Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
' "! COMMUNITY DEVELOPMENT Permit #: FPS201200182
T I U A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012
Parcel: 2S114AA00100
Jurisdiction: TIGARD
Site address: 9000 SW DURHAM RD
Project: THS - Team Room Rennovation Subdivision: 1993 -078 PARTITION PLAT Lot: 2
Project Description: Relocate (3) fire sprinkle heads
Contractor: WESTERN STATES FIRE PROTECTION Owner: TIGARD - TUALATIN SCHOOL DISTRICT
13896 FIR ST STE B 6960 SW SANDBURG ST
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 657 -5155 PHONE: 503 - 431 -4000
FAX: 503 - 657 - 5182
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/18/2012 $77.99
12% State Surcharge - Building 12/18/2012 $9.36
Type of Use: COM Plan Review - Fire Life Safety - COM 12/18/2012 $31.20
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 $118.55
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,500.00
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 • . is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility . ification Cen - - Th• - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir= t questions to OUN • , call' g 13.232.1987 or 1.800.332.2344.
../
Iss ed By: - I /' A (/ ` _ ', Permittee Signature: A.-- (:. 40..
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 ApplicatimfECEIVED
Fire Protection System FOR OFFICE USE ONLY
DEC 18 2012 Received n /
City of Tigard Date /B : /� ���I PennitNo.: �rsagel 49X06 4,07—,
• 11111 I. 13125 SW Hall Blvd., Tigard, OR 972 TT OF TIG 0 pn Plan Review Other Permit: ��
Phone: 503.718.2439 Fax: 503.5986 Q Ill ttaF7fIU Date /B
Inspection Line: 503.639.4175 'L DING DIVISION Date Ready /By: Juris: ® See Page 2 for
TIGARD
Internet: www.tigard - or.gov Notified /Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: I- 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
i gtAddition/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 %Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION INFORMATIIONANDLOCAATION Total number of floors:
Job site address: 90� S(N 8m/4A/14 go New dwelling area: square feet
City /State /ZIP: .70 4 rd /O /l / 9 Garage/carport area: square feet
Suite/bldg. /apt. no.: a Project name � Hs 6.413 L.A.,. iz,,», ra, �IM,4WtK 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 v alue of the w ork 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.
QQ N lk AeC.Vre. S prMida Iu.a4 S t p ro. .44. Valuation:Vp $ /
i
eta erU44-e. sprthiq 4 tt.risre �I a to.J4 /I /S reilt,ot/ed . Existing building area: square feet
6(ISfin p
q e a � 6w
rtls. t�N.ekt.tey.1. A ow. VerS (J ;II AL <JAI, New building area: square feet
ni PROPER 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: p , 15AL cAt A3•C A e7 / +/J All contractors and subcontractors are required to be
Contact name: k h C l ` ��� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: /3576 Fir 5t jurisdiction in which work is being performed. If the
City /State /ZIP: Qre n C /o xi / 7 70 95 applicant is exempt from licensing, the following reasons
° /� apply:
Phone: (93)- 6, 5 �`'_ 5156 Fax:: ( )
E -mail: rnit loVtt . bates ® w5.cp. t15
CONTRACTOR BUILDING PERMIT FEES*
Business name: C e� Above. (Please refer to fee schedule
Permit fee: 77, q1
Address: J
City /State /ZIP: State surcharge (12% of permit fee): -1 , 3(,
FLS plan review (40% of permit fee): L .Z0
Phone: ( ) Fax: ( ) (Due upon application)
�'
CCB lie.: Total permit fees: 7 .35"
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: &e.4e., C Date: /z --! 7 _7011.„ within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County But ing Indust L�
Service Board. /1e. • �
I:A Building APermits,FPS- PermitApp.doc Rev 01/05/2012 440- 4613T(1 l /02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
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:oe 3 P �wt .5 0 .4.144.r • �S.
Type �em (Complete A, B, C or D as a plicate):
A.) Commercial Sprinkler
Wet ❑ Dry
Additional Standpipes
Information: Hazard Group j i•
Density � D -- / g pip ye. z
Design Area 375 sp,,.,. F•�
K. Factor 5. (
Sprinkler Project Valuation: $ / 500
B. .T 1. I - Hood Fire Su. ' ression es_
Hood Project Valuation: $
C.) Fire A larm
Submittal shall Batter. Calculations ❑ 1 c;
include: Individual Component ❑ l cs
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 5404.39
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $ / 5 0.
Permit fee based on project valuation (see fee schedule): $ 7,?. qq
Permit fee based on square footage (see D above): $ ----
State Surcharge (12% of permit fee): $ '7.34
FLS Plan Review (40% of permit fee): $
TOTAL: _ $ 97,15
Plan review requires a completed application and ill= (3) sets of plans at submittal.
Plan review fees are required at submittal.
C:\ Users \mibates \Downloads \FPS- PemutApp (1).doc Rev 01/05/2012 2