Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2015-00007
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/18/2015
Parcel: 25101 BC00301
Jurisdiction: Tigard
Site address: 12350 SW KNOLL DR
Project: Elite Care at Knoll Subdivision: CROW PARK 217 Lot: 4
Project Description: Fire sprinkler system for a 30 bed group living facility.This permit does not cover any underground lines.
Contractor: SIMPLEXGRINNELL LP Owner: REED,WILLIAM C
6305 SW ROSEWOOD ST. PO BOX 12564
LAKE OSWEGO, OR 97035 PORTLAND, OR 97212
PHONE: 503-683-9000 PHONE:
FAX: 503-675-6521
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/05/2015 $443.70
12%State Surcharge-Building 03/05/2015 $53.24
Type of Use: COM Plan Review-Fire Life Safety-COM 03/05/2015 $177.48
Class of Work: NEW Type of Const: VB Info Process/Archiving-Lg$2.00(over 03/05/2015 $6.00
Occupancy Grp: R-4 Height: ft 11x17)
Stories: 3 Info Process/Archiving-Sm$0.50(up to 03/05/2015 $10.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .10 Design Area: 1020
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 $690.42
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $37,245.00
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 • 111.332.2344.
Issued By: ( -ermittee Signature:
�_ J �. - `ril/
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Call 503.•39.4175 by 7:00 a.m.for the next available inspe•+ion date.
This permit card shall be kept in a conspicuous place on the job site until completio of e project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Applicatio +�r it
Fire Protection System ECEI M EP l (llz t 11 I I( I I ..l ,I,,I ,
Received
City of Tigard Date/Br 80 / kr Permit No.: 50/5 19'7
13125 SW Hall Blvd.,Tigard,OR 2 0 2015 Plan Revie ■ 1
= Phone: 503.718.2439 Fax: 503.598.1960 Date/Sy: ' ' r l' l� Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: ` Juris: RI See Page 2 for
Internet: www.tigard-or.gov ���i �/� ��Al�1J� Notified/Method: N 15-120d Supplemental Information
J
3ITIT. 1V�;DP-TSi; � 1...0r-). 1 ; —emu 910/i- of tY
TYPE OF WORK 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: $
El Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
12-35V 4-lA3 7n JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site addresg:.1,25 SW Knoll Drive New dwelling area: square feet
City/State/ZIP:Tigard,OR.97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Elite Care at Knoll 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Install sprinkler system for new building Valuation: $$37,245.17
Existing building area: square feet
New building area: 9,596 square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: 3
Name: Type of construction: Wood
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
® APPLICANT ® CONTACT PERSON
NOTICE
Business name:SimplexGrinnell All contractors and subcontractors are required to be
Contact name:Jon Nelson licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:6305 SW Rosewood St. jurisdiction in which work is being performed.If the
City/State/ZIP:LAke Oswego,OR.97035 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)683-9000 Fax::(503)675-6521
E-mail:jonnelson @simplexgrinnell.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Same As"Applicant" (Please refer to fee schedule
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.:149921 Total permit fees:
Authorized sign ure: r _ ,, / Amount received:
�• w This permit application expires if a permit is not
L rint name:Jon N on Date: 1/16/1S within 180 days after it has been accepter'
* Fee methodology set by Tri-County Building
Service Board.
uilding\Permits TPS-PermitApp_0715I4.doc 440-46I3T(I I/02/COM/WEB)
� A
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
® New system Number of sprinkler heads: Number of alarm devices:
El Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
® Wet El Dry
Additional Standpipes
Information: Hazard Group Light
Density 0.10
Design Area 1020
K. Factor 5.6
Sprinkler Project Valuation: $ 37,245.17
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations El 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: $
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Hydrant Flow Report http://tiggisiw/mox6/actions/flow_report_hydrants.cfm?inspno=105043
Hydrant Flow Report for Asset FHO1 800501
Work Order Number [Asset ID FHO1B00501
Address
Comments
Start Date 2009-09-23 00:00:00.0
Assigned To Inspection Number 105043
Completed By I BEATTAR Completion Date 2009-09-23 00:00:00.0
Residual Static Pressure(psi) Gallons Per Minute(gpm) 1480 96 94 Pressure(psi)
Rating G
Crew
Project
1 of 1 6/25/2012 2:39 PM