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Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT COMMUNITY DEVELOPMENT Permit #: FPS2011 -00143 TIGARD _ 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/13/2011 Parcel: 2S101AB00100 Jurisdiction: TIGARD Site address: 12005 SW 70TH AVE Project: Acupuncture Clinic Subdivision: Lot: Project Description: Fire sprinkler modification Contractor: FIRESTOP CO Owner: RED ROCK BUSINESS ASSOCIATES LLC 3203 NE 65TH ST. #2 23077 SW NEWLAND RD VANCOUVER, WA 98663 WILSONVILLE, OR 97070 PHONE: 360- 718 -8604 PHONE: FAX: 360- 718 -8603 FEES Description Date Amount Specifics: Permit Fee - COM 11/2912011 $123.72 12% State Surcharge - Building 11/29/2011 $14.85 Type of Use: COM Plan Review - Fire Life Safety - COM 11/29/2011 $49.49 Class of Work: ALT Type of Const: VB Info Process /Archiving - Lg $2.00 (over 11/29/2011 $2.00 Occupancy Grp: B Height: ft 11x17) Stories: 2 Info Process /Archiving - Sm $0.50 (up to 11/30/2011 $1.50 11x17) Commercial Sprinkler System: Sprinkler Required: Yes Sprinkler Type: Wet Standpipe Required: Hazard: LT Density: .2 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 $191.56 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $4,340.00 Residential Square Footage: 0 Fire Alarm Valuation: $0.00 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if - is not started within 180 days of issuance, or if_work is suspended for more the 180 days. ATTENTION: Oregon law requires you to olio the rules adopted by the Oregon Utility ification Ce Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -00•S. ou may obtain a copy of the rules or dire questions to OUN c. . 51 . 232.1987 or 1.800.332.2344. Issue By: ' — de Permittee Signature: i Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Fire 124 Protection System FOR OFFICE USE ONLY 2 ` City Ol o Tigard k1 � ' Date �� Permit No.: �i.� �j ,// ._QQ / . ✓ - '� 13125 SW Hall Blvd., Tigard, 0r „ f ',t ma Plan Revie / / / .1 Phone: 503.718.2439 Fax: 503�5q$:1960 Date/By: I r! I Other Permit. U a o9 T I'GARD Inspection Line: 503.639 2.0\1 Date Ready /By: tuns ® See Page 2 for Internet: www.tigard- or.gov N OV 2 J Notified Method: / / � /�` Supplemental Information -, Tit_, ,'1© e- / al , .6 TYPE OF4,,,V10R l K' aby fl kA 't' n REQUIRED DATA: 1 AND 2- FAMILY DWELLING ❑ New construction Dein lition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all til Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ I- and 2- family dwelling 14 Commercial /industrial Valuation: $ El Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder Ell Other: Number of bathrooms: w 65 JOB SITE INFORMATION' AND LOCATION Total number of floors: Job site address: I„— $ ' W 1 o'T1- A E • New dwelling area: square feet City /State /ZIP: - r1 6 - A R D_ i 0 1 1 2. 0 L.n 6 • A Garage /carport area: square feet ip ldg./apt. no.: tip 0 Project name: 12ED (2, cf.( C ^ AGU PUNCiUAE Covered porch area: square feet job site: 1 2= r;l N ( G Cross street/directions to J S. W ., 7 o Ave . � S, W' • Deck area: square feet 6P 1ZTM 6 T1-1 — EA ST 6 F S ,W . 1 Z h-4- AVE. - Other structure area: square feet " 6 - F F - OF M W 'j . 2 (7 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. A /rD F-(1rt-E s eiuN I L^ //"\ N fssA -P--1 RP- Valuation: $ 9- 3 +', T ENtsr N r IMP 1 / 2-0V /t/l Ew T--• Existing building area: 31 ±S0 square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: I - f - , e. %. . Name: b 0 V 6_ i __' S Frz_,v Type of construction: V !3 Address: °2_3 0 - 7 1 S vJ NEW LA NI) I'LI) Occupancy groups: g City /State /ZIP: V/l (�St1N J( l_k ( a R • q 7 0 7 '0 Existing: Phone: ( ) Fax: ( ) New: • - 1g APPLICANT ❑ CONTACT PERSON NOTICE Business name: F ((� STb P (A , 1 t L.. C All contractors and subcontractors are required to be Contact name: So (7B G` EN licensed with the Oregon Construction Contractors Board / under ORS 701 and may be required to be licensed in the Address: 3 Zo 3 NI ,E 6 . s- 71 '` ST , I S Q,°tc Z jurisdiction in which work is being performed. if the City /State /ZIP: VAN coy V ER lrVAi . 18 6 3 applicant pp is exempt from licensing, the following reasons Phone: ( 360) 1 1 8-$ 6 di- Fax:: (360 )1 18 - 8 G o 3 apply: 1 0 b1 9ve - h — I-e s top Lo. Co r,1 CONTRACTOR BUILDING PERMIT`FEES (Please refer to fee schedule) Business name: S a h') e a s Ck, 6 o ye- Permit fee: Address: State surcharge (12% of permit fee): City/State /ZIP: FLS plan review (40% of permit fee): Phone: ( ) Fax: ( ) (Due upon application.) CCB lic.: I $ 3 y1 1 Total permit fees 01.5/, Authorized signature: `1�_ ,� „ r k P.A...4...0.,......_ Amount received: V r """�` This permit application expires if a permit is not obtained Print name: 120 g E (LT D -, -(„ N Date: l / 22/ I I * within 180 days after it has been accepted as complete. 1 Fee methodology set by Tri- County Building Industry 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 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: 5° 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 (-1 Cz i-I T Density I o Design Area l S o - o K. Factor 5 .6 • Sprinkler Project Valuation: $ 4 3 1-13 6 7° — 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 2 sets of plans at submittal. Plan review fees are required at submittal. hup . / /www.tigard- orgoy /city_ha11/ departments /cd /dots /EI'S- YerniiLApp.doc 02 /01 /t)1 CITY OF TIGARD FEE AND PAYMENT HISTORY � , ", 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD FPS2011 -00143 - 12005 SW 70TH AVE, TIGARD, OR 97223 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due Permit Fee - COM 230 - 0000 -43104 $123.72 $123.72 $123.72 11/29/11 Check 184692 $0.00 12% State Surcharge - Building 100 -0000 -24001 $14.85 $14.85 $14.85 11/29/11 Check 184692 $0.00 Plan Review - Fire Life Safety - COM 230 - 0000 -43108 $49.49 $49.49 $49.49 11/29/11 Check 184692 $0.00 Info Process /Archiving - Lg $2.00 (over 230 - 0000 -43135 $2.00 $2.00 $2.00 11/29/11 Check 184692 $0.00 11x17) Info Process /Archiving - Sm $0.50 (up to 230 - 0000 -43135 $1.50 $1.50 $1.50 11/30/11 Credit Card 184714 $0.00 11x17) Totals for Fees $191.56 $191.56 $191.56 $0.00 Receipt # Payment Method Check # Payor: Receipt Date Receipt Amount 184692 Check 14005 Firestop Company 11/29/2011 $190.06 184714 Credit Card Firestop Company 11/30/2011 $1.50 Total Payments: $191.56 ' Balance Due: C $0.00