Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00053
T [GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012
Parcel: 1 S126CA01000
Jurisdiction: Tigard
Site address: 9009 SW HALL BLVD 115
Project: Sport Clips Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Adding (10) sprinkler heads to existing fire suppression system.
Contractor: PACIFIC FIRE SYSTEMS LLC Owner: CAFARO NORTHWEST PARTNERSHIP
6704 RIVERIA CT PO BOX 422
WEST LINN, OR 97068 FLORHAM PARK, NJ 07932
PHONE: 503 - 710 -6646 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 04/10/2012 $88.75
12% State Surcharge - Building 04 /10/2012 $10.65
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
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 $99.40
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,847.00
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: j ` • e!j Signature:
►� �
Call 5 by 7:00 a.m. for the next available inspection.! . e.
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
1
City of Tigard � Received
DateB : i Permit No.: t 03' . 1 O' , S
° 13125 SW Hall Blvd., Tigard, OR 9. Plan Review
C
1 : Phone: 503.718.2439 Fax: 503 Ip '.: 1 Date/By: Other Permit: /1 � �� ) 1) ���
rto
T I G R u Inspection Line: 503.639 N.% !• Date Ready/By: - �ya1:�„ See Page 2 for
Internet: www.tigard -or.gov �`,� O� ��� w` Notified/Method: �1�(y Supplemental Information
1 I 0,`
TYPE OF Wp� 1 S REQUIRED DATA: 1 -AND 2- FAMILY DWELLING
❑ New construction • 0 • lition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
�4ddition/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 ,�.mm
Coercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / o0 9 s (U /J / ( eh, c New dwelling area: square feet
City /State/ZIP: et L4.. < , 0 7 3 Garage /carport area: square feet
(uite ldg. /apt. no.: //6 I Project name: 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.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
) DESCRIPTION OF WORK work indicated on this application.
/7/� d / d (C) e. ff'eCA-I, 4w-u_ Nt :LA) Valuation: $ / ;L/,> 0—C2
/f��r�(�'''�j Existing building area square feet
L / New building area: square feet
❑ PROPERTY OWNER I 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 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 leensed in the
Address: jurisdiction in which work is being performed. If the
City / State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) I Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: �Q c t Fs 'c r;"14.4.. Sy 7 C r ,,,- s i L C Permit fee:
Address: (D 7o If 11 1./ I t t L4 C 7 —
State surcharge (12% of permit fee):
City/State /ZIP: e 4, 1. 1 0 g 7Q e 8- FLS plan review (40 % ofpermit fee):
Phone: ( , 0 7 ) 7/ V - G to y 6 Fax: ( ) (Due upon application.)
CCB lic.: / 4 / (. 0 j/ 7 Total permit fees: r. (9 . L 0
Authorized signature:
Amount received:
�/ /�� This permit application expires if a permit is not obtained
Print name: ehr¢p / 4 ‘774 -7 144 g:::9---- (. Date: /, ^/D within 180 days after it has been accepted as complete.
/Z * Fee methodology set by Tri -County Building Industry
Service Board
I:\ Building \PermitsWPS- 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 2.) Modific to sprinkler heads only:
❑ Addition -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: J
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: I $
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.
I: Building \Permits \FPS- PemvtApp.doc 02/01/2011 2