Permit • • 1
CITY OF TIGARD : %�; FIRE PROTECTION SYSTEM PERMIT 6
$111- _ C OMMUNITY DEVELOPMENT Permit #: FPS2013 -00045
Date Issued: 04/24/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 105
Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Modification of (18) fire sprinkler heads for TI. 6/24/2013: REPRINTED to correct suite address.
Contractor: FIRE ONE FIRE SYSTEMS INC Owner. PORTLAND SW CENTER LLC
PO BOX 734 BY FELTON PROPERTIES INC
OREGON CITY, OR 97045 ATTN: FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: 503 - 557 -9050 PHONE:
FAX: 503 - 557 -9268
FEES
Description Date Amount
Specifics: Permit Fee - COM 04/02/2013 $102.20
12% State Surcharge - Building 04/02/2013 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 04/02/2013 $40.88
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Sm $0.50 (up to 04/02/2013 $3.50
Occupancy Grp: B Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $158.84
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,250.00
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 OUN by calling 503.232.1987 or 1.800.332.2344.
Issued By: �f1 / Permittee Signature: 0 /974 / -�
V � 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.
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11111 • COMMUNITY DEVELOPMENT Permit #: FPS2013 -00045
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/24/2013
T E C;.AR. Ct 9 Parcel: 2S113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 100
Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Modification of (18) fire sprinkler heads for TI
Contractor: FIRE ONE FIRE SYSTEMS INC Owner: PORTLAND SW CENTER LLC
PO BOX 734 BY FELTON PROPERTIES INC
OREGON CITY, OR 97045 ATTN: FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: 503 - 557 -9050 PHONE:
FAX: 503 - 557 -9268
FEES
Description Date Amount
Specifics: Permit Fee - COM 04/02/2013 $102.20
12% State Surcharge - Building 04/02/2013 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 04/02/2013 $40.88
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Sm $0.50 (up to 04/02/2013 $3.50
Occupancy Grp: B Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $158.84
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,250.00
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.
Issued By: Permittee Signature: / /� �.
Call 503.639.4175 by 7:00 a.m. for the next available in --•ection 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 R ECEVED
Received 1.0R ()Hi( I I Sl. ().[.\ City of Tigard 1� Date/By: y � , i Permit No.: , A � jr /,/
13125 SW Hall Blvd., Tigard, OR 97223 \P R
0 2 201 Plan Review nn
111 . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: IP f 'dC I { Other Permit: I f j ��
I I c i AP, n
Notifie
Inspection Line: 503.639.4175 CITY OF TIGARD Date ReaReady/By: sT luris_ 0 See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION
Notified/Method: t �/�� Supplemental 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 ( romded 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 14 Commercial /industrial Valuation: $
❑ 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: "7 A 3 ,
' . 1 - ) t t_sti R .:0 , New dwelling area: square feet
City /State /ZIP: . P . D I (c-AI.6 Garage /carport • ea: square feet
Suite/bldg. /apt. no. '/ Project name: � L Covered . I rch area square feet
Cross street/directions to job site: 7, . iNV o De.' 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 (romded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
5 7
� ZZ
N4 p c°� _ls /11s Pte% �k 5� t1� 13�+k (t.
\-\,1 r,N P el - N ��.) C- - V u_rit'CL 1...5 Existing building area square feet
>y 6 . ps New building area: square feet
❑ PROPERTY OWNER jik TENANT Number of stories:
Name: A p ev Type of construction:
Address: '-i 6 3 -Z 5v W i t) \) a -( r, Occupancy groups:
City /State /ZIP: T1 &1) Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT X. CONTACT PERSON NOTICE
Business name: \ to Y () (U13 Y
T. �1� lc 515 - All contractors and subcontractors are required to be
Contact name: Ns I c V 0 C �F.t . licensed with the Oregon Construction Contractors Board
1r under ORS 701 and may be required to be licensed in the
Address: P w v 0 M4 , 3 ji jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State /ZIP: - - 0 jJ (.1 vrY C • .0 /Ter
� apply:
Phone: 6-03,) S , `"e is 5. I (�o'b) 5 I
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
Permit fee:
Address: ( ...!5 yicM,ts is- (12%
City /State /ZIP: State surcharge (12 of permit fee):
FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.c4 S `L' Total permit fees:
Authorized signature: ` Amount received: 1/5 .( Y
This permit application expires if a permit is not obtained
Print name: ag___ROcc `l Date: .x/r,Z, /3 within 180 days after it has been accepted as complete.
' Fee methodology set by Tri -County Building Industry
Service Board.
I:\ Building \Permita\FPS-PermitApp.doc Rev 01/ 05/2012 440- 4613T(l1 /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: $
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.
I: \Building \Permits \FPS- PermitApp.doc Rev 01 /05/2012 2
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
7632 SW DURHAM RD 100, TIGARD, OR, 97224
Commercial - Fire Protection System
910 Sprinkler Rough-In
04/25/2013 00:00
FPS2013-00045
PASS
Violation Summary:
Inspector Contractor