Permit e 4 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IN COMMUNITY DEVELOPMENT Permit#: FPS2014-00105
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/11/2014
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 320
Project: Bridgeport Family Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Adding(10)sprinkler heads for TI.
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 06/11/2014 $64.54
12%State Surcharge-Building 06/11/2014 $7.74
Type of Use: COM Plan Review-Fire Life Safety-MF 06/11/2014 $25.82
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .10 Design Area: 1500
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 $98.10
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,000.00
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 r -s adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You obtain a opy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.3
Issued By: Permittee Signature:
C 39.4175 •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.
Building Permit Application
Fire Protection System D FOR OFFICE USE Old I 1
Received
City of Tigard \\11 DateB : �i Permit No.. �I _et i
• 13125 SW Hall Blvd.,Tigard,OR 97 g `� f
g �4 Plan Review
': . Phone: 503.718.2439 Fax: 503.598. w\ + , 10 Date/By: Other Permit: 13,1 f 2elit(—c so 1 (1
i i c, ,ii 1l Inspection Line: 503.639.4175 0 1 WO Date ReadyBy: Juris: ® See Page z gr
Internet: www.tigard-or.gov (� Notified/Method. ,�`�a Supplement a1Information
�` �t
TYPE OF WO 400
REQUIRED DATA:1-AND 2-FAMILY DWELLING❑New construction ❑ ion Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
ddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CO TRUCTION 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: /`0 Y ) 5 Z� spelt-jam 0. j �� 7 New dwelling area: square feet
City/State/ZIP: JJ (�V 4 J \d� -4�. �,P7 L7i ` Garage/carport area: square feet
Suite/bldg./apt.no.: '›, 0 Project name: Nj y�, LL7-*Q 7 Covered porch area square feet
Cross street/directions to job site: is-I L 7 IA 4 k— 1 1 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(rotnded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: S
Ab0Lr)) 5 1,.)✓��z5 1) ova �`
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: -j , L. AL!-_16s2 -,y,J I Ize ---pIZ) All contractors and subcontractors are required to be
Contact name: �� t�fl L�! licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be!sensed in the
Address: (S) I Z )0 W G�O J t - -Z jurisdiction in which work is being performed.If the
City/State/ZIP: / applicant is exempt from licensing,the following reasons
w�"4p ✓6, Pt-a-- 1r1 A - Z B ( apply:
Phone:(5 ) 2 <- 3, 1 3 Flax: :(3 Ds _�) Le 2
E-mail: Z`i
CONTRACTOR BUILDING PERMIT FEES*
- _L-4_1 (Please refer to fee schedule)
Business name: -6 t QA . Q k F-1 Z r✓ I�
Permit fee: (91-1,
Address: L 17 ft)L ))Z L o
City/State/ZIP: 1 r ' - rf� /� State surcharge(12/o of permit fee):
y w ��'��n ( VA r "l � FLS plan review(40%of permit fee): r�
Phone:( ) '07 _ Fax:(36 p) 13 9- (p L (Due upon application] c25• a 2
CCB lie.: 1 �Gr J Total permit fees: t, L1g,t
Authorized signature: ( Amount received: + qg•(Q
This permit application expires if a permit is not obtained
Print name: 'VI l 1 Date: [/ within 180 days after it has been accepted as complete.
/," ul- . /Ii T * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building 1Permits\FPS-PermitApp.doc Rev 01/05/2012 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) ❑ New 2.) fication to sprinkler heads only:
❑ Addition 1-10 heads: No plan review required.
teration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: /0
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 _ Lil CL(.-( I
Density
Design Area /1bC)
K Factor 5 ,
Sprinkler Project Valuation: $ v oo��
1,
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.
I:\Building\Pernuts\FPS_PemvtApp.doc Rev 01/05/2012 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16083 SW UPPER BOONES FERRY RD 320,
TIGARD, OR, 97224
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
July 25, 2014 at 10:06:48 AM
FPS2014-00105
Chip Barnett
Violation Summary:
Inspector Contractor