Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• COMMUNITY DEVELOPMENT Permit#: FPS2015-00105
T I(iARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/21/2015
Parcel: 151343C00300
Jurisdiction: Tigard
Site address: 12266 SW SCHOLLS FERRY RD
Project: Pacific Dental Services,LLC Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Fire sprinklers-Modification of(39)heads,
Contractor: CROSSFIRE SPRINKLER CO Owner: FW OR-GREENWAY TOWN CENTER LLC
17400 SE 82ND DR ONE INDEPENDENT DRIVE, SUITE 114
CLACKAMAS, OR 97015 JACKSONVILLE, FL 32202
PHONE: 503-210-5506 PHONE: 503-603-4709
FAX: 503-210-5538
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/21/2015 $156.00
12%State Surcharge-Building 07/21/2015 $18.72
Type of Use: COM Plan Review-Fire Life Safety-COM 07/21/2015 $62.40
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 07/21/2015 $0.50
Occupancy Grp: B Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: 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 $237.62
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $7,475.00
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 q ons to OU .• ng 503.232.1987 or 1.800.332.2344.
Issu By: 14na-1 Permittee ignature: 0', , ":/�
Call 503.639.4175 by 7:00 a.m.for the next available insp- on 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.
Buildin Permit A lic t'
Fire Protection System EIVE1'j�
l t)R()i 1.1( 1: 1 ti,L ()NI.I
City of Tigard Received
• iyJ ' Permit No.: p
• 13125 SW Hall Blvd.,Tigard,O t4 i223 9 2015 Plan Revie 1�, �r (b
Phone: 503.639.4171 Fax: 503.598.1960 pQ(� Date/B : .��� Other Permit:
T I t i A R I) Inspection Line: 503.639.41�S CITY OF Tl V AAIU Date Ready/By: Juris: Hi See Page 2 for
Internet: www.tigard-or.gov�� Notified/Method: Supplemental Information
I3UILDING DIVISION
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El 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 OR CoNSTRUCTIOAI work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial
Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
12 Master builder ❑Other: Number of bathrooms:
4: 0Au� M) LOCATION Total number of floors:
Job site address:12266 SW Scholls Ferry Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Pacific Dental Greenway Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
.R�1�Cf RCtALUSE tIIECKI ST
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
DESCRtpTiotxT or WORK=;, work indicated on this application.
Relocate Existing Sprinkler Heads into new ceilings to maintain proper coverage Valuation: $$7,475.00
Existing building area: square feet
New building area: square feet
rItOPERTY (ice 0 A Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
El APPLICANT 0 CONTACT PERSON +
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax::(
E-mail:
Business name:Crossfire Sprinkler CONTRACTOR R turr FEES*
wllr#�
Company Permit fee:
Address: 17400 SE 82°d Drive
City/State/ZIP:Clackamas,OR 97015 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)210-5506 Fax:(503)210-5538 (Due upon application.)
CCB lic.:174746 3 i Total permit fees:
Authorized signature: �I//' +' Amount received:
rThis permit application expires if a permit is not obtained
Print name:Timothy A Bishop Date:7/6/15 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
C\Building\Permits\FPS-PermitApp.doc 10/01!09 440.46131(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done: _
1.) ❑ 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: 39
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 Light Hazard
Density .10
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 7475
B.) Type I - Hood Fire Suppression System
1 10 (1 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 2 sets of plans at submittal. Plan review fees are required at submittal.
C:\Documents and Settings\CAD\My Documents\Pemrits\tigard permit.doc 10/01/092