Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
"1 g • COMMUNITY DEVELOPMENT Permit #: FPS2012 -00146
T t G A.R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/05/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9432 SW WASHINGTON SQUARE RD K02
Project: Hannah Society Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Relocate 4 fire sprinkler heads for new wall locations
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR WASHINGTON SQUARE LLC
9095 SW BURNHAM PO BOX 847
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE: 503 - 684 -2928 PHONE:
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - COM 09/05/2012 $51.09
12% State Surcharge - Building 09/05/2012 $6.13
Type of Use: COM Plan Review - Fire Life Safety - COM 09/05/2012 $20.44
Class of Work: ALT Type of Const: Info Process /Archiving - Sm $0.50 (up to 09/05/2012 $0.50
Occupancy Grp: Height: ft 11x17)
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 $78.16
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
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 503.232.19877 o 1.800.332.2344.
Issued By: `1 /I Permittee Signature:
y l' 3.A Call 503.639.4175 by 7:00 a.m. for the next available inspect' date.
This permit card shall be kept in a conspicuous place on the job site until ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
II I Building Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY
City of Tigard Received r Permit No. /� ,�f
- Date/By: Q/J I,. Sr / O S i�l v/IL- Ott / O
13125 SW Hall Blvd., Tigard, OR 97223 SEP 0 5 2012 Plan Review
2 P1 Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permi ju friP.2O4).. 42,4sZ
TIGARD Inspection Line: 503.639.4175 CITY OF Date Ready/By: Juris: a See Page 2 for
Internet: www.tigard- or.gov l�/ C 1 TIGARD Notified/Method: 71 (p Supplemental Information
B'J!LD G DIVISION
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
% Qddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION • work indicated on this application.
El 1- and 2- family dwelling Commercial/industrial
Valuation: $
ED Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
gut 32.-JOB SITE INFORMATION /S AND / LOCATION Total number of floors:
Job site address: 9/''z. SW w1.5/,L1!v 4 f )j ' New dwelling area: square feet
City/State/ZIP: Tt 6 , 9 /` q7 Z23 Garage/carport area: square feet
Suite/bldg. /apt. no.: /t - Z Project name: ii4N /'s.H SD cis T Y 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.
t��C.A'L �i 4 AR sp/iiiXzEn_ J7 WS 11::..z_ Valuation: $ 3A 5. —
/JiIq'u_ Loc.A-'Tf NS . 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: .
PPLICANT 0 CONTACT PERSON NOTICE
•
Business name: " epAl e _ 4 C-rbx._ 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: w if p//2. T� G -i ) (Pleaserejdrtofeeschednlel
Address: o 95' SMJ g 0,P., ott S'-, Permit fee:
D2 9 22 State surcharge (12% of permit fee):
City/ State/ZIP: [ i O 4,it2J n
J FLS plan review (40% of permit fee):
Phone: (9)3) fp 34.— Z g' L , g Fax: (503) t g4 . 96 5 7 (Due upon application.)
,s isCB lic.: ‘ 4b77 Total permit fees:
Authorized signature: ���� Amount received:
This permit application expires if a permit is not obtained
Print name:,614,E - /..4-7/ii-4--- /J Date: *9 -S '!Z within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I: Building \PcrmitskEPS- PermitApp.doc 03/23/06 440-4613T( I I /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 jg. 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: Pcrmit 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/depart ments /cd /docs /FPS- PermitApp.doc 2