Permit r(,
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
.'1 COMMUNITY DEVELOPMENT Permit #: FPS2009 -00036
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/29/2009
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 170
Subdivision: Lot: 0
Project: Spec Space
Project Description: TI - Add (3) heads and relocate (1) head.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY
Permit Fee - COM 05/29/2009 $62.50
#300 12% State Surcharge - Building 05/29/2009 $7.50
PHONE:
Contractor: •
DELTA FIRE INC
14795 SW 72ND AVE
PORTLAND, OR 97224
PHONE: 503 - 620 -4020
FAX: 503 - 620 -1058
Type of Use: COM
Class of Work: - FPS Type of Const:
Occupancy Grp: Height: ft
Stories:
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $70.00
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1000 • •
Residential Square Footage: 0
Fire Alarm Valuation: 0
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 , • . • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ■ 'cation Center. T are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or ect questions to OUNC calli P g 03.246.6699 or 1.800.332.2344.
I /
Issued By:- / I 4 , Permittee Signature: �
• 1 _I I Ly
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
I
•
• BOding Permit Application
.1✓'
Fire Protection System RECFRIE
FOR OFFICE USE ONLY
City of Tigard Received Date/Bv: ` e 9 f Permit No.: ..10.59 ,rte iii
N • 13125 SW Hall Blvd., Tigard, OR 97214AY 2 2009 % Plan Review ��'
= Phone: 503.639.4) 71 Fax: 503.598.1960 _ Date/By: _ Other Permit:
T I GA R p Inspection Line: 503.639.4175 CITY OF � IGABD Date Ready/By: Juris ® See Page 2 for
Internet: wwtiv.tigard- or.gov BUILDING DIVISION Notifred/Method: 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 (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.
❑ I- and 2- family dwelling TCommercial/industrial
Valuation: $
Accessory buildin
❑ r}' g ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 at g(bc, �a ',`,� � New dwelling area: square feet
City/State /ZIP: 'Pc f-� l� t11 a f OR '� 97 P-aL( U Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name :'! 1a- a no c 7pec Aim Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
RFQUIItED DAT:.CONIINfERCIAL- usg,, ECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rotnded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
' DESCRIPTION OF WORK (( work indicated on this application.
Ad4 3 hea.�S a- ?e IOCc,i.�P_ I. — -(`lr naz Tr Valuation: $ 1 000.00
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:
X APPLICANT ❑ CONTACT PERSON •
NOTICE
Business name: d V te, roc. All contractors and subcontractors are required to be
Contact name: H Ar k,
i 1 ,,_ . licensed with the Oregon Construction Contractors Board
c.l under ORS 701 and may be required to be lensed in the
Address: ILI 795 c�'W 7a nr e. jurisdiction in which work is being performed. If the
City /State /ZIP:Mal a c, (k '1 /AaL4 , applicant is exempt from licensing, the following reasons
��,,rt�� -^� apply:
Phone: (50316, ao ' Lioko Fax.. 6 f9o�,0 - 105
E -mail: he c eA 0.Ok,1 Pee, m •
CONTRACTOR BUILDING PERMIT FEES*
Business name: 0.6, die oe• ((please re %ri6(tesehedule1
t Permit fee:
Address: l4I7 , 7anea Ave.
City /State /ZIP: 0 (Maoa O /M1 9 ,.. 11 State surcharge (12 % of permit fee):
^ ^ " ^ `� 111'1 1 V`r �' FLS plan review (40 %ofpermit fee):
Phone: (5e ', o /40a0 Fax: (50N6 A0 _ 1OF"s, (Due upon application.)
CCB lic.: Coq 1 71/ Total permit fees:
Authorized signature: Amount received:
4....0971 This permit application expires if a permit is not obtained
Print name: � 5
't .n )8k_ Date: 5/951/0q within 180 days after it has been accepted as complete.
�C * Fee methodology set by Tri - County Building Industry
Service Board.
I Buildin \Permits\FPS- PermitApp.doc 03/23/06 440- 4613T(I1 /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: 1 4
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
/g1 Wet ❑ Dry
Additional Standpipes '7h
Information: Hazard Group L' h}-
Density , IV
Design Area 1 500
K. Factor 5.619.
Sprinkler Project Valuation: $ t O, co
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $ N
C.) Fire Alarm :
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ Jf�r
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: /V!A_ sq. ft.
Fire Protection Permit Fees /
Project valuation subtotal (see A, B & C above): $ l WO 00
Permit fee based on project valuation (see fee schedule): $ I C 50
Permit fee based on square footage (see D above): $ NIA
State Surcharge (12% of permit fee): $ 1 tO
FLS Plan Review (40% of permit fee): $
TOTAL: $ 70.00
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.
I: \ Building \Permits \FPS- PernitApp.doc 2