Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1- -! COMMUNITY DEVELOPMENT Permit #: FPS2011 -00146
T 1Gt4RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2011
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 350
Project: Williston Financial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: Relocating (7) sprinkler heads.
Contractor: FIRESTOP CO Owner: PACIFIC REALTY ASSOCIATES
3203 NE 65TH ST. #2 ATTN: N PIVEN
VANCOUVER, WA 98663 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 360- 718 -8604 PHONE:
FAX: 360 - 718 -8603
FEES
Description Date Amount
Specifics: Permit Fee - COM 11/30/2011 $64.54
12% State Surcharge - Building 11/30/2011 $7.74
Type of Use: COM Plan Review - Fire Life Safety - COM 11/30/2011 $25.82
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .10 Design Area: 1500
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 $98.10
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $975.00
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 • - rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. ou •ay obtain a copy of the rules
or direct questions to OUNC b calling 503.232.1987 or 1.800.33 • 4. -
Issued By:` / 4111116A ittee- Signature:
Call 50 . • 5 by 7:00 a.m. for the next available inspec n 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 ‘ ‘ c ' . c)
Fire Protection System .. �,� FOR OFFICE ICE USE ONLY
City of Tigard • to Received , 0 „
a e dr t / Permit S (0(),... p j,(
II ��
13125 SW Hall Blvd., Tigard, • • • .• ••722 J (�Q Plan Review
.: ��' s\ Other Permit:
Phone: 503.718.2439 Fax: 503.598\G OW Date Date/By: abila-i (-' UO036 T I G A R D. Inspection Line: 503.639.4175 ' Q�( ��\S Date Ready/By: , Juris � See Page 2 for
Internet: www.tigard or.gov p0. G��O```GO Notified/Method: 1 1 Supplemental Information
TYPE OF vro K \`` REQUIRED DATA: 1- AND 2- 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
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling Commercial /industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
1:1 Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1Z '-j 0 <! 5 ii 44) i I V� r , � , 4-! New dwelling area: square feet
City /State /ZIP: ) + A t Z 4 ,,--. ) . 1? L Garage /carport area: square feet
Suite/bldg. /apt. no.: 3L:-.
� Project name: ? L A S - r , �, A Covered porch area square feet
Cross street/directions to job site: ((, 7O L 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.
Taz 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.
< Valuation: $ c,
— V- [--( -fa -7 (7) S:?? 1 Existing building area square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: I c4, y _ ! --) /_-1- Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT . CONTACT PERSON ' NOTICE .
Business name: "FI it , - D - 1 1 " (', /y'I pi i ; ;, All contractors and subcontractors are required to be
1 / licensed with the Oregon Construction Contractors Board
Contact name:
�Vi W--rtl l t-if under ORS 701 and may be required to be licensed in the
Address: .-- -- ) . - .-- -- ) . -7- ( � �1 /` � ✓ !
- I '`�� j jurisdiction in which work is being performed. If the
Cit City/State/ZIP: -11 ( applicant is exempt from licensing, the following reasons
y �? 6 ��, t .,,_) O r C
c '/ G G /Off- 1� Z 7 apply:
Phone: (A46 - : z 1 1 j 4l i p ._ = : U l0 i `( Fax:: ( Z,,%) ' -j r f i,t2 4
E -mail:
CONTRACTOR BUILDING PERMIT, FEES*
/ (Please'rejer to fee schedule) )1 c�'"`)1
Business name: . I_C)),yn p.c,„�1,1/ j Permit fee:
Address: -1-2 -1-2 7n x) t?) / /.t - 11.1, f 5i; o
City /State /ZIP: \ );4 1 ,_) 1, r 1 1 `` 5) � � - <-6 ? State surcharge (12 /o of permit fee):
L J I 6 FLS plan review (40% ofpermit fee):
Phone: ( ,) - - c) :,/ Fax: (? (, )) ` ( - t a (Due upon application.)
CCB lie.: / ( 2 - C: Total permit fees: t r lb
Authorized signature:
Amount received: (U I
This permit application expires if a permit is not obtained
Print name: _ 1. ' <S �� ` " U I �' Date: ` __ii within 180 days after it has been accepted as complete.
� ' �� r' * Fee methodology set by Tri- County Building Industry
Service Board.
I''Building\Permits\FPS- PermitApp doc 02/01/2011 440- 4613T(11/02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New Modification to sprinkler heads only:'
Addition X1 -10 heads: No plan review required.
Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
(
I� U �C:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
' Wet ❑ Dry
Additional /Standpipes
Information: Hazard Group (
Density i D
Design Area j X77
K. Factor ! ; (p
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
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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