Permit (147) CITY OF TIGARD111
FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00186
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/30/2016
T'GAR;Alt.L} g Parcel: 1 S 135BC00700
Jurisdiction: Tigard
Site address: 10831 SW CASCADE AVE
Project: Rose City Futsal Subdivision: None Lot: None
Project Description: New fire alarm and detection system for tenant remodel.
Contractor: GB MANCHESTER INC Owner: CASCADE FUTSAL LLC
6000 NE 88TH ST 5010 NE OREGON ST
VANCOUVER,WA 98665 PORTLAND, OR 97213
PHONE: 360-816-0484 PHONE:
FAX: 360-816-0482
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/30/2016 $145.24
12%State Surcharge-Building 11/30/2016 $17.43
Type of Use: COM Plan Review-Fire Life Safety-COM 11/30/2016 $58.10
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 11/30/2016 $10.00
Occupancy Grp: A-3 Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 11/30/2016 $6.00
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: No Smoke Detectors Req: No
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $236.77
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $6,129.00
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 rif work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
y 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 .ling 503.232.1987 or 1.800.332.2344.
Issued By: /, Permittee Si,nature:.10 / PO
Call 503.639.4175 by 7:00 a.m.for the next available i ;•ection 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
FirEProtection System FOR OFFICE USE ONLY
Received //_ r Permit No. Q n /
City of Tigard Date/By: /�/3//7'' M . / S O� Q1))/f )
13125 SW Hall Blvd.,Tigard,OR101li) Plan Review yy� � 11 .��yy� r
Phone: 503.718.2439 Fax: 503 5 cj Date By: t% ..A1�✓ \1 LF,`1��1 .. Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for
T l G A R.1-)
p Notified Method: Supplemental Information
Internet: www.tigard-or.gov t�� as 7 E�� , : "/r*brae_ t4 te
TYPE OF WOR �!c laG NW)
, V REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction `�o`# 11A-..V �05` Permit fees*are based on the value of the work performed.
\yVr r Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement .I. equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling ®Commercial/industrial Valuation: $
Number of bedrooms:
ElAccessory building 0 Multi-family
ElMaster builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:10831 SW Cascade Ave New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Rose City Futsal Covered porch area: square feet
Cross street/directions to job site:SW Greenburg Rd. Deck area: . square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 1 Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Provide new Fire Alarm and Detection system for Tenant Remodel Valuation: $$6,129.00
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: ,Q licensed with the Oregon Construction Contractors Board
/l� 4,Ai AIL under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Y
Phone:( ) Fax: :( )
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:GB Manchester,Inc
Permit fee:
Address:6000 NE 88th St.Suite 13103
State surcharge(12%of permit fee):
City/State/ZIP:Vancouver,WA 98665
FLS plan review(40%of permit fee):
Phone:(360)816-0484 Fax:(360)816-0482 (Due upon application submittal.)
CCB lic.:202097 .---77 Total permit fees:
Amount received:
Authorized signator
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Nat an Butz Date: 11/03/2016
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.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
❑ 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
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 6,129.00
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: $
G:\Jobs\Active Jobs\_Work Orders\Rose City Futsal Tigard WO 2759\15-Permits\FP92PermitApp.doc