Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1 4 a COMMUNITY DEVELOPMENT Permit #: FPS2013 -00064
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2013
Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 200
Project: Swipe Now 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:
FAX: 503 - 257 -7121
FEES
Description Date Amount
Specifics: Permit Fee - COM 06/04/2013 $86.06
12% State Surcharge - Building 06/04/2013 $10.33
Type of Use: COM Plan Review - Fire Life Safety - COM 06/04/2013 $34.42
Class of Work: ALT Type of Const: IIB Houlry Building Rate 06/04/2013 $180 00
Occupancy Grp: B Height: ft Hourly Building 12% State Surcharge 06/04/2013 $21.60
Stories: Info Process /Archiving - Lg $2.00 (over 06/04/2013 $8.00
11x17)
Info Process /Archiving - Sm $0 50 (up to 06/04/2013 $4.00
Commercial Sprinkler System: 11x17)
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:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $344.41
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage 0
Fire Alarm Valuation: $1,800 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:
����CCC 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
Eri City of Tigard f;' . 2 3 2013 Date /Bed c23 /3 Perms No , .,pp0
" 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ij �p
Phone 503 718.2439 Fax 503 598 Date /B ,r IS Other Pei�43� QD��
TIGARD Inspection Line 503.639 4175 Y OF TIGARD Date Ready I tuns ® Sec Page 2 for
Internet. www.tigard -or gov BUILDING DIVISION Notified/Method '( 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
® Addition /alteration /replacement ❑ Other. equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application
Valuation: $
❑ 1- and 2- family dwelling ® Commercial /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: 10220 SW Greenburg Rd Tigard, OR (Two Lincoln) New dwelling area: square feet
City /State /ZIP• 97223 Garage /carport area square feet
Suite/bldg. /apt. no.: Ste 200 Project name. Swipe Now 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 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: $1,800.00
Existing building area: square feet
New building area: square feet
Z PROPERTY OWNER ❑ 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 to fee schedule
Permit fee. 86.06
Address: 11401 NE Marx Street
State surcharge (12% of permit fee). 10.45
City/S /�,I): Portland, OR 97220
FLS plan review (40% of permit fee):
Phone: (54255 - 9488 Fax: (503) 255 - 1966 (Due upon application) 34.42
CCB lie.: 48748 Total permit fees: 130.81
_" Amount received:
Authorized signature.
This permit application expires if a permit is not obtained
Print name Dan Wilson Date 5/17/2013 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I \ Building \Pcmuts \FPS- PcmwApp doe Rev 01 /05/2012 440.46 1 JT(t I /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: $ 600.00
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): $ 1,800.00
Permit fee based on project valuation (see fee schedule): $ 86.06
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $ 10.33
FLS Plan Review (40% of permit fee): $ 34.42
TOTAL: $ 130.81
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
U.\ FA Jobs \zz130770 -45 Swipe Now, 2Lincoln-200 \ 1 FPS- PenrutApp.doc Rev 01/05/2012
PERMIT FEE DOUBLES IF WORK HAS STARTED WITHOUT BENEFIT OF PERMIT
TO CALCULATE TOTAL FEE
PERMIT FEE CALCULATION (REFER TO TABLE)
$ 1,800.00 ROUNDED VALUATION
$ 51.09 (BASE FEE FOR FIRST $ 500.00 OF VALUATION)
+ $34.97 ($ 2.69 PER $ 100.00
$86.06 BASE PERMIT FEE
+ $10.33 STATE SURCHARGE = 12% OF BASE PERMIT FEE
+ $34.42 PLAN REVIEW CHARGE = 40% OF BASE PERMIT FEE
+ $12.00 RECORDS RETENTION FEES
+ $5.00 MISC ADMIN FEE (MAILING)
$147.81 TOTAL DUE FOR THIS PERMIT
EXAMPLE