Permit xTr ' CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I I _- COMMUNITY DEVELOPMENT Permit#: FPS2015 00194
a Date Issued: 12/17/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
•;i ,�,,; Parcel: 2S102AC00500
Jurisdiction: Tigard
Site address: 12492 SW MAIN ST
Project: Baileys on Main Subdivision: BURNHAM TRACT Lot: 1
Project Description: Install new UL-300 fire suppression system in Type I hood.
Contractor: ABC FIRE EXTINGUISHER INC Owner: WOODARD LIVING TRUST
3201 SE 50TH AVE PO BOX 23303
PORTLAND, OR 97206 TIGARD, OR 97281
PHONE 503-772-1643 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/17/2015 $64.54
12%State Surcharge-Building 12/17/2015 $7.74
Type of Use: COM Plan Review-Fire Life Safety-COM 12/17/2015 $25.82
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 12/17/2015 $11.50
Occupancy Grp: A-2 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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $109.60
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,000.00
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 Notific. .- ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of t e rules
or direct•.estions to O C by calling 503.232.1987 or 1.800.332.2344.
i ";
Issue. By: / /� �� / Permittee Signature: r
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 project.
Approved plans are required on the job site at the time of each inspection.
? .-
Building Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY j- '' Q
Received, -.� S q^ S /
City Of Tigard Date/By: 0 Permit No.: ge.
.. 13125 SW Hall Blvd.,Tigard,OR 97223 - ,r,
Phone: 503.718.2439 Fax: 503.59@ED 8 2015 Plan Date/By:Review-- ‘a'' fi ) , Other Permit:. �1 onw f�J"f�05�L'j 1
TIGARD Inspection Line: 503.639.4175 Date Rea,i. Juris El See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
New construction 0 Demolition Permit fees* are based on the value of the work performed.
Indicate the value(romded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
. CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling 2dommercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: a. Su) ,, l N `A New dwelling area: square feet
City/State/ZIP: ct,,v4 0 C ¶722 (./t Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: p. t r S "'���"'���41, Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rowded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
s ,V (fie ) Ck l-a (� W-tde41-t, I t1 L coo
�GG�` tom, cI Existing building area 1.'00 square feet r
1 TK�CC'�� New building area: e square feet
0 PROPERTY OWNER 4TENANT Number of stories: t
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
41 APPLICANT 0 CONTACT PERSON NOTICE
Business name:,fiv f L All contractors and subcontractors are required to be
Contact name: ��� 563—
D �89 �� licensed with the Oregon Construction Contractors Board
V under ORS 701 and may be required to be lensed in the
Address: a s6 56' n jurisdiction in which work is being performed.If the
City/State/Zll� t,.\,\i6\2 �i..� c()4 applicant isexempt from licensing,the following reasons
apply:
Phone:(a,)3) "i p��C�� _/6 ft �Q�(( Fax: :( )
E-mail: �C.)�0.lit/ T /1'.15\/ k .e)< L C6
CONTRACTOR BUILDING PERMIT FEES*
/� (Please refer to fee schedule
�Business name: 4 - € 45 Pt(56 J 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 lie.:/3 3;-I /�/ (`l 1/t/,7 Total permit fees:
/Authorized signature: 0.e./
Amount received:
��' (4( This permit application expires if a permit is not obtained
Print name:.. ^ Date: within 180 days after it has been accepted as complete.
���...II! * Fee methodology set by Tri-County Building Industry
Service Board.
!1 \F
I\Building\PermitsPS-PermitApp_071514.doc 440-4613T(11/02/COM/WEB)
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
El 11+ heads: Plan review required and El 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: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $ I
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El 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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