Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2013-00118
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2013
Parcel: 2S113AB00500
Jurisdiction: TIGARD
Site address: 16083 SW UPPER BOONES FERRY RD 300
Project: Spec Space Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Add(11)new fire sprinkler heads
Contractor: BLACKSTONE FIRE PROTECTION LLC Owner: G&S FC LLC
612 NE SQUIRE RD 16083 SW UPPER BOONES FERRY RD,
WASHOUGAL,WA 98671 STE
TIGARD,OR 97224
PHONE: 503-708-7437 PHONE:
FAX: 360-838-0162
FEES
Description Date Amount
Specifics:. Permit Fee-COM 10/07/2013 $67.23
12%State Surcharge-Building 10/07/2013 $8.07
Type of Use: COM Plan Review-Fire Life Safety-COM 10/07/2013 $26.89
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 10/07/2013 $3.50
Occupancy Grp: . Height: ft 11x17)
Stories:
• Commercial Sprinkler System:
Sprinkler Required: Yes ' Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .10 Design Area: 1500
K Factor: 11.2
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $105.69
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,100.00
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: • Permittee Signature: / -
-
W
C• .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 RECEIVED FOR OFFIC[: tiSE ONLY
g Received �ir � Ps /2 n
III q City of Tigard Permit No.: J a
13125 SW Hall Blvd.,Tigard,OR 97223'81-11.J 2013 Plan Review i��, ��
C Phone: 503.718.2439 Fax: 503.598,J,Q ) , p Date/B : Other Permit:
TI G n K D Inspection Line: 503.639.4175 (;j j�'OFTIGARD Date Ready/By: Q Iter tug /tj ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: ! �� / /v Supplementallnformation
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(rotnded to the nearest dollar)of all
Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
J CATEGORY OF CONSTRUCTION work indicated on this application.
—
❑ I-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: / '/i n%3 5 y, J -p-,-, _ oalfe53.Z.D7 New dwelling area: square feet
City/State/ZIP: L .IZ D Z. Garage/carport area: square feet
Suite/bldg./apt.no.: 300 Project name: 41��0i �� A, ��- 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(rowded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.f , Valuation: $ I a
�� L \\) tr�I j�ZiIb.4L�25 i ) od
Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
/APPLICANT "CONTACT PERSON NOTICE
Business name:
(A�4STv n1>,:, )ri re G 0 1 All contractors and subcontractors are required to be
Contact name: �� C�C� l.0 licensed with the Oregon Construction Contractors Board� under ORS 701 and may be required to be licensed in the
Address: (0\'L A) ` (D ✓t I2,. Z1✓, jurisdiction in which work is being performed.If the
City/State/ZIP: �� applicant is exempt from licensing,the following reasons
�``--,,, "" 4 t 0.11., R L� 4 A apply:
Phone: .11/3 ) �O - , _ Fax: :6620) 3A- ni LIZ
E-mail: �k44-n) P "b t r4 C!e5'1'O1J t✓�1_C .Cd 4i1
CONTRACTOR BUILDING PERMIT FEES'
Business name: , t J(S pi t, .1 ?ZC 1 LL (PleaserejerrPermi fee:schedule)
Address: L O ZIr 1� Permit fee:
City/State/ZIP: W� tAr L., Wl k_ State surcharge(12%of permit fee):
�kp ) FLS plan review(40%ofpermit fee):
Phone:(5j>)goo-�4 3-7_ Fax:( 0) a`(9'Z_ (Due upon application.)
CCB lic.: f er t CI)/v Total permit fees:
Authorized signature: CX Amount received:
This permit application expires if a permit is not obtained
Print name: _ Date:
I c9
• Fee methodology set by Tri-County Building Industry
Service Board.
1:tBuilding\Penniu\FPS-PermitApp.doc Rev 01/05/2012 4404613T(11/02/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.
Alteration )2L11+heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work: I7 )( )U\
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Wet ❑ Dry
Additional Standpipes
Information: Hazard Group L—I
Density t f D
Design Area I c' )
K. Factor
Sprinkler Project Valuation: $ f n0 ceD
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.
1:\Building\Permits\FPS-PermitApp.doc Rev 01/05/2012 2