Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
12 . COMMUNITY DEVELOPMENT Permit #: FPS2012 -00140
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/21/2012
Parcel: 1 S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 200
Project: GTS Subdivision: 1991 -055 PARTITION PLAT Lot: 1
Project Description: Modification of (9) fire sprinkler heads
Contractor: PACIFIC FIRE SYSTEMS LLC Owner: LINCOLN CENTER LLC
6704 RIVERIA CT BY SHORENSTEIN PROPERTIES LLC
WEST LINN, OR 97068 5335 MEADOWS ROAD, SUITE 300
LAKE OSWEGO, OR 97035
PHONE: 503 - 710 -6646 PHONE: 503 - 619 -3200
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 08/21/2012 $64.54
12% State Surcharge - Building 08/21/2012 $7.74
Type of Use: COM Plan Review - Fire Life Safety - COM 08/21/2012 $25.82
Class of Work: ALT 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 $98.10
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $970.00
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
issuan , or if wor '- suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili Notification Center. T e , are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may •'tain a copy of the rules
or irect que tions to OUNC - ' callin• 503.232.1987 or 1.800.332.2344.
Is ued By: • 4.6/4/1_,4.41 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspectio.',
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 p n' F OFFICI USE ONLY n, �f
City of Tigard DateBBy: o 44 l)" 1 Permit No.: XX5AUf a PO Nel
IN ° 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review Q� a ��
11: Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: �/ �l
Ti G n K D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov Notified/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 (rotnded to the nearest dollar) of all
f i fk6ddition/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 WComerciaUindustrial
Valuation: $
m
❑ 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: ID.26 5 f2.0 Cc..1 j
b ei: New dwelling area: square feet
City /State /ZIP: (!/ ,2 K d / 77,22 Garage /carport area: square feet
Suite/bldg. /apt. no.: 00 Project name: 6� 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 (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
4di J / U N �� / eek � c 1 Valuation: $ ?(�
a C [ O c l 1 6 t �' / / Dkr_ r Existing building area square feet
(emu IC 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:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 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 leensed 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*
(Please refer to fee schedule)
Business name: /4" , - -, Fi Sr‹ / / C. Permit fee:
. Address: 6 A - 041 7 () / - f -, C7
y Z��TZ J 9 /2.. `' 7v � State surcharge (12% of permit fee):
City/State/ZIP: / f FLS plan review (40% ofpermit fee):
Phone: (S'?j) 7/0 – �! e 4/ Fax: ( ) (Due upon application.)
CCB lie.: /?-0 0 / y 0 Total permit fees: A O
Authorized signature: / �/
Amount received: Ff qg * Cv
This permit application expires if a permit is not obtained
Print name: ��`� , � , A.....; Date: ��a — �� 4. within 180 days after it has been accepted as complete.
Fee methodology set by Tri- County Building Industry
Service Board
I:\Building\Permits\FPS- PermitApp.doc 02/01/2011 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
• P 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
❑ 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 •.$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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1:\ Buildin \Pemvts \PPS - PermitApp.doc 02/01/2011 2