Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• • ° ••• COMMUNITY DEVELOPMENT Permit #: FPS2012 -00151
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/02/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9455 SW WASHINGTON SQUARE RD A15
Project: Things Remembered Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Modification of approximately (25) fire sprinkler heads for new tenant.
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 09/24/2012 $112.96
12% State Surcharge - Building 09/24/2012 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 09/24/2012 $45.18
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 09/24/2012 $2.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 09/24/2012 $8.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: ORD1
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 $181.70
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $3,779.00
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.
ietialtby a
Issued By: AG Permittee Signature:
•
Call 503.639.4175 by 7:00 a.m. for the next available inspe ion date.
This permit card shall be kept in a conspicuous place on the job site unti completion of the project.
Approved plans are required on the job site at the time of each inspection.
Buildin Permit A lication
El ;
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Fire Protection System ��pp FOR OFFICE USE ONLY
.
City of Tigard S 4 2012 Received G,
Plan R 411:2-1.. . bat)/ -d��S�
' 13125 S W Hall Blvd., Tigard, OR 97223 P l� Date/By: hew I' n I
'- Phone: 503.639.4171 Fax: 503.59 'TIGA D Date/By: C , yV Y 1 I 1 ( ..— Other permitNo.:
Inspection Line: 503.639.4175 ��'' 1 � ± DIVISION }��� g y � y Date Ready/By: 1 Tuns: E l See Page 2 for
TIGARD Internet: www.tigard - or.gov 13UILD1NGDW1S ON Notified/Method:f /,2 Supplemental Information
S?'a LO • n/ /(2G
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
p .ddition/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 gCommercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
91-75` c- JOB SITE INFORMATION AND LOCATION Total number of floors:
• Job site address: S14 w 11E r r Sc? , D New dwelling area: square feet
City/State /ZIP: `�l G , J / D/L 7 2_ 2_ 3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: ��- !//e s 2sf 8,5,✓ j 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
• y, (��( DESCRIPTION. OF WO work indicated on this application.
744)-D 4 b� ✓'�Cit -FJL ll��� A - 6 /L c7,5 F/ Valuation: $ Si 77,, .
.1i7� / /L f � � ������� ,� /Tye
�Q j - Existing building area: square feet
tC �� �� S Y� 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:
3 --- _.�j(J12,4 `Z2/ 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: ( ) I Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: t/V y,9._- / /is �„ ,G72e) (Please refer to fee schedule)
Address: 91025 14/ �U /L /U)4 5-7-, Permit fee:
�/-
City/State /ZIP: -,4 /> / q 7 Z2
/ 3 State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (�3) � A ¢ z _9 Z p, I Fax: (S?)3) , 8 - q 5- 7 (Due upon application.)
CCB lic.: 6 0 7 7 a Total permit fees:
alpr
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: thia g,(/ -j A i Date: D9 /yL //� within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
t:\ Building \Permits\FPS- PermitApp.doc 03 /23/06 440- 4613T( I I /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Dscrili'e Weirk ittd: e='d'one - • • • - . •
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
El Alteration 'i11+ heads: Plan review required.
❑ Repair s,
Number of sprinkler heads: 2_S
Additional description of work:
:_Type of System. (Complete;A, B' C,o'r 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 Fife SuppressionSyste rrni -
Hood Project Valuation: $
`C.)• Fire 'Alarm'
•
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fite Alarm Project Valuation: $
D'.) Residential Sprinkler (Stand Alone System) ' •
Square Footage: Permit Fee: •
O 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.
htt p:/ /www.ci.tigard.or.us /city_hall/ departments /cd /docs/'FPS- PerrnitApp.doc 2