Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
•
2 _ COMMUNITY DEVELOPMENT Permit #: FPS2012 -00073
T t G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/09/2012
Parcel: 2S102BD00701
Jurisdiction: Tigard
Site address: 12785 SW PACIFIC HWY
Project: Burgerville Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 8
Project Description: Fire alarm covering hood suppression and duct smoke detector
Contractor: AMERICAN SECURITY ALARMS, INC. Owner: BENNETH, CATHERINE MCNICOL
5411 SE MCLOUGHLIN BLVD 3830 ROBIN CREEK LN
PORTLAND, OR 97202 WEST LINN, OR 97068
PHONE: 503 - 231 -0303 PHONE:
FAX: 503 - 230 -1044
FEES
Description Date Amount
Specifics: Permit Fee - COM 05/09/2012 $80.68
12% State Surcharge - Building 05/09/2012 $9.68
Type of Use: COM Plan Review - Fire Life Safety - COM 05/09/2012 $32.27
Class of Work: ALT Type of Const: Info Process /Archiving - Lg $2.00 (over 05/09/2012 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process /Archiving - Sm $0.50 (up to 05/09/2012 $7.50
11x17)
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 Catcs Provided: Cut Sheets Required:
Total $132.13
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0 •
Fire Alarm Valuation: $1,595.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct que ' • s to 011 by . "n • 03.232.1987 or 1.800.332.2344.
Issued B : 4 6 % Permittee Signature: S
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Iilding Permit Application PCENBD
Fire Protection System FOR OFFICE USE ONLY �y�, -7
City of Tigard MAY -9 2012 Received Permit No. E, 'ZQCZ-M
IIINI n 13125 SW Hall Blvd., Tigard, OR 97 - . � Plan Rem
0 Phone: 503.718.2439 Fax: 503.5$ w I OFT G A I' P DateB : 4 .%„.„711 i 1 .L Other Permit:
d �,]� „�` a . Date Rea.) : • Sufis: El See Page 2 for
Inspection Line: 503.639.4175 / j r� ���g N
T 1 G A R D Internet: www.tigard or.gov Notified/Method: Supplemental Information
II ' TYPE O WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
Permit fees* are based on the value of the work performed.
❑ New construction El Demolition Indicate the value (rounded to the nearest dollar) of all
ill'Addition/alterationireplacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: • $
❑ 1- and 2- family dwelling Commercial/industrial
❑ 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: (2.'g " S ,AZ-/ flC ' /f Zr/y New dwelling area: square feet
City /State/ZIP: 7%6 D Q 4 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: �3‘=- ieOLGE 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: 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.
//Y 5 729 F ( A'/ZJ1 Cag v15/2 --M16 Valuation: $ /57 S
S OJD .f/tipp /- /ON /4WD ,Dt tc7 Existing building area: square feet
S i foie DF1sG 1 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:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: c f 4-h/ S 0/ Ty All contractors and subcontractors are required to be
Contact name: /C e/f licensed with the Oregon Construction Contractors Board
,, " under ORS 701 and may be required to be licensed in the
Address: $/ , // f / G ! — [I 4fh/L /'C/ Bt. (/D, jurisdiction in which work is being performed. If the
City /State/ZIP: pen--ne /.D 0v2 7 211- applicant is exempt from licensing, the following reasons
• a ppl y:
Phone: (55) 70 G - /S• P r Fax: : (5 ) ' . 3 C) ,t 10 t/ y E -mail: 4 r° a {k" /�;' • �-`4'' 7
CONTRACTOR BUILDING PERMIT FEES*
Business name: 4 vt 4- / ' 1 / C A°2t,/ ; e c ri•1 ) (Please refer to fee schedule)
Address: 67/// 9e /'7G- creof Lr•N gG t/,D Permit fee:
City/State/ZIP: State surcharge (12% of permit fee):
ty �G7GTZ ��° FLS plan review (40 %ofpermit fee):
Phone: (.7Z) 70 ( 'A 43 - I Fax: (s T3) ;0° i.31 L4 (Due upon application.)
CCB lic.: `j e G, (/O Total permit fees:
Authorized signature: '
Amount received:
This permit application expires if a permit is not obtained
Print name: Date: �� y within 180 days after it has been accepted as complete.
' Fee methodology set by Tri- County Building Industry
Service Board.
1:\ Building \Pamits\FPS•PermitApp.doc Rev 01 /05/2012 440.46)3T(1I/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ Ne w 2. ) Modification to sprinkler heads only:
El Addition ❑ 1 -10 heads: No plan review required.
[ Alteration / y e/441 ❑ 11+ heads: Plan review required.
El 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: I $
C.) Fire Alarm
Submittal shall Battery Calculations es
include: Individual Component [ E Yes
Cut Sheets ..
Fire Alarm Project Valuation: $ /5"c
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): $ / s9 r
Permit fee based on project valuation (see fee schedule): $
Permit fee based �n 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 revie -w - fees -are- required -at- submittal.
ht tp: / /www.tigard- or.gov /city_hall/departments /cd /docs /FPS- PermitApp.doc Rev 0115/2012