Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111 �' COMMUNITY DEVELOPMENT Permit #: FPS2009 -00054
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/23!2009
T [ G AR .L? Parcel: 1S135BB00501
Jurisdiction:
Site address: 10575 SW CASCADE AVE 130
Subdivision: Lot: 0
Project: HEMCON
Project Description: Alter (8) heads for TI
Owner: FEES
CH REALTY III /PORTLAND INDUSTRIA Description Date Amount
BY THOMSON PROFESSIONAL & Permit Fee - COM 06/23/2009 $62.50
REGULATOR, CONTROLLING OWNER OF 12% State Surcharge - Building 06/23/2009 $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: ALT Type of Const:
Occupancy Grp: 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 $70 00
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation 1500
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 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246 6699 or 1 800 332 2344.
Issued By: Permittee Signature: tj,/it .i(
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.
Building Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ON LY
City of Tigard Received
4 Permit No
13125 SW Hall Blvd., Tigard, OR 97223 JUN 2 3 2009 DateBy. �l {�(�jpQ.000S�f
0
Plan Review ���
11 14
Phone 503.639 4171 Fax 503 598 1960 Date/By Other Permit. IA Z
TI G A R D Ins Line' 503 639 4175 CITY OF TIGARD
W Date Ready /By. tuns _ I ®See Page 2 for
Internet wW tigard - goy Notified/Method. Supplemental Information
BUILDING 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
Vi, Addition/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 lECCommercial/industrial Valuation S
❑ 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 10E 1 5 5 A) c. grip ,)� New dwelling area: square feet
City /State /ZIP: 'f �" p R Garage /carport area square feet
Suite/bldg. /apt. no.: ' Project name: kern con zacik l .Il{ Covered porch area square feet
Cross street/directions to job site • 4 reinxiel. 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.
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.
Valuation: S j 500 .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 /Z1P•
Existing:
Phone•( ) Fax: ( ) New:
12t, APPLICANT ❑ CONTACT PERSON
NOTICE
Business name.
h r (Y� Tnc . All contractors and subcontractors are required to be
Contact name: µ G mod b licensed with the Oregon Construction Contractors Board
V under ORS 701 and may be required to be liensed in the
Address. 1419 5 3(4 - Tana jurisdiction in which work is being performed. If the
City /State /ZIP ��r a�d 1 op, -1(,1 applicant apply- exempt from licensing, the following reasons
Phone: (603) & 90— ti0X ! Fax . ( iM ) CAL- /05.? E -mail' he\dt �& do i4c4..C`tue. . C
CONTRACTOR BUILDING PERMIT FEES*
Business name: << � 1 re r�c (Please refer to fee schedule)
C Permit fee:
Address: I/4 7..15 � 'Z Age,
} me, n . rn of ^ ^ State surcharge (12 %ofpermn fee)
� O
City /State /ZIP: (' ) �{y.
FLS plan review m
iew (40 %ofperlt fee)'
Phone. (f. &go_ (IOW Fax. (0z5 &p(� _ lam' (Due upon application )
CCB lic : 61,417q Total permit fees
Authorized signature OO /I ,, Amount received:
�t .Gf IV� ^ This permit application expires if a permit is not obtained
it has been accepted as complete.
Print name. Nerd\ fir„ lor Date: 6 9 * Kithin 180 Jays afte
Lt�c.� I(�I V t� Fee methodology- set by Tn- County Building Industry
Service Board
4a0- 4613T(1 I /02iCOAL�1'EB)
1 Bu idmglPermns�FPS- PermiWpp doc 03/23/06
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to b a done:
1.) ❑ New 2.) Modification to sprinkler heads only.
❑ Addition RI 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 fibk
Information: Hazard Group L (Cr h�
Density
Design Area I SOO
K. Factor
Sprinkler Project Valuation: $ 4500
B.) Type - I - Hood Fire Suppression System -
Hood Project Valuation: $ MA
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ pc
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 5381.50
Sprinkler Project Square Footage: /V ) sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $ f100
Permit fee based on project valuation (see fee schedule): $ (4.50
Cj
Permit fee based on square footage (see D above): $ A f
State Surcharge (12% of permit fee): $ 'j,jp
FLS Plan Review (40% of permit fee): $ /U Ac
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.
[ \Buld:n \Perrurs \FPS- Perrur.A,pp doc 2