Permit r CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
III e , COMMUNITY DEVELOPMENT Permit#: FPS2015-00104
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/16/2015
Parcel: 2S 101 AB03000
Jurisdiction: TIGARD
Site address: 7150 SW DARTMOUTH ST
Project: Pediatric Associates Northwest Subdivision: 2012-009 PARTITION PLAT Lot: 2
Project Description: Fire sprinkler system for new medical office. Approximately 164 heads.
Contractor: MCKINSTRY COMPANY LLC Owner: DF DEVELOPMENT LLC
16790 NE MASON ST., STE. 100 23077 SW NEWLAND RD
PORTLAND, OR 97230 WILSONVILLE,OR 97070
PHONE: 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Description Date Amount
Specifics:, Permit Fee-COM 07/16/2015 $306.64
12%State Surcharge-Building 07/16/2015 $36.80
Type of Use: COM Plan Review-Fire Life Safety-COM 07/16/2015 $122.66
Class of Work: NEW Type of Const: VB Info Process/Archiving-Lg$2.00(over 07/16/2015 $4.00
OccupancyGrp: B Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 07/16/2015 $17.50
11x17)
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 $487.60
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $22,000.00
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 rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-009 You may obtain a copy of the rules
or direct questions t•OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Oka Permittee Signature: -
or
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.
' Building Permit Appliclt
Fire Protection System ` O ()Nil
FOR I ll< I. 1 til: N,
City of Tigard Date/B : 7 t IMM Permit No.:'I —.4 -,do le)
514
. 9 13125 SW Hall Blvd.,Tigard,ORJ jk23 2 2015 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960
Date/B : A��IAt�� �1 Other Permit:
Inspection Line: 503.639.41 Date Ready / luris See Page 2 for
T I G A R D 'Cs IT V OF T lU ARD
Internet: www.tigard-or.gov Notif ed/Method: • S upplemental
Information
RIJILDING DIVIS10'. .0 ;4, -r-Mme,.tier'
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
'x]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 I-and 2-family dwelling Commercial/industrial Valuation: $
El Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: .-21 50 5(x) DA RTMId0 T H New dwelling area: square feet
City/State/ZIP: TI L °`{�1.° i) /o ReGo N/ 1'7 223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: T1 GA2-0 PEA l A-T-(Z l L5 Covered porch area: square feet
Cross street/directions to job site: Suj 0 SW D TM 0 i T H Deck area: square feet
t 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: $ 227 COO S2 F S�P P CFS S t O.Ai G'itS - M 1 A),, A 4 L
Existing building area: square feet
New building area: .5 6 a 6 square feet
t
❑ PROPERTY OWNER ❑ TENANT Number of stories: t
Name: Type of construction: I 'j '&0 I(L OFF/Ge
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
14-APPLICANT ❑ CONTACT PERSON NOTICE
Business name: A'l c k.F N 5,7-0_ ( (cM pAikt ii All contractors and subcontractors are required to be
Contact name: IoM 1_L licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: t(o'7 Gt d Ai E Mkso N S 7--12._E-&--1-- jurisdiction in which work is being performed.If the
City/State/ZIP: Po RTZ„ N p / cg_E G on) / q`,z 3d applicant is exempt from licensing,the following reasons
apply:
Phone:(S03) '1j 0'7 -41 t 5”I Fax::( )
E-mail: A„_,,,l 1111 t) e /Lk c_k t / T "( ,; 7 (O M
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: M G k i di 5 T( y CO M pAm y Permit fee:
Address: 16 `)"1 d m its.,Ai 1"1-1`e-e-T
State surcharge(12%of permit fee):
City/State/ZIP: pc t2Tt_A-Al p (12 r`c,d Ai l G1 "2 2 3 Q FLS plan review(40%of permit fee):
Phone:(9j3 ) '30-2 _CT ) c ( Fax:( )/ (Due upon application submittal)
CCB lic.: i "� Z 51 ( Total permit fees:
Authorized signature: Amount received:
This permit application expires if a permit is no o tained
Print name: A0A-M M U L Lt....TL Date: within 180 days after it has been accepted as complete.
���`"' l 2 1 * Fee methodology set by Tri-County Building Industry
Service Board.
t:\Building\Perm its\FPS-PermitApp_071514.doc 440-4613T(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: 16`I/ 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
\\'et ❑ Dry
Additional Standpipes
Information: Hazard Group ' - s
Density , ,Q
Design Area
_ K. Factor .w
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: $
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