Permit q CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
:� 1 :' ' COMMUNITY DEVELOPMENT Permit#: FPS201300122
Date Issued: 08/26/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 320
Project: Thenell Law Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: Add(2)new fire sprinkler heads and relocate(3)heads for TI
Contractor: WESTERN STATES FIRE PROTECTION Owner: PACIFIC REALTY ASSOCIATES
13896 FIR ST STE B ATTN: N PIVEN
OREGON CITY, OR 97045 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-657-5155 PHONE: 503-624-6300
FAX: 503-657-5182
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/26/2013 $64.54
12%State Surcharge-Building 08/26/2013 $7.74
Type of Use: COM Plan Review-Fire Life Safety-COM 08/26/2013 $25.82
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 $98.10
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $989.00
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 -stions to •b 6,C by calling 503.232.1987 or 1.800.332.2344.
Issued B,• AL / Permittee Signature:
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 FOR OFFICE USE ONLY
1 Received OOl�Z
City of Tigard RECEIVE, Date/B : ��,, Permit No Q5�l,3r
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
- - 2: Phone: 503.718.2439 Fax: 503.598.1960 AUG 2 6 2013 Date/B : Other Permit: 6L00690/3-601 77
T l G A R D Inspection Line: 503.639.4175 Date Ready/By: Jun s: ® See Page 2 for
Internet: www.tigard-or.gov C!n/n[T!/�A pD Notified/Method: Supplemental Information
TYPE OF WORK l�®�vf� 1DIVIISfl10�' REQUIRED DATA: I-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
dition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ t-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: I j.90'! Q"'" a,.k,y�ica. -- ti� I New dwelling area: square feet
� P as ,t� 3
City/State/ZIP: T.k ,O . COL _3 Garage/carport area: square feet
Suite/bldg./apt.no.: PS2.0 Project namefittit \ ‘,4,,j• G.y-n,,13 ir Qy` N S1-649 Covered porch area: square feet
Cross street/directions to job sitet Deck area: square feet
5 W ika. ct-on . c 1-g-) 6814` P-4ktA1ky 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
• DESCRIPTION OF WORK work indicated on this application.
Valuation: $ 1 al
R
�koutt� 3 s pri v.kje-t" l In cQue 6,. 3es
i'V,a! dvr,lt a 1 e�ei/I I VIA R7V in �'i Existing building area: square feet
(4r,I) C�� }4-€1:1--D k Etu�-T-� C,3 New building area: square feet
• ❑ PROPERTY OWNER 1 ��❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups: L j ,4 Ha ,e cQ
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
APPLICANT <. CI CONTACT PERSON - • NOTICE
Business name: we_s "ervr c5 iaLk.e S r l re Fr,,to�•i..lb) All contractors and subcontractors are required to be
Contact name: ���ael C , V`f Z�S "� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: u3gq(p 1, s cC jurisdiction in which work is being performed. If the
City/State/ZIP: R�jj 0 applicant is exempt from licensing,the following reasons
OYe �Yl �t 41� l Q apply:
Phone:(5t,3).._ c _c15 Fax: :( )
E-mail: �fl kklQd_ des 2 (,l'c5 _ as
CONTRACTOR . BUILDING PERMIT"FEES*
/'/ (Please refer in fee schedule)
Business name: (NeS f ykt S-ktCS , iv y
�/ Permit fee:
Address: /3E376 F Y' �-t
State surcharge(12%of permit fee):
City/State/ZIP: OYe_jtbt__ Gay / OR 9 7095-
i FLS plan review(40%of permit fee):
Phone:(503 ).- -j 7 .-515 Fax:( ) (Due upon application.)
CCB lie.: /0570 Total permit fees:
Authorized signature: / _ /� Amount received: 9S o
`- ���� 'eZ £ - -_ This permit application expires if a permit is not obtained
Print name: t L, . j C.,, Date: within 180 days after it has been accepted as complete.
/1
"l �`� * Fee methodology set by Tri-County Building Industry
Service Board.
is\Building\Permits\FPS-Permit App.doc Rev 01/05/2012 440-46 13T(I 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 1151-10 heads: No plan review required.
alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 3
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 (I D/O 7/0
Design Area
K. Factor 5-co
Sprinkler Project Valuation: $ 751"
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.
C:A Users\mibates\Downloads\l I S-PermitApp(3).doc Rev 01/05/2012 2