Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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0 • COMMUNITY DEVELOPMENT Permit #: FPS2012 -00072
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2012
Parcel: 25101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY
Project: Clear Channel Radio Subdivision: VARNS ACRES Lot: 9
Project Description: Modification of fire sprinkler system on 3rd & 4th floors.
Contractor: AMERICAN SPRINKLERS INC Owner: TRIANGLE POINTE LLC
7950 N LONE PINE RD 901 NE GLISAN ST, #100
TERREBONNE, OR 97760 PORTLAND, OR 97232
PHONE: 541 - 948 -0679 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 06/04/2012 $231.32
12% State Surcharge - Building 06/04/2012 $27.76
Type of Use: COM Plan Review - Fire Life Safety - COM 05/09/2012 $92.53
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 06/04/2012 $4.00
Occupancy Grp: B Height: ft 11x17)
Stories: 4 Info Process /Archiving - Sm $0.50 (up to 06/04/2012 $15.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
Density: .10 Design Area: 817
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 $370.61
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $15,000.00
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:
/ . :4‘17 ,z.,...._______
Permittee Signature: A 1
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.
Building Permit Application
Fire Protection System RECEIVED F`)I( "hFic1.: USE O I.'
City of Tigard Received 0 9 /0102/b L P erm i t No –512041 _D00 7 02..
III ° 13125 SW Hall Blvd., Tigard,OR 9722.?, Plan Revie
e. Phone: 503.718.2439 Fax: 503.598.19SAY - 9 2012 Date/By: �l 1 _-(21ther Permea/oo2042 — e.1Ot7.2/
Inspection Line: 503.639.4175 Date Ready/By: curie: iii See Page 2 for
1 1 G A It D Internet: www.tigard -or.gov CITY OF TIGARD Notified/Method: (0//// z �i
� G � �p supplemental Information
BUILDING 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
,Addition /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 Co mmerciaUindustrial
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: / 3 33 1 54" 6 IF T '5 pal /Z.__ New dwelling area: square feet
City/State /ZIP: Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: e.bie. o 6 A p ij/ / 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.
Tax map /parcel no.: Indicate the value (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Pt v7I,., C / b/Zi ff/`4,1 Valuation: $ /5 %
J Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
,in APPLICANT ❑ CONTACT PERSON NOTICE
Business name: ,,,,Ai r/t !viwi 'fa. ,'/� All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Cbnstruction Contractors Board
under ORS 701 and may be required to be lcensed 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*
Business name: Ap #4/ c44 _+�J4.. (Please referro(ccschedule
Address: 9 Permit fee:
7 T. N „Lori ' n State surcharge (12% of permit fee):
City/State /ZIP: Ay �0 0 0 At ! 114 Q
` FLS plan review (40 % ofpermit fee):
one: ( S`I/y Q yS , 69 7 I Fax: ( ) (Due upon application.)
t CB lic.: 6 if g o . 5 (�/� Total permit fees:
4
q
Authorized signature Amount received: • 3
This permit application expires if a permit is not obtained
Print name: C Uci< /X/T' . f I Date: within 180 days after it has been accepted as complete.
' Fee methodology set by Tri -County Building Industry
Service Board.
1:\ Building \Permiu\FPSPermitApp.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.) Modification to sprinkler heads only:
❑ Addition • ❑ 1 -10 heads: No plan review required.
Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: / S' � '�•,
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
. A.) Commercial Sprinkler
. Wet f- ❑ .-Dry
Additional Standpipes �'` ' `o' ' ` 3'3 °7•• .. • _ `
Information: 'Hazard Group
Density i / c.•3
.Design Area 1.1
K. Factor / (, 7 S • (, •
Sprinkler Project Valuation: $ (S ^ ( pm C'
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 Mann 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 square : footage (see D above): $ .. • •
State Surcharge (12% of permit fee): $ �° 1� +''` ' - °+
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. 6:
I:\ Building \Permits \FPS - PermitApp.doc 02/01/2011 ` b
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