Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00087
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
Parcel: 1 S135CA02600
Jurisdiction: Tigard
Site address: 11130 SW GREENBURG RD
Project: Good Neighbor Center Subdivision::HERS ADDITION TO GREENBURG HE Lot: 3
Project Description: Replace faulty fire alarm panel
Contractor: UNITED FIRE HEALTH & SAFETY EQUIPMENT CO IN Owner: EAST WASHINGTON COUNTY SHELTER
4611 NE MARTIN LUTHER KING JR BLVD PARTNERSHIP COUNCIL
PORTLAND, OR 97211 DBA GOOD NEIGHBOR CENTER
11130 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503 - 249 -0771 PHONE:
FAX: 503 - 249 -0572
FEES
Description Date Amount
Specifics: Permit Fee - COM 06/27/2012 $88.75
12% State Surcharge - Building 06/27/2012 $10.65
Type of Use: COM Plan Review - Fire Life Safety - COM 06/05/2012 $35.50
Class of Work: FPS Type of Const: VB Info Process /Archiving - Sm $0.50 (up to 06/27/2012 $27.50
Occupancy Grp: Height: ft 11x17)
Stones: 1
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: Yes Alarm Type: Automatic
Pull Station Required: Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $162.40
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,900.00
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 " OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B Permittee Signature:
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 rO iz o r r l c, i l r (1\1,1
City of Tigard may: W -S 42.. Permit Ny Sao %2 —000 P7
13125 SW Hall Blvd., Tigard, OR 97223 JUN 06 2012 plan Review �
C Phone: 503.7182439 Fax 503.598.1960 Date/By: , 7A t y Outer Pern»trig 4Y/ /a � // 0
T - I G A R iD Inspection Line: 503.639.4175
CITY OFTIGARD Dale Reed'/By. / ants, El See page 2 for
Internet: www.tigard -or.gov ohfitxUMetltod: �F7 /� � rl Supplemental Information
BUILDING DIVISIO 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 ® 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: 11130 SW Greenberg Road New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg/apt no.: I Project name: Good Neighbor Center 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 (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Replace faulty Fire Alarm Panel Valuation: $81,900.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I 181 TENANT Number of stories:
Name: Good Neighbor Center Type of construction:
Address: 11130 SW Greenburg Road Occupancy groups:
City/State/ZIP: Tigard, OR 97223
Existing:
Phone: (503)443-6084 Fax: (503)443 -3745 New:
APPLICANT ® CONTACT PERSON
NOTICE
Business name: United Fire and Safety All contractors and subcontractors are required to be
Contact name: Ed Wallace 971 5 { 2 licensed with the Oregon Construction Contractors Board
✓ 1 under ORS 701 and may be required to be licensed in the
Address: 4611 NE M.L.K. Jr. Blvd. jurisdiction in which work is being performed. If the
City/State/ZIP: Portland, OR 97211 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 249-0771 I Fax: : (503) 249-0572
E- mail: ed@unitedfireandsafety.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: United Fire and Safety (Please rcjert° fee schedule)
Permit fee:
Address: 4611 NE M.L.K.Jr. Blvd.
City/State/ZIP: Portland, OR 97211 State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (503) 249 -0771 I Fax: (503) 249 -0572 (Due upon application.) 35 .5
CCB lic.: 65290 Total permit fees:
Authorized signature: �� Amount received: 35 S
This permit application expires if a permit is not obtained
Print name at Oat j2 Date: 6 I Z • within 180 days after it has been accepted as complete.
• Fee methodology set by Tri-County Building Industry
Service Board.
I.\ Building\ Permits \FPS- PaniitApp.doc Rev 01/05/2012 40- 4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
L) ❑ 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: _
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 ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1900.00
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 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 three (3) sets of plans at submittal.
Plan review fees are required at submittal.
C: \Documents and Settings \ Ed \ My Documents \Proposals \Proposals 2012 \Good Neigtbor Center FPS- PermitApp.doc Rev 01/05/2012