Permit (58) 111 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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COMMUNITY DEVELOPMENT Permit#: FPS2016-00120
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/02/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9364 SW WASHINGTON SQUARE RD R01
Project: Blue Nile Subdivision: None Lot: None
Project Description: Adding and relocating(12)sprinkler heads for TI.
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR WASHINGTON SQUARE LLC
9095 SW BURNHAM PO BOX 847
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/02/2016 $102.20
12%State Surcharge-Building 08/02/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 08/02/2016 $40.88
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Sm$0.50(up to 08/02/2016 $5.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: No Sprinkler Type: Wet
Standpipe Required: No Hazard: ORD1
Density: .15 Design Area: 1500
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 $160.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,872.00
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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
0&5 <..2.7--e--'
Call 503.639.4175 by 7:00 a.m.for the next available inspecti.• .ate.
This permit card shall be kept in a conspicuous place on the job site until ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System k FOR OFFICE USE OMM,V
a
City of Tigard ,F --1 k.Ra Received
Date/By Permit No.: ____ �1 6�2ckJ
13125 SW Hall Blvd,Tigard,OR 97223 Plan Review L(�
IN
c Date/By h I her Permit: !>'
Phone: 503.718.2439 Fax: 503.598.1960 ��L `3 ?Olb \ y 6a1/° 1 i7r�
TI G A R D Inspection Line: 503.639.4175 Date Ready/: Jug ® See Page 2 for
Internet: www.tigard-or.gov ) l'',:-...: 4 ;'. Notified/Method:o/o,/t'�J ,Q .L.V Y j-w Supplemental Information
CITY 'l'''11 f Q
TYPE OF ,_ ,,w • LATA:1-AND 2 FAIVOL`f WELLING' i
0 New construction 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
1. 4 Y OiSTB "+ION 4,1 pp
work indicated on this application.
�.�
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
' #5 Y dO Srn j"1 . I II'LOCATION £ � ?,"i Total number of floors:
Job site address:9364 SW Washington Square Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:R01 Project name:Blue Nile Wash Sq Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIA 44}SE CHECKLIST`,
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
equipment,materials,labor,overhead,and the profit for the
?, .4 .r s ... �� . .i
DESCRIPTIO 1� OIx' VF,'O' —'� � work indicated on this application.
Add and relocate fire sprinkler heads as required for TI Valuation: $$2,872.00
Existing building area: square feet
New building area: 0 square feet
F ' ❑ PROPER OWNER. )"`.c 0 TEN MM t' - Number of stories: 1
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: Ordinary 1
Phone:( ) Fax:( ) New: If
` .►ts�4CANT ; egi it "CONTACT ERS N x NOTICE t
�. Y
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Max Colley licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham Rd jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)684-2928 Fax::( )
E-mail:mcolley@wyattfire.com
CONTRACTORr.- " ' BUILDING PERMIT FEES* ,
Business name:Wyatt Fire Protection
(Please refer to fee schedule)- `?N _)
Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.)
CCB lic.:64077 Total permit fees:
Authorized signature: ��
Amount received:
��2 This permit application expires if a permit is not obtained
Print name:Max Colley Date:7/13/16 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
Describe woik to be done: '>; x. . e
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: 12
Additional description of work:
Type of S'ygen'(CompleteA,B,C a applieable)a 1 :n
A.) Comore tial Spri tiler t, 44 ` 4 „4�
® Wet ❑ Dry
Additional Standpipes 0
Information: Hazard Group Ordinary 1
Density 0.15
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 2872
B.) Tyje oodFire Suppression'System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
D) Residential Sprinkler(Stand lone 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 *"r
Sprinkler Project Square Footage: sq. ft.
.,t Fire Protection PermitFee ° .. `
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: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
W:\Max\1112 PERMIT APPLICATIONS\Tigard App.doc Rev 01/05/2012 2