Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IN i COMMUNITY DEVELOPMENT Permit#: FPS2015-00108
T f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/23/2015
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: New fire alarm system for TI.
Contractor: CHERRY CITY ELECTRIC Owner: DF DEVELOPMENT LLC
1596 22ND ST SE 23077 SW NEWLAND RD
SALEM, OR 97302 WILSONVILLE, OR 97070
PHONE: 503-566-5600 PHONE:
FAX: 503-571-4410
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/23/2015 $220.56
12%State Surcharge-Building 07/23/2015 $26.47
Type of Use: COM Plan Review-Fire Life Safety-COM 07/23/2015 $88.22
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 07/23/2015 $8.00
Occupancy Grp: B Height: ft 11x17)
Stories: 1
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: Smoke Detectors Req: No
Battery Cates Provided: Yes Cut Sheets Required: Yes
Total $343.25
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $13,410.00
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 Notifi - •• - ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire .uestions to OU . by callin. 503.232.1987 or 1.800.332.2344.
' t
Is-ued By: Permittee Signature: V ipipi /
`
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 p.oje• .
Approved plans are required on the job site at the time of each inspection.
Bu' ding Permit Application
-Fire Protection System OFFICE USE ONLY
City of Tigard lifjCVSSI tfl Rimed ( Permit No. t�
>�� ,R 1572 0,10e
Ili, 13125 SW Hall Blvd.,Tigard,OR Plan Review t / yI
Phone: 503.718.2439 Fax: 503.598.1960 1� Date/By: ( l� i� Mer Permrt:, ' atg ,op 37
Iii,,�i;I Inspection Line: 503.639.4175 Jul. 1 5 20 Date Ready �� 5: 1 See Page 2 for C J"+
Internet: www.tigard-or.gov Notified/method: Z7 IS 1 {_ Supplemental Information
iVISIUN
TYPE OF���D REQUIRED DATA:1-AND 2-FAMILY DWELLING
7
®New construction olrtion 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.
Ill 1-and 2-family dwelling ®Commercial/industrial
Valuation: $
1=1 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:7150 SW Dartmouth St New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Tigard Pediatrics Covered porch area: square feet
Cross street/directions to job site:SW 72"d and Dartmouth Deck area: square feet
Red Rock Building"B" 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.
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.
Fire alarm system for a small pediatric outpatient clinic. Valuation: $$13,410.00
Existing building area: square feet
New building area: 8,212 square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 1
Name:Pediatric Associates of the Northwest Type of construction: V-B
Address:2701 NW Vaughn St,Suite 360 Occupancy groups:
City/State/ZIP:Portland,OR 97210 Existing:
Phone:( ) Fax:( )
New: B
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name:Cherry City Electric All contractors and subcontractors are required to be
Contact name:Sherri Murray licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:8100 NE St.Johns Road,Suite D-101 jurisdiction in which work is being performed.If the
City/State/ZIP:Vancouver,WA 98665 applicant is exempt from licensing,the following reasons
apply:
Phone:(360)571-4411 Fax::( )
E-mail:smurray @cherrycityelectric.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Cherry City Electric !Please refer to fee schedule)
Permit fee:
Address:8100 NE St.Johns Road,Suite D-101
State surcharge(12%of permit fee):
City/State/ZIP:Vancouver,WA 98665 FLS plan review(40%of permit fee):
Phone:(360)931-2980 Fax:( ) (Due upon application submittal.)
CCB lic.:91668 7 ,( Total permit fees:
/ Amount received:
Authorized signa - iv
This permit application expires if a permit is not obtained
Print name:Sherri Murray Date:7-14-15 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building industry
Service Board.
1-SuildingTermits\FPS-PermitApp_071514.dce 44046131(11/02/COM/WBB)
-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 ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: I $ 13,410
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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