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Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 11111 2 , COMMUNITY DEVELOPMENT Permit #: FPS2013 00021 T LCARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/11/2013 Parcel: 1S135AB01003 Jurisdiction: Tigard Site address: 10300 SW GREENBURG RD 465 Project: Doral Healthcare Finance Subdivision: METZGER, TOWN OF Lot: 9 Project Description: Fire alarm for TI Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC 11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 - 255 -9488 PHONE: 503 - 619 -3200 FAX: 503 - 257 -7121 FEES Description Date Amount Specifics: Permit Fee - COM 02/11/2013 $51.09 12% State Surcharge - Building 02/11/2013 $6.13 Type of Use: COM Plan Review - Fire Life Safety - COM 02/11/2013 $20.44 Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 02/11/2013 $8.00 Occupancy Grp: B Height: ft 11x17) Stories: 5 Info Process /Archiving - Sm $0.50 (up to 02/11/2013 $3.00 11x17) Misc Administration Fee 02/11/2013 $5.00 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: Yes Alarm Type: Automatic Pull Station Required: Yes Smoke Detectors Req: Yes Battery Calcs Provided: Yes Cut Sheets Required: Yes Total $93.66 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $1,200.00 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 O calling � 503.2 or 1.800.332.2344. /� /\ , 1 Issued By: Permittee Signature: D id A PPL/ /+ 4 J Iv 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 ApplicatioCEIVED Fire Protection System FoR OFFICE USE ONLY FEB 4 2013 Receive Cit of Tigard Permit No.: . Y Date /B �. .� .�Psao /3 —ovo� '' 13125 SW Hall Blvd., Tigard, OR YOFTIGARD Plan Revi� Other Permit. P �� D�� J ? Mill ` Phone: 503.718.2439 Fax: 503 Date /B N �� Inspection Line: 503.639.4175 ���IMG DIVISION Date R •/ Juris: ® See Page 2 for TIGARD N otified/Method: Su Internet: www.tigard- or.gov pplemental 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 (rounded to the nearest dollar) of all ® 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 ® Commercial /industrial Valuation: $ El Accessory building ❑ Multi- family Number of bedrooms: 1=I Master builder El Other: Number of bathrooms: - JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 10300 SW Greenburg Rd Tigard, OR (1- Lincoln) New dwelling area: square feet City /State /ZIP: 97223 Garage /carport area: • square feet Suite/bldg. /apt. no.: Ste 460 Project name: DORAL HEALTH T.I. 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. Install fire alarm devices per plans Valuation: $1,200.00 Existing building area: square feet New building area: square feet ® PROPERTY OWNER El TENANT Number of stories: Name: Shorenstein Realty Services 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 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: Capitol Electric Company, Inc. (Please refer ro fee schedule) Permit fee: 69.92 Address: 11401 NE Marx Street State surcharge (12% of permit fee): 8.39 City /State /ZIP: Portland, OR 97220 0 FLS plan review (40% of permit fee): Phone: (530) 255 - 9488 Fax: (503) 255 - 1966 (Due upon application.) 27.97 CCB lic.: 48748 Total permit fees: 122.28 Amount received: Authorized signature: This permit application expires if a permit is not obtained Print name: Dan Wilson Date: 1/17/2013 within 180 days after it has been accepted as complete. * Fee methodology set by Tri- County Building Industry Service Board. 1: \Building'Pemws \FPS- PemiitApp.doc Rev 01 /05/2012 440- 4613T( II /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 ❑ 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: $ 1,200.00 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): $ 1,200.00 Permit fee based on project valuation (see fee schedule): $ 69.92 Permit fee based on square footage (see D above): $ State Surcharge (12% of permit fee): $ 8.39 FLS Plan Review (40% of permit fee): $ 27.97 TOTAL: $ 122.28 Plan review requires a completed application and three (3) sets of plans at submittal. Plan review fees are required at submittal. U: \FA Jobs \zz130432 -45 Doral Healthcare @ 1Lincoln -465\ 1 FPS- PermitApp.doc Rev231 /05/2012 PERMIT FEE DOUBLES IF WORK HAS STARTED WITHOUT BENEFIT OF PERMIT 'i 0 CALCULATE TOTAL FEE PERMIT FEE CALCULATION (REFER TO TABLE) $ 1,200.00 ROUNDED VALUATION $ 51.09 (BASE FEE FOR FIRST $ 500.00 OF VALUATION) + $18.83 ($ 2.69 PER $ 100.00 $69.92 BASE PERMIT FEE + $8.39 STATE SURCHARGE = 12% OF BASE PERMIT FEE + $27.97 PLAN REVIEW CHARGE = 40% OF BASE PERMIT FEE + $11.00 RECORDS RETENTION FEES + $5.00 MISC ADMIN FEE (MAILING) $122.28 TOTAL DUE FOR THIS PERMIT EXAMPLE CITY OF TIGARD RECORDS RETENTION FEES WORKSHEET BUILDING PERMITS Fees for scanning building department submittals. Size # of Pages Cost per Page Total 8 1/2" x 11" 6 X $0.50 $3.00 8 1/2" x 14" X $0.50 $0.00 11" x 17" X $0.50 $0.00 18" x 24" X $2.00 $0.00 24" x 36" X $2.00 $0.00 30" x 42" 4 X $2.00 $8.00 Other formats X $2.00 $0.00 TOTAL RECORDS RETENTION FEE I $11.00 I Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 10300 SW GREENBURG RD 465, TIGARD, OR, 97223 Commercial - Fire Protection System 998 Alarm Final 05/10/2013 00:00 FPS2013-00021 PASS - No C of O Violation Summary: Inspector Contractor