Permit IN a CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2013 00097
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2013
Parcel: 2S113AA01000
Jurisdiction: Tigard
Site address: 16570 SW 72ND AVE B9
Project: Stay'N Power Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C
Project Description: Add & relocate (6) sprinkler heads for TI.
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 07/16/2013 $61.85
12% State Surcharge - Building 07/16/2013 $7.42
Type of Use: COM Plan Review - Fire Life Safety - COM 07/16/2013 $24.74
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
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 $94.01
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $870.00
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 co. of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
4(4?Z Permittee Signature: IF-
Air
Call 503.639.4175 by 7:00 a.m. for the next available inspe • ion date.
This permit card shall be kept in a conspicuous place on the job site u ' completion of the project.
Approved plans are required on the job site at the time of -ach inspection.
Building Permit Application
• Fire Protection System RECEIVED FOR OFFICE USE ONLY •
City of Tigard Received 13126 SW Hall Blvd., Tigard, OR 97223
7 6 /3 PernvtNo s�0/3 `DD09?
JUL 1 2013 Date Review
[J
111 11
't Plan Review
Phone: 603.639.4171 Fax: 603.698.1960 DateBy: Other Permi/%24_,3 - Q0 %5,3
TIGAR Inspection Line: 503.639.4175 CITY�TIGARI) Date Ready/By: 3uris: 0 See Page 2 for
Internet: www.tigard or.gov gUILDINGDNISIO NotifiedMethod: - Supplemental Information
' T YPE O 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
. Qddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
: CATEGORY CONSTRUCTION . work indicated on this application.
❑ 1- and 2- family dwelling 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: / (25-70 v '72 New dwelling area: square feet
City/State /ZIP: �iG°O 0/ 9 722¢ Garage/carport area: square feet
Suite/bldg. /apt. no.: 2 9 Project name: 5— l' / A/ PE) Li(« 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
5
1 DESCRIPTION OF WORK work indicated on this application.
R� q
vG — ,I1 o a Di< ' 4 ,� F! e Valuation: $ .'7O .
57�A - 1 - - t =pit 6 , /" !_ 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:
Phone: ( ) Fax: ( )
New:
9PPLICANT ❑ CONTACT PERSON NOTICE
Business name: Car) 7j¢e..- 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 PER�VIIT FEES* . ,,..
WWI- m n , 0 � 0 A .. ( Warta' fee sc .' `
Business name: . .
/ tl y/�
Address: 90,9 5 6k-/ ,�vmhy. 7 ,67--, Permit fee:
City/State /ZIP: 7 , 3� 04 97 22 State surcharge (12% of permit fee):
/ FLS plan review (40% of permit fee):
Phone: (5-p3) 6 g¢ - 2-92 g Fax: (503) 4 - 9 6 57 (Due upon application.)
CCB lic.: t 4 -77 Total permit fees:
Authorized signature: _ Amount received: 9 Of
This permit application expires if a permit is not obtained
Print name: , i)6 �V ; Dater' 7 - Jo ! within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits \FPS- PermitApp.doc 03/23/06 440 -4613T(11 /07JCOM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe Wait.< to be doiae?
1.) fl New 2.) Modification to sprinkler heads only:
Addition „g4-10 heads: No plan review required.
+lit—Alteration 0 11+ heads: Plan review required.
Repair
Number of sprinkler heads:
Additional description of work:
_ype of System fe4 or D as applicable)
A) Commercial Sprinkler
EI Wet D Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Fire Suppression System •
Hood Project Valuation:
, =,
C) Fire Alarm
Submittal shall Battery Calculations 0 Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: $
- D.) ,Itesi4eiltial (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://www.ci.tigard.or.usicity_hallidepartments/cd/docstFPS-PermitApp.doc 2