Permit (87) CITY OF TIGARD IIII FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT
Permit#: FPS2017-00190
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/12/2017
f"G4 ' 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: Adding(1)sprinkler head and relocating(20)sprinkler heads for suite 200 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 $102.20
12%State Surcharge-Building 12/12/2017 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 12/12/2017 $40.88
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 $4.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: ORD1
Density: 0.1 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 $161.34
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 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 , 1.800. ' 344.
Issued By: '• mittee Signature:
t--� --r irk'."_
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 # ' ,.�
a FOR OFFICE,LSE ONLY
City of Tigard D E u 5 2017 RDate/By: a /7 Permit No.: i.52/, 7- / e)
iv 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review a+ 1` ' v
Phone: 503.718.2439 Fax: 503 598( 9 iti q Date/By:
Other Permit:guidi,‘,.y7-a),24,Y'
I I L A It t) Inspection Line: 503.639.4175 p a y n P `. Date Ready/By: J) funs: See Page 2 for
2.1
Internet: www.tigard-or.gov " (Notifieddoiethod_ /,/4//f/p j Supplemental Information
/
T.~-'-YPE OI . YORK . #,lrl I" D t TA:1-AND 2-FAM1LYDWELLING
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
CATEGORY OF CONSTRUCTION, work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
Accesso buildin Number of bedrooms:
IDry g ❑Multi-family
0 Master builder IDOther: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:16083 SW Upper Boones Ferry Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 L t he f y. A.1),G / Garage/carport area: square feet
Suite/bldg./apt.no.: ,57 n0 Project name:1a,u�u Cluck 2"''flus. Covered porch area: square feet
Cross street/directionst�o job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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
DESCRIPTIO mOF WORK work indicated on this application.
Add/relocate heads in tenant improvement for corridor. Valuation: $$3,000.00
4 ur (Q) r at'dfi' er- lExisting building area: square feet
C/Y/)J New building area: square feet
0 PROPERTY OWNER ❑ 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: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 BUILDINGPERMIT FEES*
Business name:Fire Systems West (Please refer tofee`schedule)
Permit fee:
Address:600 SE Maritime Ave
City/State/ZIP:Vancouver,WA 98661 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(360)693-9906 Fax:( ) (Due upon application submittal.)
CCB lic.:49732 Total permit fees:
9,,, ,,'' . _--, Amount received:
Authorized signature: ,
&------- This permit application expires if a permit is not obtained
Print name:Jackson Zeiner Date: 12/05/17 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I.\BuildingWermits\FPS-PeimitApp_031016.doc 440-4613T(11/02/COM/WEB)
t
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to bedone::
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 21 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 .1
Design Area
K. Factor 5.6
Sprinkler Project Valuation: $ 3000
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: $
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: $
C:\Users\JacksonZ\Downloads\FPS_PermitApp(6).doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16083 SW UPPER BOONES FERRY RD 200,
TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00190
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor