Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• COMMUNITY DEVELOPMENT Permit #: FPS2013 -00182
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2013
Parcel: 2S113AA00400
Jurisdiction: Tigard
Site address: 16200 SW 72ND AVE B2
Project: Spec Space Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: Relocate approximately (8) fire sprinkler heads for TI
Contractor: FIRESTOP CO Owner: PACIFIC REALTY ASSOCIATES
3203 NE 65TH ST #2 ATTN: N PIVEN
VANCOUVER, WA 98663 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 360 - 718 -8604 PHONE: 503 - 624 -6300
FAX: 360 - 718 -8603
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/18/2013 $75.30
12% State Surcharge - Building 12/18/2013 $9.04
Type of Use: COM Plan Review - Fire Life Safety - COM 12/18/2013 $30.12
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 $114.46
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,329.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance T wor suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Center. Those les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a c• • if the rules
or irect questions to OUNC b ing 5!' 32.1987 or 1.800.332.2344. 41
sued By: / �� / r Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspectio •ate.
This permit card shall be kept in a conspicuous place on the job site until c • pletion of the project.
Approved plans are required on the job site at the time of each inspection.
Buildip2 Permit Application
Fire Protection System OFFICE USE ONLY
Cl of Tigard CEIVED Received h t 1 N n
City Date/By: / S / 3 ( �/' J 3 -G'U($
• 13125 SW Hall Blvd., Tigard, 0 Phone: 503.718.2439 Fax: 503598 Plan Review
one: ..ax: . t. Other Permit: ,� • p� v 5- ��i
' ` � 1 8 2U13 Date/By: 'CXL/ 01fJ��`� /
T I GA R D Inspection Line: 503.639.4175 Date Ready /By: Juris ® See Page 2 for
Internet: www.tigard {� GITY DFTIIGARD Notified/Method: Supplemental Information
°ll
TYPE 1 D IVISION 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
indicated on this application.
El 1- and 2- family dwelling Commercial /industrial Valuation: $
El 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 b0.00 5i4/ 72, A�1� . New dwelling area: square feet
City /State /ZIP: ��G j D 4 9 7 2;24- Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 1 oBP108 - i& Z )j S 1 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 F WORK / work indicated on this application.
q .Gi
e _ 'n� �/ , ?/ J� /0,._mi � Valuation: S / 222, a:-') i OC :- I f7 7Z, /) e - 5_, 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:( 1 New:
g APPLICANT ❑ CONTACT PERSON NOTICE
Business name:
a2,e)"r�/q 72DAI 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 PERMIT FEES*
� / .. ��? � 0 � A I (Please refer to fee schedule)
Ze-(
Business name: v�v
Address: 3 2393 /c � ( , 5r� ,,,v.., Permit fee:
City /State /ZIP: VA-4)69 OV e/�. 1 / °� (p63 State surcharge (12 % of permit fee):
Phone: (3b n) 7/ 6-N704 / Fax: 560) 7/6 -g6 D3 FLS plan review (Due p o permit fee):
Due u on a lrc
' CCB lie.: /63 2 79 Total permit fees: 4
Authorized signature: Amount received: VP l // /
This permit application expires if a permit is not obtained
Print name: L4 70 `.. Date:/2 — 16 ' - 1 �j within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1 Vluilding \Permits\FPS- PermitApp.doe Rev 01 /05/2012 440- 4613T(I 1/02 /C0%1 ■■ 1 Ii
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.
0 .„ lteration ❑ 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: $
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.
http : / /www.tigard - or.gov /city_hall /departments /cd /docs /FPS- PermitApp.doc Rev 01/25/2012
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
16200 SW 72ND AVE B2, TIGARD, OR, 97224
Commercial - Fire Protection System
999 Sprinkler Final
2014-01-29 00:00:00
FPS2013-00182
PASS - No C of O
Violation Summary:
Inspector Contractor