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