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Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 11 COMMUNITY DEVELOPMENT Permit #: FPS2012 00085 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2012 Parcel: 2S 101 AD03200 Jurisdiction: Tigard Site address: 12909 SW 68TH PKWY 320 Project: Thenell Law Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT Project Description: Add (2) new sprinkler heads for TI Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES 9095 SW BURNHAM ATTN: N PIVEN TIGARD, OR 97223 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 - 684 -2928 PHONE: FAX: 503 - 684 -9657 FEES Description Date Amount Specifics: Permit Fee - COM 06/04/2012 $56.47 12% State Surcharge - Building 06/04/2012 $6.78 Type of Use: COM Plan Review - Fire Life Safety - COM 06/04/2012 $22.59 Class of Work: FPS Type of Const: IIB Info Process /Archiving - Sm $0.50 (up to 06/04/2012 $0.50 Occupancy Grp: B Height: ft 11x17) Stories: 4 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 $86.34 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $0.00 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtai ..py of the rules or direct questions to O NC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: Call 503.639.4175 by 7:00 a.m. for the next available Inspecti • date. This permit card shall be kept in a conspicuous place on the job site until ompletion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Fire Protection System OD FOR OFFICE USE ONLY Received 14 " City of Tigard Date/B : !o . � t Penh ° 1j 64 .5 e2e/..2 "1000eP, 13125 SW Hall Blvd., Tigard, OR 972 � � IAI Phone: 503.639.4171 Fax: 503.598. o Plan Revie 2012 Date/By: Other Permiete 22:7/0 TIGARD Inspection Line: 503.639.4175 p� Date Ready/By: Juris: 0 See Page 2 for Internet: www.tigard- or.gov CITY OFTIGARD Notified/Method: T Supplemental Information i$UItNN(i DIVISION TYPE OF WORK 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 i itAddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the • - CATEGORY O F CONSTRUCTION work indicated on this application. ❑ 1- and 2- family dwelling Commercial/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: /29, `j /4 (�8 -x 1"/ V, New dwelling area: square feet City/State/ZIP: 1767K/J , ()� 972 Garage/carport area: square feet Suite/bldg. /apt. no.: 3Z0 Project name: !i ie,AJA E _ -� .. 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. 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. kb D c9 1414> 6 P7 1 - 1,4 -Yc 1 - 1� 5 C is -5 Valuation: $ 6 Z 5 ' Existing building area: square feet ' New building area: square feet ❑ PROPERTY OWNER • ❑ TENANT Number of stories: y Name: Type of construction: e b Address: • Occupancy groups: City/ State/ZIP: Existing: Phone: ( ) Fax: ( ) New: ,APPLICANT - ❑ CONTACT PERSON NOTICE Business name: ,XI 2eAI -Ll ' . 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 City/State/ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) • Fax: : ( ) E -mail: CONTRACTOR BUILDING PERMIT FEES* . 1 v � - / 755 „1 p ` � �y l ) (Please refer to fee schedule) • Business name: � i - ��, /< �' 7/ q 1A�� Permit fee: Address: 1 %_5' _k,C � ,ti �7 City/State/ZIP: L /��� n/� 9 a7.:2_3 State surcharge (12% of permit fee): / FLS plan review (40% of permit fee): Phone: (., 3) 6A4-- 2_ Z, Fax: (r, � 4-- q� , 7 (Due upon application.) _ CCB lic.: 4--Z577 Total permit fees: Authorized signature: / Amount received: �— ����_ This permit application expires if a permit is not obtained Print name :„,E 1E' ,C4-71-/-4-A-) Date: 1 , 5 - - /2._ within 180 days after it has been accepted as complete. * Fee methodology set by Tri -County Building Industry Service Board. 1: 1Building \Permits\FPS- PermitApp.doc 03/23/06 440-4613T(11 /02/COM/WEB) City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Describe work to be done: . 1.) ❑ New 2.) Modification to sprinkler heads only: ❑ Addition heads: No plan review required. ❑ Alteration ❑ 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 $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 .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 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/ depart ments /cd /docs /FPS- PermitApp.doc 2