Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
R • COMMUNITY DEVELOPMENT Permit#: FPS2015-00143
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2015
Parcel: 1 S135BC00900
Jurisdiction: Tigard
Site address: 10855 SW CASCADE AVE
Project: Paulson's Flooring Subdivision: OAKBURG Lot: 27
Project Description: Adding(2)sprinkler heads under roll up doors.
Contractor: VIKING AUTOMATIC SPRINKLER CO Owner: PAULSON LIMITED LIABILITY CO
3245 NW FRONT AVE BY RICHARD G PAULSON SR
PORTLAND, OR 97210 10855 SW CASCADE BLVD
TIGARD, OR 97223
PHONE: 503-227-1171 PHONE:
FAX: 503-227-1552
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/09/2015 $77.99
12%State Surcharge-Building 09/09/2015 $9.36
Type of Use: COM Plan Review-Fire Life Safety-COM 09/09/2015 $31.20
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 09/09/2015 $3.50
Occupancy Grp: M Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: ORD1
Density: .15 Design Area: 0
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 $122.05
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,500.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir uestions • •UNC by calling 503.232.1987 or 1.800.332.2344.
I ued By: Permittee Signature: 411111N ;
1/0'"( e c4
Call 503.639.4175 by 7:00 a.m.for the next available inspect'•n date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
F. •• Protection System `Ali 11 l k 11 I I I t I I "I o\I ,
1
City of Tigard S$_ Received. �f :1� Permit No.: gtr r t
11
. • 13125 SW Hall Blvd.,Tigard,OR 97223 - i5 . `, 1
Phone: 503.718.2439 Fax: 503.598.1960 :,' Le i'..... r s Other "t•
1 i It l� Inspection Line: 501639.4175 ;�CLQ 0. -. _ ,;�. Fl See Page 2 for
Internet: www.tigard-or.gov ( �, sr; t•. ethod:- , /Stj , SoppIemeabttaformatioa
� � eft VM () D 4V
TYPE Or WORK l�S REQUIRED DATA:1-AND 2 FAMLY : IC -
❑New construction ❑Demoliti Permit fees*are based on the value of the work performed.
Addition/alteration/replacement ❑Other: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
CATEGORY OF commence/ work indicated on this application.
❑ 1-and 2-family dwelling Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB gam; INFORMATION AND LOCATION Total number of floors:
Job site address: IolBss , C,,,s,,ti ,e, {}vim" New dwelling area: square feet
City/State/ZIP:—Ti 404 4> Dm ‘17LZ3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: TMV l5or.7S Face.(tam Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAIAM CRECa .II T
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.
�jj Valuation: S 15-oo
Pty EtlEMtc Lx_lo rz Vot` ‘. 1:7 L ZS
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ! IN TENANT Number of stories:
Name: olh)lSot~WS F-1aa't7.- R t t C Type of construction:
Address: bgss . --,,, el0c5C1kPC uku Occupancy groups:
City/State/ZIPrt4,04r DR 4Z2-Z-S Existing:
Phone:( ) Fax:( ) New:
APPLICANT A CONTACT PERSON NOTICE
Business name: 41 t • ..,_ 10. (L Lee_ All contractors and subcontractors are required to be
Contact name:�� `�"� ��� licensed with the Oregon Construction Contractors Board
� y under ORS 701 and may be required to be licensed in the
Address: 3Z 4S t,,..., Frz , jurisdiction in which work is being performed.If the
City/State/ZIP R �dbX7 Oft an 2 C applicant is exempt from licensing,the following reasons
`` apply:
Phone:(col) -2,--Li - 1 111 Fax::(SO 221- 1STZ
E-maiLDM►VE.1-- rfrEt►^.r+.-t1.�1jltc.vc-iSrat►Jft tee. . Wes.
CONTRACTOR BUILDING PERMIT"flE'
Mare ndi►MJle. d Business name. t .t.-.y ST e. 1"4 t<fZ
Address: Permit fee:
3- 45- ,. F'¢ t 1.�
City/State/Z1P: State surcharge(12%of permit fee):
�p C� 1 vkeJ t� OR Q1• L� FLS plan review(40%of permit fee):
Phone:(5 ) ZZ 7 -1 r•t I Fax:( ) (Due upon application submittal)
CCB lic.: C,q Q--3-) Total permit fees:
VV^ -"�. Amount received: /2.
Authorized signature
--�`(((.�t- -S'_, This permit application expires if a permit is not obtained
Print name: Date: within 180 days after it has been accepted as complete.
�'� ����` � (e)(ts- ' Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PamitApp071514.doe 440-46131(11/02/COM/WEB)
. t tY of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe wads to be done:
L) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 5 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,Bt C or D as applicable):
A.) Commercial Sprinkler
5g Wet ❑ Dry
Additional Standpipes
Information: Hazard Group JZ 4-1
Density L(6j
Design Area
K. Factor S.
Sprinkler Project Valuation: $ �tdoM
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: I $
C.) Fire Mann
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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