Permit 1 111 - n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
a COMMUNITY DEVELOPMENT Permit #: FPS201300085
Date Issued: 06/25/2013
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 1 S135BA00102
Jurisdiction: TIGARD
Site address: 10164 SW WASHINGTON SQUARE RD
Project: Hannah Pet Clinic Subdivision: MYERS ESTATES Lot: 5
Project Description: Modification of (10) fire sprinkler heads for TI
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR SQUARE TOO LLC
9095 SW BURNHAM PO BOX 847
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE: 503 - 684 -2928 PHONE
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - COM 06/25/2013 $102 20
12% State Surcharge - Building 06/25/2013 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 06/25/2013 $40.88
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 $155 34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation. $2,488 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 q UNC 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 inspect n 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
I Fire Protection System FOR OFFICE USE ONLY
RECEIVED
City of Tigard RDeacteeiBiveyd
,f;i / / 5 1 Permit No : "5404-- — cA9
31111 - " 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
- Phone: 503.639 4171 Fax: 503 598.196 UN 2 4 2013 DateBy. Other Permit:
TIGA Ins Li 503 4175 Date ReadyBy. ions
El See Page 2 for
Internet: www.tigard- or.gov CITYOFTIGA Notifi;;��``e��ho��d: �� Supplemental Information
B UILDINGDIVISION ''`"` f G
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
jition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
I=1 I- and 2- family dwelling $Commercial/industnal Valuation: $
ID Accessory building Ill Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /01 b it 51,d 1,(/ $' New dwelling area: square feet
City/State /ZIP: 713, -ez:b / 6712_ 9 7ZZ3 Garage/carport area: square feet
Suite/bldg. /apt. no.: 005 Project name:I m%rj 'o l - 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: I 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
pp��
(gyp ,) �/ DESCRRIIP PT TIONT�OOF WORK ) �yI work indicated on this application. r
.
p 4 / � ie-1/ - j ' T1W t P/`� �0/1 s Valuation: $ 2 4e$ Cj mt)
01 / 7/Z &'3 0¢ zz / � 1 t _ /, 7 t ��y jV r Existing building area: square feet
(f �Y�l, D 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: i' �i(J711 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: ( ) I Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: r - 1 (Please refer to fee schedule,
Address: 9095 31/ Bvpu eim . // Permit fee.
City/State /ZIP: I/a /K �` r " � 9722-3 State surcharge (12% of permit fee):
/ ' FLS plan review (40% of permit fee):
Phone: (J' 73) 2_ Z I F ax: (.,0_3) 4 t - 96,6 (Due upon application.)
CCB lic.: 61 077 Total permit fees: �,/
Authorized signature: Amount received: /c� ' 3 7
This p ermit application expires if a permit is not obtained
Print name: a � �» 9 Date: z4.. -1 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board
I \Buildin PerrutApp doc 03/23/06 440- 4613T(11 /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition 10 heads: No plan review required.
llteratton ❑ 11+ heads: Plan review required.
❑ Repair 7,,
Number of sprinkler heads: V
Additional description of work:
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�CotririeYCi ` a1� , Sr ' `nkler� "•:;, _ . °,, r.
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Project Valuation: $
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Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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Square Footage: Permit Fee:
0 to 2,000
LLy5 _. ' Y te • *4 ;� '?•'i "e ?' ; s, ;i;,x,ie- :: °�hH � -;r,
; yr , t.• " - -'
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.
z} m,:• t- '' ':a'::,x,• ;r` " 'z, °,'' .`r.'r` 4444' =r= ,t'�� • F.c 4.' ,444 .-'.4 ;d •. 4 44 e,:•r :•., s"
,.�,. , r.�g�, t,j.«,. - .,...u�.,�� �:',~ y ",.:.... ,�._�,�..�.�F. ire• mProtectioia ,�Permit,EeeS�t�•�;�� >�: � .<,_ �,;�� >� ";a;.�� °��z.,� , .,,�•r;�w,.,'�, -- >... x
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.
htt p. / /www.a.tigard.or.us /city_hall /departments /cd /dots /FPS- PermitApp.doc 2