Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
INCOMMUNITY DEVELOPMENT Permit#: FPS2014-00024
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/24/2014
T f�''�R O g Parcel: 2S113AD01900
Jurisdiction: Tigard
Site address: 16640 SW 72ND AVE B10
Project: Copytronix Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Modification of fire sprinkler heads for TI,approximately 43 heads.
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES
9095 SW BURNHAM ATTN: N PIVEN
TIGARD, OR 97223 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-684-2928 PHONE: 503-624-6300
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/24/2014 $112.96
12%State Surcharge-Building 02/24/2014 $13.56
Type of Use: COM Info Process/Archiving-Lg$2.00(over 02/24/2014 $2.00
Class of Work: ALT Type of Const: 11x17)
Occupancy Grp: Height: ft Info Process/Archiving-Sm$0.50(up to 02/24/2014 $5.00
Stories: 11x17)
Plan Review-Fire Life Safety-MF 02/24/2014 $45.18
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .10 Design Area: 1000
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 $178.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,540.00
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 ob a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By(121 Permittee Signature:
Call 503.638.4175 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.
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Building Permit Application
Fire i'rotection System RECEIVED FOR OFFICE USE O1\1.1
City of Tigard Received , Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223r Date/B . •_„�/ r —QQ�pl
q� Plan Review
Phone: 503.718.2439 Fax: 503.598.1 EB 1 1 2014 Date/By:i /y 1 Other Permit: Pc/f-cifee
TI , iz I) Inspection Line: 503.639.4175 Date Ready/By: Juris: 65 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method:,/.// . 3,) Supplemental Information
lANNG DIVISION Sf'6 ke G'_ ''T7,[bt GGt^S hkigt
TYPE O 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.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: S
❑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:16640 SW 72ND AVE New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Copyronix 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.
Add and relocated sprinklers for TI Valuation: $$3,540.00
Existing building area: square feet
New building area: 0 square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 1
Name: Type of construction: Comb
Address: Occupancy groups:
City/State/ZIP:T
Existing: Light
Phone:( ) Fax:( )
New: Light
® APPLICANT 0 CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ashley Payne licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham Rd jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)684-2928 Fax: :(
E-mail:a.payne @wyattfire.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection (PlasrrejerroJeeselYedrle�
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) f Fax:( ) (Due upon application.)
CCB lic.:64077 . t if, Total permit fees:
` 4 1
Authorized signature: Amount received:
. This permit application expires if a permit is not obtained
Print name:Ashley Payne Date:2/10/2014 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Pmnita\FPS-PennitApp.doc Rev 01/052012 440.46131(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 ® 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 41
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Z Wet ! ❑ Dry
Additional Standpipes
Information: Hazard Group Light
Density .10
Design Area 1000
K. Factor 5.6
Sprinkler Project Valuation: $ 3540
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El 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:\Users\Ashley\Desktop\TigardApp.doc Rev 01/05/2012 2
CITY OF TIGARD FEE AND PAYMENT HISTORY
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i • 13125 SW Hall Blvd..Tigard OR 97223
503.639.4171
TIGARD
FPS2014-00024 - 16640 SW 72ND AVE B10, TIGARD, OR 97224
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Permit Fee-COM 230-0000-43104 $112.96 $112.96 $112.96
12%State Surcharge-Building 100-0000-24001 $13.56 $13.56 $13.56
Info Process/Archiving-Lg $2.00(over 230-0000-43135 $2.00 $2.00 $2.00
11x17)
Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $5.00 $5.00 $5.00
11x17)
Plan Review-Fire Life Safety-MF 230-0000-43108 $45.18 $45.18 $45.18
Totals for Fees $178.70 $178.70 $0.00 $178.70
Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount
Total Payments: $0.00
Balance Due: $178.70