Permit t p CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
`!'1 S COMMUNITY DEVELOPMENT Permit#: FPS2015-00014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/12/2015
Parcel: 2S 101 DC00200
Jurisdiction: Tigard
Site address: 13535 SW 72ND AVE 200
Project: Umpqua Bank Subdivision: 72ND BUSINESS CENTER Lot: 13
Project Description: Clean agent(HFC-125)fire detection and suppression system for the 2nd floor server room.
Contractor: NORTHWEST FIRE SUPPRESSION INC Owner: PNWP LLC#2
1800 NW 169TH PL, STE C600 BY PACIFIC NW PROP LTD PTNSP
BEAVERTON, OR 97006 PO BOX 2206
BEAVERTON, OR 97075
PHONE: 503-644-7720 PHONE:
FAX: 503-644-8289
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/12/2015 $177.52
12%State Surcharge-Building 02/12/2015 $21.30
Type of Use: COM Plan Review-Fire Life Safety-COM 02/12/2015 $71.01
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 02/12/2015 $4.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 02/12/2015 $22.50
11x17)
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 $296.33
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $10,000.00
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 req sires you • follow the rules adopted by the Oregon /
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 52-001-0091. You may obtain a copy of • rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee 5• nature:
Call 503.639.4175 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.
uildin2 Permit Application
Fire Protection System RECEIVE , I ()lit)1 1 1( I i 1 11\1 1
City of Tigard Received " ;•
13125 SW Hall Blvd.,Tigard,OR 97223 JAN 2 6 2015 D81CB �;'!� Permit No.: •Sa X45 !
II II Plan Re e
Phone: 503.718.2439 Fax: 503.598.1960 Dme/B :��y� �® other Pe"n464P.29/
Inspection Line: 503.639.4175 CITY OF TIGAR
ifid/Mth d Julia El See Pea2 for
t`) Internet: www.tigard-or.gov BUILDING DIVISI• o (S
Seppleaeetal Information
•a,,.-oe
TYPE OF WORK REQUIRED DATA:i-AND I-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 ❑Off. Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:13535 SW 72w'Ave New dwelling area: square feet
City/State/ZIP:Tigard Garage/carport area: square feet
Suite/bldg./apt.no.:200 Project name:Umpqua Bank Covered porch area: square feet
Cross street/directions to job site:217 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.
Clean agent(HFC-125)fire detection and suppression system for the 2'd floor Valuation: $510.00
server room 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:( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name:Northwest Fire Suppression All contractors and subcontractors are required to be
Contact name:Dan Loch licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:1800 NW 169' Place Suite C600 jurisdiction in which work is being performed.If the
City/State/ZIP:Beaverton Oregon applicant is exempt from licensing,the following reasons
apply:
Phone:(503)644-7720 Fax: ( )644-8289
E-mail:danloch @nwfire.com
CONTRACTOR BUILDING PERMIT
Business name:Same as above
Mew **Oak,
Permit fee:
Address:
State surcharge(12%of pennit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.)
CCB lic.:088629 Total permit fees:
Authorized si t . Amount received:
\ / This permit application expires if a permit is not obtained
Print name:Dan Loch D ate: within 180 days after it has been accepted as complete.
Imo_ • Fee methodology set by Tri-County Building Industry
Service Board.
[Mudding\Permits\FPS-PermitApp.doc Rev 01/05/2012 440-46131(11/02/COM/WEB)
w
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
Describe work to be done:
1.) 0 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: —
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.
C:\Users\danloch\Downloads\FPS_PermitApp.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
13535 SW 72ND AVE 200, TIGARD, OR, 97223
Commercial - Fire Protection System
920 Suppression trip test
PASS
FPS2015-00014
Jeff Grove
Violation Summary:
Inspector Contractor
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
13535 SW 72ND AVE 200, TIGARD, OR, 97223
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2015-00014
Jeff Grove
Violation Summary:
Inspector Contractor