENT Permit #: FPS2009-00051
TKG 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/10/2009
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 120
Subdivision: Lot: 0
Project: Ameriprise
Project Description: Relocate (3) heads.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
Permit Fee - COM 06/10/2009 $62.50
CALIFORNIA ST 49TH FL 12% State Surcharge - Building 06/10/2009 $7.50
PHONE:
Contractor:
. PACIFIC FIRE SYSTEMS LLC
6704 RIVERIA CT
WEST LINN, OR 97068
PHONE: 503 - 710 -6646
FAX:
Type of Use: COM
Class of Work: FPS Type of Const:
Occupancy Grp: B Height: ft
Stories:
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:
Battery Calcs Provided: Cut Sheets Required:
Total $70.00
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
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
applic. • t . • , ark will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
i • ance, or if work is s •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. ho , les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of - les
or direct questions to OUN •y callin• - 13.246.6699 or 1.800.332.2344.
r
Issued By: /, Permittee Signature: i
Call 503.639.4175 by 7:00 a.m. for an inspection that business :!y.
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 '3-t.e P a,pp 1 - coo
Fire Protection System FOR OFFICE USE ONLY • City of Tigard RECEIVED Received /O O �j Permit No.: .5491009—C,06957 "' ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /
Phone: 503.639.4171 Fax: 503.598.196 Date/By: Other Permit:
TIGARD
Inspection Line: 503.639.4175 ,�U N 10 2 009 Date Ready /By: gia� 65 See Page 2 for
Internet: www.tigard or.gov Notified/Method: i (Cis. Supplemental Information
CITY OF TIGARD
TYPE 013WWINCi DIVISION REQUIRED DATA: 1- AND 2-FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
�
` Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
• f CATEGORY OF CONSTRUCTION work indicated on this application.
CI 1- and 2- family dwelling [Commercial /industrial
Valuation: $
I=1 Accessory building CI Multi-family Number of bedrooms:
❑ Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: l 0 22.E (. gt, iaki," AO L10/ N -..z._ New dwelling area: square feet
City/State/ZIP: Pa / D4 / Garage /carport area: square feet
S/ uite ldg. /apt. no.: ./ project name: A bvt I ^., - NrA a t ., ( Covered porch area: square feet
Cross street/directions to job site: �" 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.
e / oce 3 J " Valuation: $ 4/60, a cJ
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON. NOTICE
Business name: "gl f izi r tri _ 5 <7 All contractors and subcontractors are required to be
Contact name: � ,� licensed with the Oregon Construction Contractors Board
„,,.
At-..-- under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::( )
E -mail:
CONTRACTOR BUH.DING.PERMIT FEES*
Business name: az �K . 5 � (Please refertofeeschedule
Permit fee: CA .50
Address: p t ` /7---
City/State/ZIP: � ' � ? j � L , State surcharge (12% of permit fee):
/ v' 2 t� 7d �� FLS plan review (40% of permit fee):
Phone: (5 7/ -. L Fax: (5 3 y 7 —34'7 (Due upon application.) -
CCB lie.: /i/;1 /''� Total permit fees:
Authorized signature: 4 --- Amount received:
This permit application expires if a permit is not obtained
Print name: (7, �j , //� � Date: C -AO— within 180 days after it has been accepted as complete.
/ V �� * Fee methodology set by Tri- County Building Industry
Service Board.
1.\Building\Permits \FPS- PermitApp.doc 03/23/06 440- 4613T(11/02 /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:
El Addition El 1 -10 heads: No plan review required.
❑ Alteration El 11+ 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
El 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 El Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
•
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50
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 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.
1: \ Building\ Permits \ FPS-PermitApp.doc 2