Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
Pi a - COMMUNITY DEVELOPMENT
Permit#: FPS2017-00142
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/04/2017
T i�'; I? g Parcel: 2S 113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Project: Clean Water Services Subdivision: None Lot: None
Project Description: Fire sprinkler supply line for interior remodel and 520 sf addition.
Contractor: TS GRAY CONSTRUCTION Owner: CLEAN WATER SERVICES
12705 SW HERMAN RD 2550 SW HILLSBORO HWY
TUALATIN, OR 97062 HILLSBORO, OR 97123
PHONE: 503-692-4675 PHONE:
FAX: 503-692-9292
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/29/2017 $209.80
12%State Surcharge-Building 09/29/2017 $25.18
Type of Use: COM Plan Review-Fire Life Safety-COM 09/29/2017 $83.92
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 09/29/2017 $2.00
Occupancy Grp: F-1 Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 09/29/2017 $10.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: NO 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 $330.90
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $13,000.00
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 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 503.23 •87 or 1.800.332.2344.
Issued By: Permittee Signature: -P,0'0
Call 503.639.4175 by 7:00 a.m.for the next available inspecti• date.
This permit card shall be kept in a conspicuous place on the job site until c mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application � " c�°�i
Fire Protection System ( FOR OFFICE USL O Ll'
City of Tigard „CiI """' Received /
Date/By �, � Permit No.
11111 13125 SW Hall Blvd.,Tigard,OR 97223 7 /g
■ Phone: 503.718.2439 Fax: 503.598.1960 " P '2017 Plan Revi: 1 A�� I&fl f 7__eye,
,_
i 2 � Date/By: Other Perr
T I G A R D Inspection Line: 503.639.4175 Date Ready/ kris'
Internet: www.tigard-or.gov ..t, i l c,R : l See Page Supplemental2 Informationfnr
Lit
�i } 1I,+ Notrfied/Method: a�/
TYPE OF ' 10.th REQUIRED DATA:1-AND 2-FAMILY DWELLING
,KIVew 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
CATEGORY OF CONSTRUCTION 1 work indicated on this application.
❑ 1-and 2-family dwelling NCommercial/industrial Valuation: $
D Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
ii.
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 16 b c,o S uo &sin A,via New dwelling area: square feet
City/State/ZIP: -rt,p, , `� G Gara
Ute" -`7'L�iy ge/carport area: square feet
Suite/bldg./apt.no.: 1 Project name: L✓/17r'-p Covered porch area: square feet
Cross street/directions to job site: S&-T•il/ Deck area:
��j square feet
lyilevt,L, 0 Ltet-bitiA Other structure area: square feet
R'EQUIIL D DATA;CQMMERCIAI USE CDECH.ISTT
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
, ;, DESCRIPTION OF.WORK _ '- s ' work indicated on this application.
i�1���i -� ,� of ��1� �xt�;t.1,� ,+
NAV`'' t S P� „,,Fi 'u&Q• S��9 LN Ls+�^►1 s Valuation: s 3 Ck.
Existing building area: square feet
New building area: square feet
PROPERTY OWNER
„�4. ,, 11. 0 ,� 1:1T»itANI' .-k. 4•,.„. of stories:
Name: t/L6l t4 ..reit S E? ,GC6S Type of construction:
Address:
V b 6,0, O p
v..) its-r" et1/4)9 Occupancy groups:
City/State/ZIP: 1('40,1242,4 C7p, cr4'-1,1,
Existing:
Phone:( ) Fax ( )
rP t + Ir'API " tt te, New:
0 CONTACT PER Olt 4 a `
t�'w _, z NOTIC1v
Business name: .� �Y•Yrt "� . a ":�� � ���y�
T (.c F4ET(Z-u(T''_vli All contractors and subcontractors are required to be
Contact name: As.' iNtrocki(4LID .5 a r7_3 ea/f licensed with the Oregon Construction Contractors Board
/ ! under ORS 701 and may be required to be licensed in the
Address: �`/ �Q6 ( jurisdiction in which work is being performed.If the
City/State/ZIP: �J 5�j G�� 17/'i applicant is exempt from licensing,the following reasons
apply:
Phone:( ) 621; i ..,7� Fax::( )
E-mail: Tv ,i
• z . C1), CT x; It .1t4 BUILDING PERMIT FEES* •
Business name: �s c4,�,� / OL `t-ra,AAG-f'sci (P/egsereJer ojeesch se/faille) ,.
Address: �a + V i`1J 1 N Rl Permit fee:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: 1151,5 Total permit fees:
Authorized signature: ilitAmount received:
This permit application expires if a permit is not obtained
Print name: 67' 'f'f/ r.4re L Date: R/�fr./ within 180 days after it has been accepted as complete.
i-�'1-TY�C"a l * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
_____...........mimmmmmi•••I•im•.m.i••i•i••i•.••.•iim_ 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 0 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 1 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
AdT4clietioonfae
sl ydsstc:iiiptiocnofofitiwiiloertk:
eA,B, of
I)
a applicable):
fri
A) tominf'eral SpI10:der,
Sprinkler Type 0 Wet [1:1 Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes El No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Fire Suppression
„7
13.) Type I
Hood Project Valuation:
17- •z.
