Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00042
T I G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2012
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 460
Project: State Farm Subdivision: VARNS ACRES Lot: 9
Project Description: Modification of fire sprinkler system for TI
Contractor: VANPORT FIRE SPRINKLERS INC. Owner: GK TRIANGLE CORPORATE PARK III L
6101 NE 127TH AVE. BY THOMSON REUTERS INC
VANCOUVER, WA 98682 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 503 - 241 -2311 PHONE: 503 - 221 -1900
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 03/20/2012 $112.96
12% State Surcharge - Building 03/20/2012 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 03/20/2012 $45.18
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 03/20/2012 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: 3 Info Process /Archiving - Sm $0.50 (up to 03/20/2012 $2.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 0
K Factor: 11.2
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $175.70
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $3,800.00
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 the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � Permittee Signature:
Cal 75 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 Protection System RECEIVED Rece
j i olz oiiicl usl: ()Nix
CI of Ti and RE ived �?, �� Permit No.: �/ �/ ...,,A �' g DateB : d / /// i �
la
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review .
p �_ Other Permit:
Phone: 503.718.2439 Fax: 503.598.1Q h O 2012 DateB
T I G A R D Inspection Line: 503.639.4175 II � t '' „ 4 2 Date Ready/By: 3 �� r
Juris: Supplemental See Page 2 for
Internet: www.tigard or.gov Notified/Method: 7' Supplemental Information
CITY OF TICARD a
TYPE ': 11 ( 4 I T I I 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
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: S gi!
El I- and 2- family dwelling Commercial /industrial
1:1 Accessory building ID Multi-family Number of bedrooms:
ID Master builder ['Other:
Number of bathrooms:
JOB SITE INFORMATION AND / LOCATION Total number of floors:
site address: 1 3 a I n 0 6g� P 4.1\7 New dwelling area: square feet
M arc( and og g7aa3 Garage /carport area: ' square feet
Suite/bldg. /apt. no.: '' L.I Project name: S 4- F 7: 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: I 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.
Valuation: $ 3 800 -
(0446e,-1" -Flo ex m S z',,5i►U neo datcS or reloccric
C. ldlo 4D �CCLOJr1 ,- .P. NGvJ rr 1"290.. Existing building area: /Q5 7square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories: 04 t, •
Name: Type of construction:
Address: Occupancy groups: 1.J 1�J 6
City /State /ZIP: Existin
. g:
Phone: ( ) Fax: ( ) New:
X APPLICANT ❑ CONTACT PERSON NOTICE
Business name: I J /J o (`-1 f - rG S h r M le r$ All contractors and subcontractors are required to be
Contact name: p -p�� e r S� licensed with the Oregon Construction Contractors Board
/_/_ r /� under ORS 701 and may be required to be licensed in the
Address: 6, 101 NC , �4 -vtrr , >y, t/ G dw M jurisdiction in which work is being performed. If the
City/State /ZIP: Ve AC Ou L Ver h4 � 868(2 apply:
is exempt from licensing, the following reasons
a s i 6 - $3 S I pp l y
Phone: ( ) Fax::( )
E -mail: 6,1 r%SS id +c- IJp.coril
CONTRACTOR BUILDING PERMIT FEES*
Business name: Vol p( 1- Flit (tl1A (Pleaserr�awfeeschednfe
Address: b f o t NE /a7 * A, -- Sc. /vc Permit fee:
City /State /ZIP: VCf 4 60(4Vcr �4 966a LS plan (10%of permit fee):
36v a �� � 9 � 3 0 I FLS plan review (40 /o of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.: 7 P'f3 G fr f 1 , Total permit fees:
Authorized signature: Amount received: ,175 • 7U
This permit application expires if a permit is not obtained
Print name: C �briSfO he r sh ieep Date: within 180 days after it has been accepted as complete.
6 /' ' Fee methodology set by Tri -County Building Industry
Service Board.
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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.
.21. Alteration 1, 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
❑ 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 ❑ 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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