Permit i
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
_ �� Permit#: FPS2013-00120
• COMMUNITY DEVELOPMENT
Date Issued: 09/16/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 16/201 0100
Jurisdiction: Tigard
Site address: 12520 SW GRANT AVE
Project: St Anthony Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 52
Project Description: Fire alarm system for new community center assembly building Connect to existing church.
Contractor: CAPITOL ELECTRIC CO INC Owner: ST ANTHONY CATHOLIC CHURCH TIGAR
11401 NE MARX STREET 9905 SW MCKENZIE ST
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 503-255-9488 PHONE:
FAX: 503-257-7121
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/16/2013 $371.16
12%State Surcharge-Building 09/16/2013 $44.54
Type of Use: COM Plan Review-Fire Life Safety-COM 09/16/2013 $148 46
Class of Work: NEW Type of Const: VB Info Process/Archiving-Lg$2.00(over 09/16/2013 $2 00
Occupancy Grp: A-3 Height: ft 11x17)
Stories: 2 Info Process/Archiving-Sm$0 50(up to 09/16/2013 $13.00
11x17)
Misc Administration Fee 09/16/2013 $5.00
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 Yes Alarm Type: Automatic
Pull Station Required Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required. Yes
Total $584 16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation $29,000.00
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 NC by calling 503 232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: e _ / ��?_./ ��04/4 )‘.177e—■
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.
q.
Building Permit Application RECEIVE
Fire Protection System FOR OFFICE USE ONLY
JI City of Tigard AUG 21 201. Date/Bea C� Permit No
,, i ��o/ % /2
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Win_
Phone: 503.718.2439 Fax: 503.598.1960 CITY TIGARD Date/By: It 1 l( L�� Other Perin R04.5 d0065'
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISI(�F Date Ready/By: . Juri- S10 upplemental See Page 2 for
Internet: www.tigard-or.gov Notified/Method: / // AL�i�� le< Supplemental Information
4//4 1 u)/ 2 -
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.
❑ I-and 2-family dwelling ®Commercial/industrial
Valuation: $
111 Accessory building El Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address•gone exx,MAILenzio Strout /2520 SG() G N 7— "49i/e-
7 v/�.ie— New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 — Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:St Anthnony Community Ctr 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 •
DESCRIPTION OF WORK work indicated on this application.
Install fire alarm system per plans Valuation: $29,000.00
Existing building area: square feet
New building area: square feet
® 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 maybe 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: 371.16
Address: 11401 NE Marx Street
City/State/ZIP: Portland,OR 97220 State surcharge(12%of permit fee): 44.54
FLS plan review(40%of permit fee): 148.46
Ph t0 rq:(5 255-9488 }( 14 If Fax:(503)255-1966 (Due upon application.)
CA lie.:48748 Total permit fees: 564.16
Authorized signature: Amount received: 581.16
This permit application expires if a permit is not obtained
Print name:Dan Wilson Date:8/20/2013 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-Perm itApp,doc Rev 01/05/2012 440-46I3T(I I/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
A 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: $ 29,000.00
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): $ 29,000.00
Permit fee based on project valuation (see fee schedule): $ 371.16
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $ 44.54
FLS Plan Review(40% of permit fee): $ 148.46
TOTAL: $ 564.16
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
U:\FA Jobs\zz130090-45 St Anthony Community Ctr\1 FPS-PermitApp.doc Rev 01/0512012
PERMIT FEE DOUBLES IF WORK HAS STARTED WITHOUT BENEFIT OF PERMIT
TO CALCULATE TOTAL FEE
PERMIT FEE CALCULATION (REFER TO TABLE)
$ 29,000.00 ROUNDED VALUATION
$ 338.92 (BASE FEE FOR FIRST$ 25,000.00 OF VALUATION)
+ $32.24 ($ 8.06 PER $ 1,000.00
_ $371.16 BASE PERMIT FEE
+ $44.54 STATE SURCHARGE = 12% OF BASE PERMIT FEE
+ $148.46 PLAN REVIEW CHARGE = 40% OF BASE PERMIT FEE
+ $12.00 RECORDS RETENTION FEES
+
•
$5.00 MISC ADMIN FEE (MAILING)
$581.16 TOTAL DUE FOR THIS PERMIT
EXAMPLE
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12520 SW GRANT AVE, TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
2014-03-07 00:00:00
FPS2013-00120
PASS - No C of O
NFPA 72 completion report received
Violation Summary:
Inspector Contractor