Permit (48) 114CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2017-00060
T f C A D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2017
Parcel: 1 S 135CA02600
Jurisdiction: Tigard
Site address: 11130 SW GREENBURG RD
Project: Good Neighbor Center Subdivision: None Lot: None
Project Description: Addition of(12)sprinkler heads in new addition.
Contractor: WESTERN STATES FIRE PROTECTION Owner: EAST WASHINGTON COUNTY SHELTER
13896 FIR ST STE B PARTNERSHIP COUNCIL
OREGON CITY, OR 97045 DBA GOOD NEIGHBOR CENTER
11130 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503-657-5155 PHONE:
FAX: 503-657-5182
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/23/2017 $102.20
12%State Surcharge-Building 05/23/2017 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 05/23/2017 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 05/23/2017 $2.00
Occupancy Grp: R-2 Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 05/23/2017 $2.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .10 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 $159.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,000.00
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/ 80 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted if the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-!I1-009.. You ' ay obtain a Xy of the rules
or direct questions to OUNC by calling 5 2.1987 or 1.800.332.2344.
Issued By: ‘ /
&. filardiAr -ti
Permittee Signature: r
11111/ IF
C. 03.639.4175 by 7:00 a.m.for the next available insp• ion date.
This permit card shall be kept in a conspicuous place on the job site unti completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System IVJED FOR OFFICE USE ONLY
City of Tigard ReceivedDate/By: 5 /6 /7 Permit No.: Y/3 o?p/7 ev,96O
. r 13125 SW Hall Blvd.,Tigard,OR 97223 7/`-; 5 2017 Plan Review OP-
Phone:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: /I
y � , r ,�1u P30/7"60a/�
Inspection Line: 503.639.4175 s`g'`t y� yyg Date Ready:y: Juris: H See Page 2 for
TIGARD Y A t�X� Notified/Method: �`;) /� i/
RD
Internet: www.tigard-or.gov } � /j Supplemental Information
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❑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
1111111111111111111104,11$10040, "Nip qmoll work indicated on this application.
El1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
11111117011110,11:02:31#11111000011;i011101 Total number of floors:
Job site address:11130 SW Greenburg Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Good Neighbor Center 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
equipment,materials,labor,overhead,and the profit for the
_.a. . �_.. .0 A
•10 �i iii * 1 �i�l I� 11 /
� I � ��=�� � I� i' p work indicated on this application.
Trimithr firWireinent Valuation: $ 00
_-e0 Existing building area: 7300 square feet
New building area: 400 square feet
p ®a,P OPERT' T 11 g T I1;14' ,4,141010060 Number of stories: 1
Name:Mountainwood Homes Type of construction: V
Address:8324 SW Nimbus Ave
Occupancy groups:
City/State/ZIP:Beaverton,OR 97008 Existing: Light
Phone:(503)746-7964 Fax:(503)746-7964 New: Light
Business name:Western States Fire Protection All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:Michael Stadelman under ORS 701 and may be required to be licensed in the
Address: 17500 SW 65th Ave jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:Lake Oswego,OR 97035 apply:
Phone:(503)505-8966 Fax: :( )
E-mail:mike.stadelman@wsfp.us
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Business name:Western States Fire Protection Permit fee:
Address: 17500 SW 65th Ave State surcharge(12%of permit fee):
City/State/ZIP:Lake Oswego,OR 97035 FLS plan review(40%of permit fee):
Phone:(503)5058966 Fax:( ) (Due upon application submittal.)
CCB lic.:104570 { 6,10,1Total permit fees:
s� / Amount received:
Authorized signature: itfThis permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Michael Stadelman Date:05-12-17 * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Informationri ���,,
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1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 12 Number of alarm devices:
® Addition or
El 110 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+f devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
e ,w4
A.) Co ! prin1dei
r1 ,R ,,RP , rF i� i��i
Sprinkler Type ® Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ® No
Hazard Group Light
Density 0.1
Design Area Room
K. Factor 5.6
Sprinkler Project Valuation: $
B.)^�1 ly ii. JEt t E __
Hood Project Valuation,;::,-,:,,,,$$
$
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6
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Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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Square Footage: Permit Fee: F`� r,�'!
0 to 2,000 $198.75 1y
2,001 to 3,600 $246.45 �� �,i h� ii l � a '�-� �����
3,601 to 7,200 $310.05 '��uo'`d�'
7,201 and greater $404.39
vnrtiiri ii t�U� ��I
Sprinkler Project Square Footage: sq. ft.
Project valuation subtotal (see A,B&C above): $
Permit fee ie project aluati (see fee hedule): $
Permitasefee based on square footage (see D above): $
State Surcharge (12% of permit
scfee): $
FLS Plan Review(40% of permit fee): $
TOTAL: $
C:\Users\michael.stadelman\Documents\Projects\Good Neighbor TI LG1191\Good PSighbor_PermitApp.doc