Permit Building Permit Application EXPIRED 3/� 7//6
Fire Protection System RECEIVED FOR OFFICE USE OLlTydiJN Received / /,3 ,7O/3�7 o
CI of Tigard Il� CahPermit No.: O
13125 SW Hall Blvd.,Tigard,OR 972,237N 1 3 2013 Plan Reviewy:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Other Permit:5i0 fj3O(/�D�
T I G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: loci s: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
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❑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
S 4£' MKk a y d b F4 ,, .rt d t�,,..74„.t@� 71tll.' '4
„Iftgri ter: f, ; '"i fr ! a x' ik ,!•.1,0'.-
" 1 t : 4. 11'' M,, ' 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:
4 "� : `” '� n ' ` Total number of floors:
,,'!'-•.,...:,,,,,k',..,,,,,,,,,,,,,,,,,,..,....g.....4,...,..-..4,r ' 'S , + -, 6M1�,r,,, Q.T.,,.u +api{I a ,..:1+°,f :.,.;1 ,, s� i;'',:
Job site address: zte t /A5i�o "w ,.%ret-v New dwelling area: square feet
City/State/ZIP:Tigard,OR Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:St Anthony's Covered porch area square feet
Cross street/directions to job site:SW Grant Ave Deck area: square feet
Other structure area: square feet
;RJ -D T O 43riCig $ , •
Subdivision:
Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(romded to the nearest dollar)of all
£P i y. equipment,materials,labor,overhead,and the profit for the
P
r rk I', * DSC''>Gt06II'q *.� a x r work indicated on this application.
<. *�!"ii row, ,u, . ,fa-i.!„11 t,w tkrt.h.. .1'0. ,..'.'' ,,,i„n,. _ x ,s= ILE ,I,.S;R.-.
Underground fire supply Valuation: $$22,761.00
Existing building area square feet
New building area: square feet
‹ PROPF "J X O1 R 1 NANT< i Number of stories:
'1
Name:St.Anthony Catholic Church Type of construction: addition
Address:9905 SW McKenzie St Occupancy groups:
City/State/ZIP:Tigard,OR Existing:
Phone:( ) Fax:( ) New:
tp f f. '®,c A;ra.0 4..., . ski ' e e, k 1®; CONTACT ?*RS(0t*( ,.`` `'BICE
Business name:Konell Construction Co All contractors and subcontractors are required to be
Contact name:Khara Hillis licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:36000 SE Industrial Way jurisdiction in which work is being performed.If the
City/State/ZIP:Sandy,OR 97055 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)668-3516 Fax: :(503)668-3518
E-mail:khara@konell.net
, P' d ' r ° ' 'rt 1 st a
EMFZSi � gai6N* p # h ''.:''''''''''''''';'14'C: ,,,¢ :*BUILD]Ngir- tMt x�, ,, ' N _: (Ptease�hJecfeesc/ lte
t
Business name:Konell Construction Co ,r
Permit fee:
Address:36000 SE Industrial Way
City/State/ZIP:Sandy,OR 97055 State surcharge(12%0of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)668-3516 Fax:(503)668-3518 (Due upon application.)
I
CCB lic.:48586 Total permit fees:
Amount received:
Authorized signature: I a k
111) This permit application expires if a permit is not obtained
Print name:Khara Hillis I Date:6/13/13 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
i\Building\Permits\FPS-PermitApp.doc Rev 01/05/2012 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
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: _
Additional description of work:
sf �i m� it ,saia�as .i p u ' ays 1f9 ® . y �$sy�, r I s}
,. _ � ,�,.In ,.P.:, �t ..s�a ,.�4lro,M.�,a.w ��u�..,�,,,.l,m,«,wudf,lum.�. � wrw lea•+UvJ�x�+�d,u�f.,�,.+k�"�rdra�'.��t�h� .�.��r6�1 ,{e2.,�,.,x�ti�r�z�u�l,at..� ail�.�...�`
; Ip, a �T Ixt nJ s �i �I . nst r "ip �� ishsfu it w iP4 rtilr�i il �Y nN
4 , rs4613t
ast,0at s a,af l laac 5 3 p`' W� Y r.��'"•_ ', �E
"..�..�a h� 7'' "'' 'Pak 3w ' :: � r
❑ Wet ❑ D
Additional Stand.i.es
Information: Hazard Grou.
Densi
Desi. Area
K. Factor
$
Hood Project Valuation: $
r.. ,5 ' G 1.� �'�irt i
'§ ' '
1rAi. mv.t�^. 34
`
Submittal shall Batte Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Pro Sect Valuation: $
.4,
4
wilrM 11e 'i!t•i}!y.`a�aI"^,9: �s=_ p4.,7 i740Ery44p, ° , .a o 446
S•uare Footate: Permit Fee: '' 'r
0 to 2,000 $198.75 .. . Pg. . .n ay
2,001 to 3,600 $246.45 "r " t"
3,601 to 7,200 $310.05
]c }P s ri
7,201 and treater $404.39 i k.. ; ;11 kkife ,n: Ip's '-
� � tfl•P
Sprinkler Project Square Footage: sq. ft.
�P, Flll' lOtttQnrmrt Fees a
Pro'ect valuation subtotal see A,B & C above : $
Permit fee based on ero'ect valuation see fee schedule : $
Permit fee based on s.uare footate see D above : $
State Surchar•e 12% of .ermit fee : $
FLS Plan Review 40% of.ermit fee : $
TOTAL: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
C:A Users\khara\Downloads\FPS-PermitApp.doc Rev 01/05/2012 2