Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
n
' COMMUNITY DEVELOPMENT Permit#: FPS2015 00144
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/22/2015
Parcel: 1S 134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Fire alarm modification for TI. Add(5)devices and relocate(5)devices.
Contractor: COCHRAN INC Owner: PROVIDENCE HEALTH SYSTEM-OREGO
7550 SW TECH CENTER DR#220 ATTN: REAL ESTATE&CONSTRUCTION
TIGARD, OR 97223 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-234-6564 PHONE:
FAX: 503-238-2098
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/22/2015 $145.24
12%State Surcharge-Building 09/22/2015 $17.43
Type of Use: COM Plan Review-Fire Life Safety-COM 09/22/2015 $58.10
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 09/22/2015 $14.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 09/22/2015 $5.00
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: Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $239.77
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $7,000.00
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
iss e, or .rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by t•- Oregon
atility Notification C- er. Th. - rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy .1 the rules
or direct questions to OUi1C •••calli • A3.232.1987 or 1.800.332.2344.
Issued By: / f Permittee Signature:
`rim
Call 503.639.4175 by 7:00 a.m.for the next available i spec ion date
This permit card shall be kept in a conspicuous place on the job site until comple on of the project.
Approved plans are required on the job site at the time of each insp-ction.
Building Permit Application
Fire Protection System RECEIVE!) FOR OFFICE USE ONLY
Received /
City of Tigard Dateray: rj�t/� ( a4) Permit No.. ✓/-j'Jfx 5-G0, 4
PPP
13125 SW Hall Blvd.,Tigard,OR 9 �. O 2015 PlanReviei Q 1/- r I L CJ�� �-��3
Phone: 503.718.2439 Fax: 503.59:'. I D��gy. ` w` tither Permit:
TIGARD Inspection Line: 503.639.4175 II / �y DateReadyBy: q J - / 1uris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF 1 ARI) Notified/Method: ik,, i5 en Supplemental Information
T REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(roweled 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 1-and 2-family dwelling ommercial/industrial Valuation: $
12 Accessory building El Multi-family Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total Total number of floors:
Job site address:/2 4' /Z s Dv/_, ��;J�./W ,eii New dwelling area: square feet
City/State/ZIP: 77 ,l 'j) ,, (�' zz3 /(.,„7",.�/ Garage/carport area: square feet
/� C
Suite/bldg./apt.no.: 00 Project name•ivi1) z — Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
it 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.
l;.eG /✓`iSL/e,12 Valuation: $
DOS a
Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
V1/4j Name: Type of construction: 8,-2-7J,ovl-L
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) I Fax:( ) New:
41 ❑ APPLICANT ❑ CONTACT PERSON NOTICE
2 Business name:(odic y./1/6 All contractors and subcontractors are required to be
t Contact name: A./9-/ licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: - 0 _ _` _ dr p jurisdiction in which work is being performed.If the
"u applicant is exempt from licensing,the following reasons
City/State/ZIP: /6./9y��,�
r/ e9ie 977Z Z3 apply:
Phone:(j 7)3)74-/4/02, / Fax::�( _q) ��yy�
E-mail:Zl�/g/ .G-- )(P(W 7/x-/5`,/1 k, " i '/
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: ', /11( C A,_ A-66
1 C Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%ofpermit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: .791,9 u Total permit fees: -
Authorized signature: Amount received: ---69----
X This permit application expires if a permit is not obtained
Print name: Date: within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\BuitdingWermi ts\FPS-PttmitApp_07I514.doc 440.4613T(I1/02/COM/'EB)
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: I $ d
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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