Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
F�1 el COMMUNITY DEVELOPMENT Permit#: FPS2013-00127
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/18/2013
Parcel: 2S 101 AD00800
Jurisdiction: Tigard
Site address: 12550 SW 68TH AVE
Project: Heintzberger/Payne Subdivision: WEST PORTLAND HEIGHTS Lot: 26
Project Description: Adding(9)heads and relocating(11)heads for TI.
Contractor: VIKING AUTOMATIC SPRINKLER CO Owner: BHKZ LLC
3245 NW FRONT AVE 12600 SW 68TH PKWY
PORTLAND, OR 97210 PORTLAND, OR 97223
PHONE: 503-227-1171 PHONE: 503-546-4151
FAX: 503-227-1552
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/03/2013 $102.20
12%State Surcharge-Building 09/03/2013 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 09/03/2013 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 09/18/2013 $2 00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 09/18/2013 $5 00
11x17)
Commercial Sprinkler System:
Sprinkler Required Yes Sprinkler Type Wet
Standpipe Required Hazard LT
Density: .10 Design Area: 900
K Factor. 5.6
Commercial Fire Alarm System:
Fire Alarm Required. Alarm Type.
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $162.34
•
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation $2,400.00
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
iss - -, or ' . is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
utility Notification Cente. 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 •., •' 03.232 1987 or 1.800.332 2344.
Issued By: / •4 r 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.
Fire Protection System
Building Permit Application ,R FOR OFFICE USi, ONLY
City of Tigard `� ,' '1 �� Permit No p (j I - do(
a 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Rewew
' Z Phone: 503.639.4171 Fax: 503.59:-4,t `P>/ ^ti(7 Date/13 . rsl/ i •" Other Permit (l
T I G A It D Inspection Line: 503.639.4175 \. Date ReadyBy. ® See Page 2 for
I Supplemental Information
Internet: www.tigard-or.gov G Nottfied/Method: "(/7 Q� `��
TYPE OF WORj �4$4i) REQUIRED DATA:I-AND 2-FAMILY DWELLING
❑New construction ❑ ,,```III r��n Permit fees are based on the value of the work performed.
Ater: Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement ❑Ater: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling laCommercial/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: (Z s-ro sw (As-TO- 14,)c New dwelling area: square feet
City/State/ZIP:1 , ., OQ cnvet; Garage/carport area: square feet
Suite/bldgiapt.no.: Project name: of PICa. V _-cc 441__ 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.
AOri (V.E1oc-tct-G Ai tIJeED�X) Feb 7. 1E►--1 A-oz s Valuation: $ Zct�
t LK FP-C.1E tMEIJ i 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:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: 1 iii of c,c SPtr ra tc traz All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
"Akv E 13 Arm u-.,ra rJ under ORS 701 and may be required to be licensed in the
Address: 3z cis- bk..., .¢o,,z y)t.,c jurisdiction in which work is being performed.If the
-p applicant is exempt from licensing,the following reasons
City/State/ZIP: tett�T trl0N o 2 9 7 Z t a
apply:
Phone:(5-e3 )z1.- - -1 t Fax::(So3) ZZ-7- .cS'Z
E-mail:Dt4V ••13 Ee"+t r1 VI V.t N C{ Spa t�ktex .tae'
�"' CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: J tk.i 1J� S tr l 1L trF�
{� Permit fee:
Address: 3145- co., 'r(, r Aide"
City/State/ZIP: State surcharge(8%of permit fee):
�o���N f7 6 rZ I1 Z(7 FLS plan review(40%of permit fee):
Phone:(5-6-5) 22.-1 -k l'1 t Fax:(ce3)ZZ-1-K S.Z (Due upon application.)
CCB lic.: to q a3-? 3 i S/s\ Total permit fees:
Authorized signal �� /�� ✓' Amount received: 5A1.ta In
UU// This permit application expires if a permit is not obtained
Print name:vAvE -i3ixr E t/,mroJ Date: g'-sez'13 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building industry
Service Board.
I.\Budding\Pennits\FPS-PermitApp doc 03/23/06 440-4613T(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 ❑ 1-10 heads: No plan review required.
[3 Alteration ® 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:Ze avt) s
tl Vet c-i•TES
Additional description of work:
ADDIr_EIoc-ibMe I15 UEoef� FoQ T ' S t ■ ?a_a -
Type of System (Complete A, B,C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes
Information: Hazard Group LtyKr-
Density
Design Area
K. Factor S. Co
Sprinkler Project Valuation: $ Z`{r)c)
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 $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 (8%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.
"Nev ' fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer,or NICET level"3" technicians.
C:\Omni Jobs\Permit Applications\City of Tigard\City of Tigard Permit App.doc 2