Permit r q CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I COMMUNITY DEVELOPMENT Permit#: FPS2015-00172
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/05/2015
Parcel: 25101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 200
Project: CNA Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Fire alarm modification for TI
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/05/2015 $102.20
12%State Surcharge-Building 11/05/2015 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 11/05/2015 $40.88
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Sm$0.50(up to 11/05/2015 $5.00
Occupancy Grp: B Height: ft 11x17)
Stories:
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 $160.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,800.00
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 952-0 . You may ..tain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: '/4 Permittee Signature: (.—
Call 503.639.4175 by 7:00 a.m.for the next available inspectio da
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
Fire Protection System
:, ,
1 oiz omit r us!:0\i.l
City of Tigard C T 2 9 2015 Received
• 13125 SW Hall Blvd.,Tigard,OR 97223 °� 9`
Phone: 503.718.2439 Fax: 503.598.1960 11((� n Date/B : O Permit $cJ4616--r71•7�
I I t,A I.I Inspection Line: 503.639.4175 � j f 0� 1V��I) �ceB Iy g:Z� /�-e Paofor tom
Other Permit:
Internet: www.ti DIVISION �u Ready : : // s �5 �4(Y 'm'°: 0 See Page 2 for
gand-0r.gov BUILDING
ILD1l,G n5ed/Method: �j"/
�ll /{/ Supplemental Information
Permit fees*are based on the value of the work
performed.
1'/ Addition/alteration/replacement Indicate the value(rounded to the nearest dollar)
❑ of construction ❑Demolition
equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
❑ 1-and 2-family dwelling
i. Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
;. _ Total number of floors:
Job site address:~ �(l i / .. ?-4.-1 -
P —'ki New dwelling area: square feet
City/State/ZIP: • t ,M v 0 Cl a-
Garage/carport area: square feet
Suite/bldg./apt.no.: : / Project name: C N 4 Ni1 Sli Ii-a
-/ Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
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
1 equipment,materials,labor,overhead,and the profit for the
lir ( (( work indicated on this :y.lication.
Il ° )C Val I 1 Ti CC 101(------
Valuation: $ �,
Existing building area: square feet
New building area: square feet
Number of stories:
Address:
Type of construction:
City/State/Z1P: Occupancy groups:
Phone:( ) Existing:
Fax:( )
New:
Business name: O f •
Contact name: / All contractors and subcontractors are required to be
I / I licensed with the Oregon Construction Contractors Board
Address:
MIN�� i mil/ /j under ORS 701 and maybe required to be licensed in the
Y� / jurisdiction in which work is being performed.If the
City/State/ZIP: / /
d(1 / a IL i 70 applicant is exempt from licensing,the following reasons
Phone: () ) /,r, ,p—9 / 0 0 • Fax::( ) ably'
E-mail: ✓Gr a -e i7 1 .vn I MILMIIIIIIII
Business name:
'O1 0 1 v ,v -, ;
Address: -G / 7j V p,. v Permit fee: },3 A11111111111.
City/State/ZIP: is , /` `^'V ` i State surcharge(12%of permit fee):
Phone: 0 ?, - I /0 6 Fax:( )
FLS plan review(40%of permit fee):
/ a e u•on application.
Total permit fees:
Authorized signature' g"� / Amount received:
Print name: • I / This permit application expires if a permit is not obtained
-GI'i Tit'. (-C- 7 Date: 1 G a-- / within 180 days after it has been accepted as complete.
1
* Fee methodology set by Tri-County Building Industry
1:\Build ng\Permits\FPS-permitApp doc Rev 01/05/2012 Service Board.
440-4613T(11/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12909 SW 68TH PKWY 200, TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2015-00172
Jeff Grove
Violation Summary:
Inspector Contractor