Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• COMMUNITY DEVELOPMENT Permit #: FPS2012 -00080
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2012
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9530 SW WASHINGTON SQUARE RD H10
Project: Apple Subdivision: Lot:
Project Description: Relocate (12) and add (2) for TI in store and breakroom for 2 levels.
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 05/23/2012 $102.20
12% State Surcharge - Building 05/23/2012 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 05/23/2012 $40.88
Class of Work: FPS Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 05/23/2012 $2.00
Occupancy Grp: M Height: ft 11x17)
Stories: 2 Info Process /Archiving - Sm $0.50 (up to 05/23/2012 $5.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard:
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 $162.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,047.00
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 . ..py of the rules
or direct questions to OUNC 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 inspec on date.
This permit card shall be kept in a conspicuous place on the job site unt' completion of the project.
Approved plans are required on the job site at the time of : ach inspection.
• Building Permit Application Fire Protection System RE FOR OFFICE USE ONLY • l City of Tigard 6� 3 DateBea - �o�3 Permit No.S�OIa2 �t %OO O
- ° 13125 SW Hall Blvd. Ti ard, OR 97223 MAY 6 3 2012 •� ai d
g Pl an Revie tggr efro t� / 942
Phone: 503 , Fax: 503.598.196 Plan Re : in r2 Other Permi
TIGARD Inspection Line: 503.639.4175 ((� ;�� �i A Date ReadyBy: / 3urisy, See Page 2 for
Internet: www.tigard- or.gov CITY 1 ® °'� ' Notified/Method: t{ /( / � , / / / Supplemental Information
BLIV Dad_;+; y ? ^ 4!ON E
. 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 ommercial/industrial
Valuation: $
0.
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Oth Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 955D ,S141 14A . (:'r R_ID . New dwelling area: square feet
City/State/ZIP: 7(%1''47 / () / 9 ; .3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project nam-• Jioptr i , 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.
0 20 v / oC� 12 ?- (.3e- -11"- / - *on S e Valuation: $ 1 -1 dt>
'- k 9 /e ) DeC- i `/ �_ I Existing building area: square feet
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:
PPL.ICANT ❑ CONTACT PERSON -
NOTICE
Business name: '� e� ,u��'-e,� 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* .
Business name: ki y r rip, Pwic,T'i7nAi (Please refertolog'sc%edulel .
Address: 9 D9 . S 51k/ �C)/2/0 .s-r-; Permit fee: �Q aZ • 20 State surcharge (12% of permit fee): / j
City/State/ZIP: -7�� O (7/e_ 97z7._ 3 , g
FLS plan review (40% of permit fee): �j
Phone: ( r6, �jL -
3) b - Z9io Fax: ( ?j) b 1t - 96j 7e
57 (Due upon application.) . jr,
CCB lic.: p4077 gteli e. Tetel- peuaitfees: 7.
Authorized signature: C� '�``� Amount received: AA, l ° This permit application expires if a permit is not obtained
Print name: ,� 4 -/) Date: 05-73-1z within 180 days after it has been accepted as complete
* Fee methodology set by Tri-County Building Industry
Service Board.
I:' Building 'Permiu \FPS- PennitApp.doc 03/23/06 440-4613T(tt /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe Work to be d one: .
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration Ng-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.) Comrn•ercial 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/ departments /cd /docstFPS- PermitApp.doc 2