Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00125
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/01/2012
Parcel: 1 S 134CC01700
Jurisdiction: Tigard
Site address: 12325 SW KATHERINE ST
Project: Mary Woodward Elementary School Subdivision: MERESTONE Lot: 13
Project Description: Replace (2) sprinklers in cooler
Contractor: AMERICAN SPRINKLERS INC Owner: TIGARD - TUALATIN SCHOOL
7950 N LONE PINE RD DISTRICT 23J
TERREBONNE, OR 97760 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 541 - 948 -0679 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 08/01/2012 $77.99
12% State Surcharge - Building 08/01/2012 $9.36
Type of Use: COM Plan Review - Fire Life Safety - COM 08/01/2012 $31.20
Class of Work: FPS Type of Const: VB
Occupancy Grp: E Height: ft
Stories:
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 $118.55
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,500.00
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: Jit.Cat. Permittee Signature:
' //4.C2 5/
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 FoR c)rricE USE ONLY
Received ?-o - �
City of Tigard Date/By: ' 1 Permit No.• PS / •
III 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
C . Phone: 503.718.2439 Fax: 503.598.1960 DateBv: Other Permit:
TIG� RD
Inspection Line: 503.639.4175 Date Ready/By: June: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: TIv7 Supplemental Information
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 (rotnded to the nearest dollar) of all
�dition/alteration/replacement ❑ Other: pm. $ p it 41/14„5 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: $ U +
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: 5.e.4 ea / Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / 23.2 S S (4, /i # . ? 4 ' � 1 New dwelling area: square feet
City/State /ZIP: -'f G A /--/e ,! t Garage /carport area: square feet
Suite/bldg. /apt. no.: I I Project name: t! 0 c ,5 ,4 l 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.
Valuation: $
12 41 i a /kr, g. 5 ? /Li4 /4 4 i h
e ao/•rZ, 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:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: � QRa ^n '/A�� $ All contractors and subcontractors are required to be
L/
r� licensed with the Oregon Construction Contractors Board
Contact name: G D eve /I. under ORS 701 and may be required to be Icensed in the
Address: 7 ? So iU L �,0 �l il,5 jurisdiction in which work is being performed. If the
City /State /ZIP: -77.414 I-` applicant is exempt from licensing, the following reasons
/ fi►OifAX [9 /?-s2 apply:
Phone: (5 5/7 3 LO J I Fax:: ( )
E -mail: G4 V G /y eI G AS+T.cOM
CONTRACTOR BUILDING PERMIT FEES"
t _ (Please refer to fee schedule)
Business name: �jJ�( � Permit fee:
Address:
State surcharge (12% of permit fee):
City/State /ZIP: FLS plan review (40% of permit fee):
Phone: ( ) I Fax: ( ) (Due upon application.)
CB lic.: 6 le ,>r a , , Total permit fees:
Authorized signs OJ/ / Amount received: I ig, If�
_ — /` ��. This permit application expires if a permit is not obtained
Print name: G D within 180 days after it has been accepted as complete.
V �'PTy.�r Date: 2 • Fee methodology set by Tri -County Building Industry
Service Board.
I:\ Building \Pennils\FPS- PermitApp.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: _
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
4 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 . • • t ,
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 $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.
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