Permit (4) 4
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CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00172
T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2012
Parcel: 2S101AB90000
Jurisdiction: TIGARD
Site address: 12011 SW 70TH AVE
Project: CH Physical Therapy Subdivision: 2012 -009 PARTITION PLAT Lot: 1
Project Description: (4) new pendant sprinklers in exam room, break room and bathroom
Contractor: CROWN FIRE SYSTEMS INC Owner: RED ROCK CREEK CONDOMINIUM
7402 SE JOHNSON CREEK BLVD OWNERS OF ALL UNITS
PORTLAND, OR 97206 00000
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PHONE: 503 - 777 -5030 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 11/19/2012 $51,09 .
12% State Surcharge - Building 11/19/2012 $12.26, •
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
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Standpipe Required: 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 $63.35
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0 •
Fire Alarm Valuation: $0.00 •
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• This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spe /'ty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is n started within 180 days of
• issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires yo to follow t • • les adopted by the Oregon
Utility Notification Center. Those rules are set forth' in OAR 952 - 001 -0010 through OAR 952 -00 -0090. Yo •y obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By:
Alai etX Permittee Signature: j/
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Call 503.639.4175 by 7:00 a.m. for the next available insp =ction date.
This permit card shall be kept in a conspicuous place on the job site until completio /'. the project.
Approved plans are required on the Job site at the time of each inspec o !
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Building Permit Application . OFFICE y
Fire Protection System RECBVE p ' FOR OFFICE USE ONLY • 1111 11 City of Tigard NOV 19 2012 D � ! 1 • Permit No )00. - )e ( 7 Y
13125 SW Hall Blvd., Tigard, OR 97223 � Plan Review A NSINNI
Phone: 503.718.2439 Fax: 503.598.1960 (� �� Date/B : / /1 .db
Inspection Line: 503.639.4175 " I _ Date ReadyBy: � Pe 13 See Page 2 for
TI GARD BUILDING Notified/Method: r1 � GDIV I SI�
Internet: www.tigard- or.gov � Supplemental
'TYPE O F WORK 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 ❑ 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: S .
El Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder El Other: Number of bathrooms.
JOB SITE INF TION AND LOCATION Total number of floors:
Job site address: 12011 SW tmouth la New dwelling area: square feet
City/State/ZIP: Tigard, OR Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: CH Physical Therapy Covered porch area: square feet
Cross street/directions to job site: SW 72 °d Ave. 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.
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 work indicated on this application.
Add (4) new pendant sprinklers in new exam rooms, break room and bathroom Valuation: $$800.00
Existing building area: square feet
New building area: square feet
' ❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT . , CONTACT PERSON NOTICE
Business name: .C7 A J /\ e.-,,.-a....ie.4 r, All contractors and subcontractors are required to be
licensed with the Oregon Construction. Contractors Board
Contact name:
0, v e �p n s under ORS 701 and may be required to be licensed in the
Address: Z c G . Z R J / Ala d 1i/pY jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: /, ,r ¢., 4 02 apply:
PP Y:
Phone: ($' j, ) S/ 9 - S ZSg I Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: Crown Fire Systems
(Please refer to fee schedule)
Permit fee:
Address: 7402 SE Johnson Creek Blvd.
City/State/ZIP: Portland, OR 97206 State surcharge (12% of permit fee):
Phone: (503) 777 -5030 I Fax: (503) 777 -0659 FLS plan review (40% of permit fee):
( ) ( ) (Due ue upon application)
CCB lic.: 163820 Y1 I J Total permit fees:
Amount received: 1 I L* •
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Authorized signature: , !
This permit application expires if a permit is not obtain d
Print name: Brent Barker Date: Nov. 15, 201 within 180 days after it has been accepted as complete.
• Fee mrthnrrnlnmr crt by Tr; -Monty Anilrrinn rnrhwtra,
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
® Addition ® 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
El Repair
Number of sprinkler heads: 4
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes 0
Information: Hazard Group light
Density .1
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 800
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
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: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.