Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111
- COMMUNITY DEVELOPMENT Permit #: FPS2012 -00013
T'GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/01/2012
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 380
Project: Spec Space Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Modification of (4) fire sprinkler heads for TI
Contractor: FIRESTOP CO Owner: PACIFIC REALTY ASSOCIATES
3203 NE 65TH ST. #2 ATTN: N PIVEN
VANCOUVER, WA 98663 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 360- 718 -8604 PHONE:
FAX: 360- 718 -8603
FEES
Description Date Amount
Sp Permit Fee - COM 02/01/2012 $67.23
12% State Surcharge - Building 02/01/2012 $8.07
Type of Use: COM Plan Review - Fire Life Safety - COM 02/01/2012 $26.89
Class of Work: ALT Type of Const:
Occupancy Grp: 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 $102.19
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,100.00
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 expir: i work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you o foil uw the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -1091. You may obtain a copy of the rules
or direct qu NC by calling 503.232.1987 or 1.800.332.2344.
Issued y: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection da
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 ONLY
114 City of Tigard DateB ff WL1 Permit No.:/ �5 0.64,1 pal 3
- ° 13 125 SW Hall Blvd., Tigard Plan Review
,OR 97223 • Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: hid s ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
,TYPE OF WORK - _REQUIRED DATA:1 ANND2 FAIMILYDWELLING
❑ New construction El Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rotnded 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.
❑ 1- and 2- family dwelling ID Commercial /industrial Valuation: S
❑ Accessory building ❑ Multi- family Number ofbedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
'' JOB SITE INFORMATION: AND LOCATION '-- -". ` . - -, Total number of floors:
Job site address: 1 S'3 S 6 S (, iJ (r/ New dwelling area: square feet
SL - G (A� ( > +
City/State /ZIP: ' ( 67` �cf( ') /( Garage /carport area: square feet
Suite/bldg. /apt. no.: 3i Project ( name: -i6ig Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
} REQUIRED D ATA: 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
ESCRIPTIONOF;WORK • • — - work indicated on this application-
. �.�.,. �, , Valuation: S /ft/U
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:
APPLI CANT _ - CONTACT ° CONTA T PERSON - • . _ �f. - - '-' . :-,
; , , ,,p , : , ;;; . : , : ,, . . � � , NOTICE .< $ - + � : .
� _
Business name: P , p �r ti j C All contractors and subcontractors are required to be
Contact name: l
1J ,, .--- licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 2- /U(.. (p S 4---: ' St- ' k 2- jurisdiction in which work is being performed- If the
City/State/ZIP: Cit applicant is exempt from licensing, the following reasons
Y l c� G �} � s� (..,3 !'� 4 C� 3
apply:
Phone: (6G°) i ( - FF (, �? 3 (� Fax: ( J 1 l c _ 6 L. 0-5
E-mail: f1(�L l� ✓ - - V e.-5iO -) 6o , �.�- --
'6
r: C ONTRACTOR .:, k - a x -, -BUILDING_ PERMIT FEES* ` °t
. giii s e refer to /eeshdi& .
Business name: _
Permit fee:
Address: �G —,_i2__
City/State /ZIP: State surcharge (12% of permit fee):
FLS plan review (40% ofpermit fee):
Phone: ( ) j Fax: ( ) (Due upon application.)
-� Total permit fees:
_ _ CCB lie.: (_ � t l l
Authorized signature: 11
1.. Amount received:
�' This permit application expires if a permit is not obtained
Print name: / l ( t �, C � (' e� _ Date: — L (_ k-
* within 180 days after it has been accepted as complete.
Fee methodology set by Tri -County Building Industry
i,"\- ve�'✓` iii' ' 5 ., ' Service Board.
1:\Building\Permits\EPS- PermitApp doc 02/01/2011 440- 4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Des work to be done;
1.) El New 2.) Modification to sprinkler heads only:
O Addition El 1-10 heads: No plan review required.
El Alteration 0 11+ heads: Plan review required.
O Repair
Number of sprinkler heads:
Additional description of work:
- ; - , TYfie of System (Cornple'fCA;BX or D gs:applic
. , ' •
.•: ' ''.' ' . , ,
COiiimerCiap*inkler •
•. l-S • . • „ . ,
1:1 Wet 0 Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I , flood Fire Suppression System:L A ,
Hood Project Valuation:
'
C.) Tire - . :; ' • •
Submittal shall Battery Calculations 0 Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: $
• , , -
• ,
D) . Residential Stotinider:(StAndAlOne
.„, •
Square Footage: Permit Fee:
0 to 2000 $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.
-
e •
Fire Pm teCtioiii Pettiut F ee
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\ Permits \ FPS-PermitApp.doc 02/01/2011 2