Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2013 -00061
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/15/2013
Parcel: 2S101CA00200
Jurisdiction: TIGARD
Site address: 7904 SW HUNZIKER RD
Project: Agilyx Subdivision: 1994 -025 PARTITION PLAT Lot: 2
Project Description: Install supply line to mobile foam cart
Contractor: SIMPLEXGRINNELL LP Owner: AGILYX CORPORATION
6305 SW ROSEWOOD ST. 7904 SW HUNZIKER ST
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
PHONE: 503 - 683 -9000 PHONE: 503 - 217 -3160
FAX: 503 - 675 -6521
FEES
Description Date Amount
Specifics: Permit Fee - COM 05/15/2013 $145.24
12% State Surcharge - Building 05/15/2013 $17.43
Type of Use: COM Plan Review - Fire Life Safety - COM 05/15/2013 $58.10
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 $220.77
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $6,303.00
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 No • - ion Ce Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire questions to OUN• • ca ling 513.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available in - section d. te.
This permit card shall be kept in a conspicuous place on the job site un ' co - etion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System ilicei,\IED FOR OFFICE USE ONLY
City of Tigard Received 5 - Permit No. ,
a 13125 SW Hall Blvd., Tigard, OR 9 •" Y 1 2013 Date/By: / 3 �O r D D j
Plan Review
' Phone: 503.718.2439 Fax: 503.598. ' .0 Date/By: Other Permit: P,90//1. -003 Z
TIGARD Inspection Line: g 03.6394 l�
175 c o riG�►') Date Ready /By: Juris: El See Page 2 for
Internet: www.ti and -or. . ov 1 D��1�I i ,, Notified/Method: Supplemental Information
BUILDING TYPE OF WORK REQUIRED DATA: 1 - AND 2- FAMILY DWELLING
❑ New construction
❑ Demolition Permit fees* are based on the value of the work perfored.
Indicate the value (rounded to the nearest dollar) of all m
Addition/alteration/replacement ID Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION
work indicated on this application.
El I- and 2- family dwelling Commercial /industrial Valuation: $
❑ Accessory building ID 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: 7 y J, n �, Nu(ZZLLrrnty Sfr�f New dwelling area: square feet
City /State /ZIP: 77 r6(� .0e • 7 n 72.23 Garage /carport area: square feet
Suite /bldg. /apt. no.: Project name: Aityx 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.
Indicate the value (rounded 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.
IktSf4Lll Suppl /. k e to A 14r_LQ. alkyl ( l- Valuation: $ 60, 3 03
Existing building area: 28 square feet
New building area: square feet
❑ PROPERTY OWNER g TENANT Number of stories:
Name: 49i lay COrport LoK_ Type of construction:
Address: ! 9‘60 A. G J. 41446.1s i Occupancy groups:
City /State/ZIP: geolib{4 UL r O. 9760g Existing:
Phone: ( ) Fax: ( )
New:
APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: SG iee Clralutel/ All contractors and subcontractors are required to be
�1' licensed with the Oregon Construction Contractors Board
Contact name:
do� Aid S‘1/' - under ORS 701 and may be required to be licensed in the
Address: (6,363- . W. pa ce(A)Oen( st jurisdiction in which work is being performed. If the
J ►` /� applicant is exempt from licensing, the following reasons
City /State/ZIP: �kP 054)646, (/
P. 4'7O p apply:
Phone: (5b 60
3) 83 • 9000 Fax: : ( S 03) 1075' ( 5 2. 1
E -mail: Jvl.UIAS0V6 S 44.pt entetvutti (,COVVk.
CONTR &CTOR BUILDING PERMIT FEES*
t • i. (Please refer to fee schedule)
Business name: Sukte As d �pitca. Per fee: ,�j . 2 q
Address: `�'
State surcharge (12% of permit fee): 17• 4 3
City /State /ZIP: FLS plan review (40% of permit fee): 1 O
Phone: ( ) Fax: ( )
(Due upon application.)
CCB lic.: /q99_/ Total permit fees: fa.0 .7
Authorized sig (...,%.../......___ Amount received:
t / �� This permit application expires if a permit is not obtained
Print name:
d gel SOl/� Date: * within 180 days after it has been accepted as complete.
Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building \Pcrmus \FPS- PcrmitApp.doc Rev 01 /05/2012 440- 4613T(t /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 tgl, 1 -10 heads: No plan review required.
Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
- arsfrtlf Supptif fuze tv ktoto.t.te foam,. Calf
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.
http: / /aww.tigard- or.gov /city_ hall /departments /cd /dots /1 PermitApp.doc Rev 01 /25/2012