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Permit
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT o • COMMUNITY DEVELOPMENT Permit #: FPS2013 -00073 T i GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2013 Parcel: 2S 113AA00800 Jurisdiction: Tigard Site address: 16490 SW 72ND AVE B6 Project: Spec Space Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C Project Description: Demo (6) sprinkler heads Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES 9095 SW BURNHAM ATTN: N PIVEN TIGARD, OR 97223 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 -684 -2928 PHONE: 503 - 624 -6300 FAX: 503 - 684 -9657 FEES Description Date Amount Specifics: Permit Fee - COM 06/05/2013 $53.78 12% State Surcharge - Building 06/05/2013 $6 45 Type of Use: COM Plan Review - Fire Life Safety - COM 06/05/2013 $21 51 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 $81 74 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $535 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 . c.py .f 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 inspecti. date. This permit card shall be kept in a conspicuous place on the job site until c•mpletion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application * Fire Protection System RECEIVE FOR OFFICE USE ONLY - City of Tigard JUN - 5 2013 DateB (p�s ,C3 S� ermu No z 1 .4.0 /3 . .pp73 _ 31111 - " 13125 SW Hall Blvd., Tigard, OR 97223 y Tigard, Plan Review R Phone: 503 639 4171 Fax: 503.598.1960 Date/By: Other Pert(Pa(ii3 - eyea S' TIGA Inspection Line: 503.639.4175 C TIGARD Date Ready/By Jurrs El See Page 2 for Internet: www.ttgard- or.gov BUILDING DIVISION Notified/Method. 776/ 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 (rounded to the nearest dollar) of all ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ ❑ 1- and 2- family dwelling mmercial/industrial ❑ 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: 142 S Id TV )/ New dwelling area: square feet City/State/ZIP: A t# , 7 zz4 — Garage/carport area: square feet Suite/bldg. /apt. no.: aw l_ , Project name: SPEC , OFFICE, 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 1� I DESCRIPTION OF WORK work indicated on this application. D gpJUNju z i 5 • Valuation: $ S35 . a� � 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: g Phone: ( ) Fax: ( ) New: OAPPLICANT ❑ CONTACT PERSON NOTICE Business name: 5 , e f r �� c77_ 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: ( J Y -7 pi 46 7� -� / / o /` (Please refer to fee schedule) Address: 9 t� / S Yom( bV jN /m -,1 f l . Permit fee: City/State/ZIP: -' l k 4 /) ©IZ 97 'zZ State surcharge (12% of permit fee): 1 FLS plan review (40% of permit fee): Phone: (5V3) / 04.- - ZG! z 8 Fax: (5p3) 6 • 9 � . cj 7 (Due upon application.) CCB lic.: (D4 77 Total permit fees: Amount received: Authorized signature: (P / G s /�� This permit application expires if a permit is not obtained � Print name: � 4 r t if �- . Date: -5 - i * within 180 days after it has been accepted as complete. Fee methodology set by Tri -County Building Industry Service Board. 1. Wuilding \Permits'FPS- PemutAppdoc 03/23/06 440- 4613T(11 /07JCOM/WEB) /(f5" ,Y ' 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. i' Alteration ❑ 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: Cp 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 El Yes Cut Sheets Fire Alarm Project Valuation: $ D.) Residential Sprinkler (Stand Alone System) Square Footage: Permit Fee: 0 to 2,000 $187.50 2,001 to 3,600 $232.50 3,601 to 7,200 $292.50 7,201 and greater $381.50 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 2 sets of plans at submittal. Plan review fees are required at submittal. "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. http: / /1.vww.a.tigard.or.us/ city_ hall/ departments /cd /docstFPS- PermitApp.doc 2 . TI GARD City of Tigard August 1, 2013 Wyatt Fire Protection Inc. Attn: Melissa Hutchinson 9095 SW Burnham St. Tigard, OR 97223 Re: Permit No. FPS2013 -00073 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 16490 SW 72n Ave. Project Name: Spec Space Job No.: N/A Refund Method: ® Check #211052 in the amount of $48.18. ❑ Credit card "return" receipt in the amount of $.00. Note: Please allow 2 -5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account "deposit" receipt in the amount of $ Comment(s): Per applicant's request as work was not completed. