Permit CITY OF TIGARD. FIRE PROTECTION SYSTEM PERMIT
• < COMMUNITY DEVELOPMENT Permit #: FPS2013 -00037
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/20/2013
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15495 SW SEQUOIA PKWY 140
Project: A Common Thread Subdivision: PACIFItRPORATE CENTER Lot: 4
Project Description: Modification of (8) fire sprinkler heads
Contractor: WESTERN STATES FIRE PROTECTION Owner: PACIFIC REALTY ASSOCIATES
13896 FIR ST STE B ATTN: N PIVEN
OREGON CITY, OR 97045 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503-657-5155 PHONE: 503 =624 -6300
FAX: 503 - 657 -5182
FEES
Description Date Amount
Specifics: Permit Fee - COM 03/20/2013 $67.23
12% State Surcharge - Building 03/20/2013 $8.07
Type of Use: COM Plan Review - Fire Life Safety - COM 03/20/2013 $26.89
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 $102.19
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,023.00
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 questio o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ag ' Permittee Signature: b
7-64./
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 Application
•
Fire Protection System RECEIVED . FOR OFFICE USE ONLY .
Received
City of Tigard Date /B : ApAgnMA. li Permit No.: r:;&,,g r J ?
a 13125 SW Hall Blvd., Tigard, OR 97223 MAR 2 0 2013 Plan Review' Q _ � / �
®' Phone: 503.718.2439 Fax: 503.598.19oti Date /B : Other Permit:
T PG A R D
Inspection Line: 503:639 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov CITYOFTIGARD 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
® Addition/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: $
El Accessory building 12 Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: •
Job site address: 15495 SW SEQUOIA PKWY. New dwelling area: square feet
City/State /ZIP: PORTLAND, OR 97224 ' ' _ Garage /carport area: square feet
Suite/bldg. /apt. no.: 140 Project name: A COMMON THREAD, INC. 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.
ADD / RELOCATE PENDENT FIRE SPRINKLERS Valuation: $$1,023.00 '
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 /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
® APPLICANT ® CONTACT PERSON
NOTICE
Business name: WESTERN STATES FIRE PROTECTION CO. All contractors and subcontractors are required to be
Contact name: DARRELL FLUIT licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 13896 FIR STREET, SUITE B jurisdiction in which work is being performed. If the
City /State /ZIP: OREGON CITY, OREGON 97045 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 657 -5155 Fax: : (503) 657-5182
E -mail: darrell.fluit @wsfp.us
CONTRACTOR BUILDING PERMIT FEES*
Business name: WESTERN STATES FIRE PROTECTION CO. (Please refer to fee schedule)
Permit fee:
Address: 13896 FIR STREET, SUITE B
State surcharge (12% of permit fee):
City /State /ZIP: OREGON CITY, OREGON 97045
FLS plan review (40% of permit fee):
Phone: (503) 657 -5155 Fax: (503) 657 -5182 (Due upon application.)
CCB lic.: 104570 Total permit fees:
/� / z // e S Amount received:
Authorized signature: k �.�
/ \ r This permit application expires if a permit is not obtained
Print name: DARRELL FLUIT Date: 03 / 20 /13 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry .
Service Board.
1:\Building \ Permits \FPS - PermitApp.doc Rev 01/ 05/2012 440-4+5 13T(1 I /02 /COM/WEB) -
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) El 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: 8
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 LIGHT
Density 0.10
Design Area N/A
K. Factor 5.6
Sprinkler Project Valuation: $ 1023
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
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: 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): $
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 three (3) sets of plans at submittal.
Plan review fees are required at submittal.
C: \My Data \Drawings \LS3299 - A Common Thread \City of Tigard permit application.d2c Rev 01/05/2012
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
15495 SW SEQUOIA PKWY 140, TIGARD, OR,
97224
Commercial - Fire Protection System
910 Sprinkler Rough-In
03/22/2013 00:00
FPS2013-00037
PASS
Violation Summary:
Inspector Contractor
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
15495 SW SEQUOIA PKWY 140, TIGARD, OR,
97224
Commercial - Fire Protection System
910 Sprinkler Rough-In
03/22/2013 00:00
FPS2013-00037
PASS
Violation Summary:
Inspector Contractor