C.) Fire Maim , . p Yes
Submittal shall Battery Calculations
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
z ,
;;‘' ;:1:";"1,
1.% Sprinkiei-(S4nd Alone Stem)ys 7,7
Residen a77
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 Froteciii*PemitFeS
Project valuation subtotal (see A,B &C above): $
Permit fee based on project valuation (seefee schedule): $
PermitD
fee based on square footage (see above): $
State Surcharge (12%of permit fee): $
FLS Plan Review(40% of permitfee):
TOTAL: $
I:\Building\Permits\FPS_PermitApP_031016.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16060 SW 85TH AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00142
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
c a . COMMUNITY DEVELOPMENT Permit#: FPS2017 00142
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/04/2017
Tf te;�Offa g Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Project: Clean Water Services Subdivision: None Lot: None
Project Description: Fire sprinkler supply line for interior remodel and 520 sf addition.
Contractor: TS GRAY CONSTRUCTION Owner: CLEAN WATER SERVICES
12705 SW HERMAN RD 2550 SW HILLSBORO HWY
TUALATIN, OR 97062 HILLSBORO, OR 97123
PHONE: 503-692-4675 PHONE:
FAX: 503-692-9292
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/29/2017 $209.80
12%State Surcharge-Building 09/29/2017 $25.18
Type of Use: COM Plan Review-Fire Life Safety-COM 09/29/2017 $83.92
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 09/29/2017 $2.00
Occupancy Grp: F-1 Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 09/29/2017 $10.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No 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 $330.90
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $13,000.00
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 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 503.23 •87 or 1.800.332.2344. /
Issued By: Permittee Signature: / 416��>4����„
Call 503.639.4175 by 7:00 a.m.for the next available inspecti• date.
This permit card shall be kept in a conspicuous place on the job site until c mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
00-nom- E rT-t-- /P151 2,
Building Permit Application
Fire Protection System FOR OFFI(t: USE ONE)
City of Tigard " Received 7j / ' /7jq ,
Date/By: / , .' Permit No..
13125 SW Hall Blvd.,Tigard,OR 97223 ;� Plan Revi: �-/- J
I Phone: 503.718.2439 Fax: 503.598.1960 E P 2 0 3(J 17 Date/By: 1t I�,q Other Pen °,f f 7.--,5,709,
T I G A R D Inspection Line: 503.639.4175 l o ti"t Date Ready/.' -�r Jur s: ® See Page 2 for
Internet: www.tigard-or.gov (1IL I I�gg3x ti Notified/Method: / J7CiTY Supplemental Information
TYPE OF .. k j REQUIRED DATA:1-AND 2-FAMILY DWELLING :.<:
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 0 Other: 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: $
❑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: 1606 Co S W gSKM A%le New dwelling area: square feet
City/State/ZIP: Tr,„p(+Q,v) et C j tj Garage/carport area: square feet
Suite/bldg./apt.no.: 1 Project name: C L LAI 4-7----72-- Covered porch area: square feet
Cross street/directions to job site: �ET-'t/j Cg'S Deck area: square feet
l+ 4' b U.fZH AVA Other structure area: square feet
UIIR.ED DATA:COMMERCIAL4JSE 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 47-, DESCRIP'T'ION WORK : work indicated on this application.
14cAN pc.11-6 SP14y4-ikt612- S‘APPLY G b Valuation: $�3 . .,, —
Existing building area: square feet
New building area: square feet
n 111,PROPERTY OWNER * * r'
1:1' T6Tt1NT 4, �"4,-t, Number of stories:
Name: c4,6pti,,,4 L1/4411c-reit. S ,GGES Type of construction:
Address: /� Y
000 f�0 �� � f��v Occupancy groups:
City/State/ZIP: " (y �z'Vam nr pR cr4,,L1,f Existing:
Phone:( ) Fax ( )
New:
APPLICANT}" ,- E ❑ NTA r P •N ''"r , , ;,:•
' NOTICE- 4 ��.'
Business name: 'w "� • -
�s t��t'c cizA4E-r-p.lt c.--mo� All contractors and subcontractors are required to be
Contact name: ,rA�*-r- licensed with the Oregon Construction Contractors Board
V y�Vi�O �� ��/!` under ORS 701 and may be required to be licensed in the
Address: fi G) '10( /(t.A.) jurisdiction in which work is being g performed.If the
City/State/ZIP: Ws �Q ���� applicant is exempt from licensing,the following reasons
:Jz 1l'/� apply:
Phone:(c 3 ) 621; 44-4(0.)
4 qi$- Fax::( ) '�j
E-mail. �/_tJJ�iM) 6( .±J ` f Y - G
jL r C td�"�., .
co '
BUILDINGPERMIT FEES
Business name: "rs c.„,,,,,,,....1 ,.O(..,5•,2„t L.-n.0%4
,= (Pleaseref rwfresc Jule .‘,.,<
Permit fee:
Address:
City/State/ZIP:
State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: tellen.5 C1 Total permit fees:
Authorized signature: liSilL(// Amount received:
This permit application expires if a permit is not obtained
Print name: j� 'x ,. u0 Date: eV/Cy within 180 days after it has been accepted as complete.
J 1 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PennitApp_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(Ct mp to B,C'or applicable): ,
A.)> Commercial�4 r
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-14 oo t Firs Suppe sio
Hood Project Valuation: $
Fie Alarm Ito
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
4
Fire Alarm Project Valuation: $
,
I)) 11.--de irtialpi•nkler(Stad Ale stem) r
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!Permiif ees
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: $
I:\Building\Permits\FPS_PermitApp_031016.doc 2