Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
III a COMMUNITY DEVELOPMENT Permit#: FPS2014-00094
T t t;A ft O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/28/2014
Parcel: 1 S 135BC00900
Jurisdiction: Tigard
Site address: 10855 SW CASCADE AVE
Project: Paulson's Flooring Subdivision: HILLSBORO Lot: PTS 1-2
Project Description: Adding(1)sprinkler to first floor office and replacing(2)existing sprinklers.
Contractor: VIKING AUTOMATIC SPRINKLER CO Owner: PAULSON LIMITED LIABILITY CO
3245 NW FRONT AVE BY RICHARD G PAULSON SR
PORTLAND,OR 97210 10855 SW CASCADE BLVD
TIGARD, OR 97223
PHONE: 503-227-1171 PHONE:
FAX: 503-227-1552
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/28/2014 $69.92
12%State Surcharge-Building 05/28/2014 $8.39
Type of Use: COM Plan Review-Fire Life Safety-COM 05/28/2014 $27.97
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: ORD2
Density: 0 Design Area: 0
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 $106.28
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,200.00
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 0 ..'v.--•. .
Issued By: • Permittee Signature:
Call 50 .• 9.4175 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 1.0R Ot l 1( l l SI 0\l.1
City of Tigard RECEIVED ,,, it No.: _, , _
IIII • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
1 ;t) Inspection Line: 503.639.4175 MAY 2 8 2014 Date Ready/By: See Pate 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OFTIGARD
TYPE OF WeR DIN(i DIVISION 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.
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 BESS 5,....., 4,.�,„,t� Au,E New dwelling area: square feet
City/State/ZIP: -1-1-t+r.4¢Q ae 4/22 3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: ( J 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.
Valuation: $ (-Loo...
Ann 1 S? w.k l Cr Frees¢ or-Ft ce
Existing building area: square feet
E9,W4-1._E Z ExtsTtt,y Sruewtc lt-us.
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: "i-WA -toote 6oveQ ta.ayS Type of construction:
Address: Ic bSS 51_-_.. Cars cdaot 4vc' Occupancy groups:
City/State/ZIP t 4iNci. otz S12-V !, Existing:
Phone:(.5::,3 )faze,_?dl3a Fax:( ) _ New:
a APPLICANT ® CONTACT PERSON
NOTICE
Business name: /t K t4,x1 St Ix 10•.11(lie All contractors and subcontractors are required to be
Contact name: �avE licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: -32.4.5- 1,14., FrZb.sT ikuE jurisdiction in which work is being performed.If the
City/State/ZIP: tSR applicant is exempt from licensing,the following reasons
e�t.h�t7 9Z Zta apply:
Phone:(.5,3) 2Z'1-t v11 Fax::(ceaV ZZ 7-t S-1-Z.
E-mail:-DAVE."g Ape 0-1460,... liii I ta.Nt4 xwlktEt.IAEA'
CONTRACTOR BUILDING PERMIT FEES*
(Please la fee l Business name: 4 tw ' R t ati t
Permit fee:
Address: 3214 1._. �Q4_,4„; !WE
City/State/ZIP: State surcharge(12%of permit fee):
� \��7 6TZ Q-1 Z l FLS plan review(40%of permit fee):
Phone:(.5::,3 1-2:-L-)_t 0 I Fax:(So3)L27- tSS 2. (Due upon application.)
CCB lic.: Co`f B Total permit fees: U(p,
Authorized signs
Amount received:
wwT ��1 This permit application expires if a permit is not obtained
Print name: v Date: c/ZS/ly within 180 days after it has been accepted as complete.
E°"Rt. • Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PermitApp.doc Rev 01/05/2012 440-4613T(I1/02JCOM/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: 3
Additional description of work: it vo I F1Evt-x. YEP z VST w
Type of System (Complete A,B, C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes Wilt
Information: Hazard Group Li 4Etr 144k2 ►ttp
Density
Design Area A(e,
K Factor
Sprinkler Project Valuation: $ l z sue'
B.) Type I- Hood Fire Session System
Hood Project Valuation: $
C.) Fite 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 egg(3) sets of plans at submittal.
Plan review fees are required at submittal.
C:\Omni Jobs\Perron Applications\City of Tigard\City of Tigard FPS-PemutApp.doc I2v 01/05/2012