Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
°11 * COMMUNITY DEVELOPMENT Permit#: FPS2015-00092
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/17/2015
Parcel: 2S112CB00900
Jurisdiction: Tigard
Site address: 15000 SW HALL BLVD
Project: Bonaventure of Tigard Subdivision: WILSON ACRES Lot: 8
Project Description: Fire alarm for new assisted care facility.
Contractor: JET INDUSTRIES INC Owner: SCHMIDT FARM LLC
1935 SILVERTON RD NE 25717 SW LABROUSSE RD
SALEM, OR 97303 SHERWOOD, OR 97140
PHONE: 503-363-2334 PHONE:
FAX: 503-363-2622
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/27/2015 $809.42
12%State Surcharge-Building 06/17/2015 $97.13
Type of Use: COM Plan Review-Fire Life Safety-COM 05/27/2015 $323.77
Class of Work: NEW Type of Const: VA Info Process/Archiving-Lg$2.00(over 06/17/2015 $22.00
Occupancy Grp: I-1 Height: ft 11x17)
Stories: 3 Info Process/Archiving-Sm$0.50(up to 06/17/2015 $15.00
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: Yes Alarm Type: Automatic
Pull Station Required: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $1,267.32
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $100,000.00
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 Noti ion Cen - Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a co. - ules
or direc uestions to OUN .y c- ••g 503.232.1987 or 1.800.332.2344.
Issu d By: / Permittee Signature: ��/
r
Call 503.639.4175 by 7:00 a.m.for the next availab = spec'•n date.
This permit card shall be kept in a conspicuous place on the job - to u completion of the pr•
Approved plans are required on the job site at the i • of each inspection.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
RECEIVED Received ( w ��j�� ys �/�
�, City of Tigard Date/By: � /�--///S \ i7�J PermitNo../ ��/5—"C�C,.(Jg�
'4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revi.. /
' Phone: 503.718.2439 Fax: 503.598 2 ry Date/By: j�' V�f 5( Other Permit:
[G A R D Inspection Line: 503.639.4175 12 015 Date Ready : p Juris: ® See Page 2 for
Internet: www.tigard-or.gov T Notified/Method: t7 /� Supplemental Information
REQUIRED DATA:1-AND 2-FAMILY DWELLING
T''PB t�L�1�t TilU9�i(iti�
ew construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rotnded 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.
❑ I-and 2-family dwelling ` ercial/industrial Valuation: $ /0 ,,D Ot
El Accessory building 12 Multi-family Number of bedrooms: 7 DS-
❑Master builder ❑Other: Number of bathrooms: / 9
JOB SITE INFORMATION AND LOCATION Total number of floors: 3
Job site address: /5-006 5,0 //19// j'/✓i) New dwelling area: /57j c/ square feet
City/State/ZIP: 77'�4� O /)�/ , 9. '2y Garage/carport area: square feet
Suite/bldg./apt.no.: / , (/ Projebt name:: veJJT/j` 77‘012,.0 Covered porch area square feet
Cross street/directions to job site: , / Deck area: square feet
fft-1..) /2-4f)- 5 Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I 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.
�/�S�//! 1c- iiloet1 �yfT-�.>v► / GV Valuation: $ /QU to
/ Existing building area square feet
,'vc'A-12 ,5,/, /i
New building area: 152 / square feet
1iROPERTY OWNER I El TENANT Number of stories: /
Name: n A19 vON,'// N jt r M Lis-. Type of construction: 11-4
Address: q'3Zs J�'c�e Ro �, Occupancy groups:
City/State/ZIP:5* e� f 1(92 9 7?03 Existing:
Phone:(5- 5 )373 -3/6 f Fax: ) ��J> 353/ New: ,e) _ _7: i
$ TPPLICANT ❑ CONTACT PERSON NOTICE
Business name: 71- rNC9✓S 7_0,e All contractors and subcontractors are required to be
Contact name: K/g� ���S � licensed with the Oregon Construction Contractors Board
�7 under ORS 701 and may be required to be licensed in the
Address: !3.5- J/lye,�TVr,,/ ,09 jurisdiction in which work is being performed.If the
City/State/ZIP: '/./e ‘),e_._ 9[730/ applicant is exempt from licensing,the following reasons
�/ apply:
Phone:�3 ) 9/L1D�l Fax::(505) 36-5_0z-ZiZ_-
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: t7-.r.+Jo ,,:sr-rd fps Permit fee: 27Q y�--
Address: `7 - .5-,1,,,..l:,D,,✓ / a ,v
City/State/ZIP: State surcharge(12%ofpermit fee): 9-g
y S/�/a K'�/ c2 9 '3 1 FLS plan review(40%ofpermit fee): / 3
Phone:( .3)?9i_/D2� Fax:( Z'3') 363 -26�� (Due upon application submittal) /I p
CCB lic.: 39 y y I3)1 0 Total permit fees: //I3 742--
Authorized signature:C- {�� Amount received:
) This permit application expires if a permit is not obtained
Print name:4.5 !� Date: 0-z_/5— within 180 days after it has been accepted as complete.
`�tf * Fee methodology set by Tri-County Building Industry
Service Board.
11Building\Pmnits\FPS-PermitApp_071514.doc 440.4613T(11/02/COM/WEB)
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:
❑ 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 ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K Factor
Sprinkler Project Valuation: I $
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations i es
include: Individual Component tr. Yes
Cut Sheets
Fire Alarm Project Valuation: $/oc9 pa —
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: $
I:\Building\Permits\FPS_PermitApp_071514.doc 2