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard- or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request forPermit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Wyatt Fire Protection DATE: 7/25/2013 Attn: Melissa Hutchinson 9095 SW Burnham St. REQUESTED BY: Dianna Howse Tigard, OR 97223 TRANSACTION INFORMATION: Receipt #: 191653 Case #: FPS2013 -00073 Date: 6/5/2013 Address /Parcel: 16490 SW 72nd Ave. Pay Method: Check • Project Name: Spec Space EXPLANATION: Per applicant's request as work was not completed; refund 80% of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Permit Fee 230- 0000 -43104 $43.02 12% State Surcharge 100- 0000 -24001 5.16 TOTAL REFUND: $48.18 APPROVALS: SIGNATURES /DATE: If under $5,000 Professional Staff If under $12,500 Division Manager NA UJ k If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM A ,D J'I INISTRATION USE ONLY Case Refund Processed: Date: I ( / /J //3 I By: I " I:\ Building \Refunds \RefundRequest.doc x 09/01/2010 Jul 03 2013 3:07PM WYATT FIRE 5036849657 p.1 'I 97/03/2913 08:25 503E9E41968 CITY OF 1'IGARD PAGE 01/81 City of Tigard • COMMUNITY DEvELOPME NT DEPARTMENT c Request Permit Action JUL 3 2013 R E C E IVED . + a 13125 SW ,Hall Blvd. • Tigard, Oregon 97223 •503.718.2439 • www.tiga M F T IGARD MOON TO: CITY OF TIGARD PAI\I Building Division Services Supervisor ' 13125 SW Hall Blvd., Tierra, OR 97223 7 I 1 ?-"/ f1 / Phone. 503.719.2430 Frax: 503.598.1960 www.dgarei- or•gov fc ROM: ❑. Owner Applicant Iiactor ❑ City Staff 111 D REFUND OR Name: �J e INVOICE TO: `w ► l . t ► �'+ //�+c - hoqy�` 1 Mailing Address: / i f 4 Nil Cit /Soto /Zip: fl ( C) 0 A 7 .2- Phone No.: ( ci0) ' 4- ` et Z PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED V): ❑ CANCEL /VOID PERMIT APPLICATION. • ,,,• REFUND PERMIT FEES (attach copy of original receipt and provide explanladon below). ,A ■ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). � � • REMOVT+, /REPLACE CONTRACTOR ON PERMTt (do not cancel permit), Permit #: — Site Address of Parcel #: • Project Name: Subdivision Name: Lot #: EXP A ION: VNY4 410 1 V � y - Pt IAA 1 . Signature, A'NZE \ /Y .1 , tr,. Date: 41 ,il/IAl 1 Pzint name: L i . ' -. ; i t' Lciaoathiliq \ I. The or adding Official rim suthertee the refund of T n 1L a) any hw which wan a .oncourty paid cc eeXcelad. b) not more then A0% rtf the land use application (cc who nn application is withdrawn er canceled before any teviaw Wert 1■aa been expended. C) w mac than All% of tlic Mind m:o applicatiun Etc for ;sowed pnmlt . Y d1 Haar more tban 50h oftha: bonding plan review fee when an applierrido it canceled bekose any plan review an," Ina txtvn aerpendad, e s � ga n.on• hin I rani t the bdldfnat it ha Ibr Ioued permits Me n• 0 ny n i apertiolw t. 2. Refunds will be t co ned to thre w i nrf Pryer perm in tlm ewie me►hod in which p a wan cao ved rcg Tloaao allow 2.4 'redo for rig axraaieg refund/. Rte to Sy/ Adtnitt: Dam 7Sz)i ,IN11Q! w j Ric to Ii , : Adntittt Doc fi Refuel Atomised: Date ,Oink •TI ravoica Paocaeeed: Data 1! _Petit Cane call Dote / /3 By ' ' ateci Tag Added: Date By Recur, # Date Method Amount $ Pt 7. .7_, P L`wodin4Vo IARcgperelitneriondtu Rcv 05121 2012 , s3, 7 Pte, /, , y3.0 a- to , 74„ sr -rte /290 6,ys S. pro /a9 / Nd : /?, iG /a . OS