Permit (83) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
.1111 1.: COMMUNITY DEVELOPMENT Permit#: FPS2017-00188
Date Issued: 12/12/2017
T(GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 200
Project: Liberty Mutual Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Fire sprinkler permit:Adding(27)sprinkler heads for TI.
Contractor: FIRE SYSTEMS WEST INC Owner: G&S FC LLC
600 SE MARITIME AVE#300 16083 SW UPPER BOONES FERRY RD,
VANCOUVER,WA 98661 STE
TIGARD, OR 97224
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/12/2017 $242.08
12%State Surcharge-Building 12/12/2017 $29.05
Type of Use: COM Plan Review-Fire Life Safety-COM 12/12/2017 $96.83
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 12/12/2017 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 12/12/2017 $3.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No 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 $372.96
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $16,000.00
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 calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: fr
Call 503.639.4175 by 7:00 a.m.for the next available inspection 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
Fire Protection System FOR OFFICE USE ONLY
Cityof Tigard I •eceived _ X19
g HEC t 1 ate/By: 11 ,)--) /7 /. Permit No.: r �iX(JI i lJ'1"1"
14 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: eite;20 7-00,2413
G A It I) Inspection Line: 503.639.4175 NOV2 7 2017 Date Ready/By: Iuiis: See Page 2 for
Internet: www.tigard-or.gov I`t Notified/Method: ` /f„ 2 I '"� Supplemental Information
ARD
TYPE OF WORK."'"t.DINGi 1 � Are \, UIRED D " : "1-AND 2 F Y 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 CONSTRUCTION 2 work indicated on this application.
Valuation:
0 1-and 2-family dwelling ®Commercial/industrial
$
ElAccessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION ANIX.LOCATION a,", Total number of floors:
Job site address:16083 SW Upper Boones Ferry Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR Garage/carport area: square feet
•
Suite/bldg./apt.no.:200 Project name: / ✓(�tev ,Ccz� Covered porch area: square feet
Cross street/directions to job site: 'v Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST.
Subdivision: I 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
Ii `! ON;Cl WORK `. work indicated on this application.
add/relocate heads for new walls and ceilings in tenant improvement. Valuation: $16000
Existing building area: square feet
New building area: square feet
❑
PROPERTY OWNER', 4 0 TENANT Number of stories:
Name:BE-NW Type of construction:
Address:135 East Hereford St Occupancy groups:
City/State/ZIP:Gladstone,OR 97027 Existing:
Phone:(503)650-4086 Fax:( ) New:
APPLICANT 0 CONTACT PERSON
,.` ;� ' NOTICE
Business name:Fire Systems West All contractors and subcontractors are required to be
Contact name:Jackson Zeiner licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:600 SE MAritime Ave jurisdiction in which work is being performed.If the
City/State/ZIP:Vancouver,WA 98661 applicant is exempt from licensing,the following reasons
apply:
Phone:(360)693-9906 Fax: :(
E-mail:jacksonz@firesystemswest.com
CONTRACTOR
wx ��" s;�" ��" • BUPERMIT.FFES* �t
Business name:Fire Systems West (Neale refer to sctesdufej
Permit fee:
Address:600 SE MAritime Ave
State surcharge(12%of permit fee):
City/State/ZIP:Vancouver,WA 98661
FLS plan review(40%of permit fee):
Phone:(360)693-9906 Fax:( ) (Due upon application submittal.)
CCB lic.:49732 Total permit fees:
Authorized signature:
Amount received:
This permit application expires if a permit is not obtained
Print name:Jackson Zeiner Date:11/21/17 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
CVBuildingVPermits\FPS-PemitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to he 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: 27 Number of alarm devices:
►1 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, -or D as applicable):
A.) Commercial$prinldlk
Sprinkler Type ® Wet ❑ Dry
Additional Standpipes e j
Information: Sprinkler Supply Line Q Yes ❑ No
Hazard Group L
Density b� 1 l(,l
Design Area ;tQ
K. Factor � C�(
Sprinkler Project Valuation: $ 16000
B.) Typef. Httod F1 Suppression System l ,
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
� Fire Alarm Project Valuation: $
"�?}
D )iResidential 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 ,,f 4
$310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire.Prot ctipn 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: $
C:\Users\JacksonZ\Downloads\FPS_PermitApp(6).doc 2