Permit = CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00043
Date Issued: 04/12/2012
T1GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S102BD00701
Jurisdiction: Tigard
Site address: 12785 SW PACIFIC HWY
Project: Burgerville Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 8
Project Description: Hood fire suppression system.
Contractor: CASCADE FIRE SAFETY INC Owner: BENNETH, CATHERINE MCNICOL
1100 W 8TH ST 3830 ROBIN CREEK LN
VANCOUVER, WA 98660 WEST LINN, OR 97068
PHONE: 360 - 695 -9212 PHONE:
FAX: 360 - 695 -3286
FEES
Description Date Amount
Specifics: Permit Fee - COM 04/12/2012 $102.20
12% State Surcharge - Building 04/12/2012 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 03/23/2012 $40.88
Class of Work: ALT Type of Const: VB Info Process /Archiving - Sm $0.50 (up to 04/12/2012 $7.00
Occupancy Grp: A -2 Height: ft 11x17)
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Unknown
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 $162.34
Valuations: . Required Items and Reports (Conditions)
Sprinkler Valuation: $3,000.00
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: / L• ff .. 7 - 70
` D
," Signature: _ '
• 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 Protection System �� FOR OFFICE USE ONLY
City of Tigard �" R eceived
� DateB : M fiit _ Permit No.: a s u... - vo l t
13125 SW Hall Blvd., Tigard, OR 972
Phone: 503.718.2439 Fax: 503.598.1960 3 '0\1 Plan Review Date/B : A►. ��/O ffiwypl Other Permit: i i// _ • (44,
TIGARD Inspection Line: 503.639.4175 kt ` N% ! p 4 Date Ready/13y: : _ Inn % See Page 2 for
Internet: www.tigard or.gov \` Notified/Method:7S , „,,/ Supplemental Information
c
TYPE OF gri REQUIRED DATA: 1- AND 2- FAMILY DWELLING
O New construction ❑ demolition Permit fees* are based on the value of the work performed.
Indicate the value (romded 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.
❑ I- and 2- family dwelling 'Commercial /industrial
Valuation: $
,(
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
/2 1Y5 1 ITE INFORMATION AND (LOCATION Total number of floors:
Job site address: .5(t / P€. -C , L i 9 4 I�t/ New dwelling area: square feet
City /State /ZIP: - 1'cg l/
rd 97 1.� 3 , Garage /carport area: square feet
Suite/bldg. /apt. no.: dJ Project name: e `ft Covered porch area: square feet
Cross street/directions to job site: j 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.
.711.541:k1/ 6 9a (Jcf� W.-.?co reankor / .A're .9slei>h Valuation: $ R ova
IrI +O tk,4a Aen H ,/ Existing building area square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: The go14 CA4 ckC4 rry 60. Type of construction:
Address: 109 W (1i! O J Occupancy groups:
City /State /ZIP: V ci , Lt. ve (7 k/ Existing:
Phone: ( ? ) 6,4(4 _ 15 a ( Fax: ( ) New:
.1 APPLICANT erCONTACT PERSON NOTICE
Business name: (Sect F, re All contractors and subcontractors are required to be
Contact name: .
licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be Ibensed in the
Address: /(00 (4) / jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: (an co 14„it, 4g66 apply:
Phone:( ) 7 - 7 0 1-0f 57 Fax::( (047 - 3ao(p
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
''� t (Please refer to fee schedule)
Business name: Cade n 1'P e, /Aie Permit fee:
Address: Hex, IA) ` sf
C /,_n State surcharge (12% of permit fee):
City /State /ZIP:
Van(ou.vler 14/4 qA IO FLS plan review (40% ofpermit fee):
h .
P e: (�) 69% — e{ a I A i I v y Fax: (ZO) s.. 3ag10 (Due upon application.)
CCB lic.: 744 )6 / P� / /L_ Total permit fees:
/ Amount received:
Authorized signature: ��' .. •
// % This permit application expires if a permit is not obtained
Print name:E e o? t I Date: within 180 days after it has been accepted as complete.
/ * Fee methodology set by Tri- County Building Industry
Service Board.
I:\Building\Permits \FPS- PermitApp.doc Rev 01/05/2012 440- 4613T(I1 /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:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: _
Additional description of work:
(R altotr UL-300 gan ward Sy Sfewi
Ty Ye 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 Suppres sion System
Hood Project Valuation: , $ 3
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): $
C: YUsersYDanYAppData #LocalYMicrosoft ¥Windows ¥Temporary Internet Files Cont2nt.lE5YI18W98WOYFPS— PermitApp.doc Rev 01/05/2012
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