Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00049
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9611 SW WASHINGTON SQUARE RD L03
Project: Jos A Bank Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Add /relocate approximately (69) fire sprinkler heads.
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR WASHINGTON SQUARE LLC
9095 SW BURNHAM BY THOMSON PROPERTY TAX SERVICES
TIGARD, OR 97223 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 684 -2928 PHONE:
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - COM 04/03/2012 $166.76
12% State Surcharge - Building 04 /03/2012 $20.01
Type of Use: COM Plan Review - Fire Life Safety - COM 04/03/2012 $66.70
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 04/03/2012 $2.00
Occupancy Grp: M Height: ft 11x17)
Stories: 2 Info Process /Archiving - Sm $0.50 (up to 04/03/2012 $3.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 0
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 $258.47
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $8,150.00
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 I. II work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuan -, or if work • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Cente Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a cop of the rules
or d' ect questions to OUN ' : ca ' • ' • 32.1987 or 1.800.332.2344.
Is. ued By: ) / 1 .40 ` Permittee S'e ' (� �
Call 503.639.4175 by 7:00 a.m. for the next available inspe ion 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 FOR OFFICE USE ONLY •
" 13125 SW Hall , , Blvd Tigard OR 97223 n Date/B : Other Permit:
fi, 7.012. ---...
City of Tigard
' - 2 Phone: 503.639.4171 Fax: 503.598.1'
. , 1 K -
1,4 Received ,. / Arffemi
Date/B :
WAIN/ II - I ' Permit No.:
Plan ReviewMg19011 et, 1 -
t:
TIGARD Inspection Line: 503.639.4175
IN of 'tiG S Date Ready :y:
Notified/Method: Supplemental Information Juris: El See Page 2 for
Internet: www.tigard-or.gov CI & - 051
' ' [;- °' '• ''' :'. • • • :- - • :' .. i . '' - ' Tl'ik eIrW ":' ' " - ' :-• ' •-' ' - ' " '•[ - ' • DATA " - ANTI FAMILY '15ii/EITANG :[• '
,,.., - 913-K -; ', f ' : „L'-;; ,. ,-,,- ' ',:' ::..., ' PikTA.17,, 47._ ,.: :
0 New construction El Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
X Addition/alteration/replacement 0 Other: equipment, materials, labor, overhead, and the profit for the
. . '' ','..;' ' -• -0 • . - CATEGORY OF: sfiecTioN , , .:- .. .-::..:,F work indicated on this application.
Valuation: $
0 1- and 2-family dwelling Ig(„Corarn erc ial/indus trial
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB S ITE : AND LOCATION ,, • ,_ 1 . : .,.. ,::._',: Total number of floors:
Job site address: 961) ,R1 5q, - RI > New dwelling area: square feet
City/State/ZEP: -- , ore 97 Z 2 3 Garage/carport area: square feet
Suite/bldg./apt. no.: 3 Project name: 2D.Semq A. , rE,- Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
'
REQUIRED PAT* CD1V414E Itc4L' _
Subdivision: 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
:,,,.' ' ' ' , ' • :.• • -• , , . - DE$CRIPTiON . Oili;VOIPC.. • : : : ' :: _ ' : ,,, ' work indicated on this application.
ka/l 449pAvx , 6g3 SPX-1i 111(-1_:,e2-S Valuation: $ S3 I SO ,4-9
1
FD/2- A)tt277i19,D -- (-- - /D s` PAC' - Existing building area: square feet
• New building area: square feet
-" -• a PROPERTY. OWNER .. • : • : • ', , • 0 TENANT Number of stones:
Name: Type of construction:
Address: • • Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( " ) New:
APPLICANT ' - ' ' ' ' ' • :' .0 CONTACT PERSON • -" ' ''•
: . . , . -.- . " • - .' ' '- NOTICE-- - ..' '. • • ' . ', -'-''-'. ;.'' ..
Business name: r:::'.-- COAYMA.CrOg 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 licensed in the
Address: jurisdiction in which work is being performed. If the
Ci /State/ZIP: applicant is exempt from licensing, the following reasons
ty
apply:
Phone: ( ) ' Fax: : ( )
E-mail:
:_•,:;.,. ,,....: . .. , -...:, ,:..., -,• , , „ - , ' :,, •r ermit ee: coNTAAcTop f; 41' .I;: * , ':'. ',.: 1 '■ :,:., :,:, -, ;.; ''' :':,:'',:.' '.:!'` . ' , T, " . 1 . 3 04: 13 1 1. , ( G_, P 0 - M I T ' W ., :
Business name: 1, 4 - 7 -- r - F ,,, e _ p
,-,-,„„ ,.,,., ::. „ • :. .-2,, , (Pleasi fefareofeescheduley . ' ,: ,..'. .,7 .,.,. '''''.• .. , •
P f
Address: 9 s - r ,
State surcharge (12% f p fee):
City/State/ZIP: i/07,410 0 i n ,e_ 97 zz_-
FLS pn re oermit fee
la
view (40% of perrnit ):
Phone: G ) ,,t3ik - 2.9 z 65 Fax: (57,_3) 6, 8 4_ - 9 ‘ 57 (Due upon application.)
CCB lic.: , 407 7 - Total permit fees:
Amount received: 4 ( 96--g • 47
Authorized signature:
This permit application expires if a permit is not obtained
Print name: l/ / /jlit-A-A Date: e 4- - 3 - 1 2_ within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
IABuilding 1. PermitsWPS-PerrnilApp.doc 03/23/06 440-4613T( I I/02/COWWEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
; doiei '
1.) ❑ New 2.) Modification to sprinkler heads only
❑ Addition ❑ 1 -10 heads: No plan review required.
' 0- Alteration 1411+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 6
Additional description of work:
•
Type of`System Coin Iete;A `B' C- or`D as '. lical le
• r
A - 4 Commercial �Sp�r'inkler • •
... __ ... ❑ Wet -- _, - 1:1 Dry
._.. _. _ -
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
- " B.) Type I Hood Fir=e. 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 $187.50` -
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50 _ • .
Sprinkler Project Square Footage: sq. ft.
: Fire,P- rotect oii;L?er fF�
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.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
http: / /www.ci.tigard.or.us/ city_ hall/ departments /cd /dots /FPS-PermitApp.doc 2