Permit (219) , y mi CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
t; COMMUNITY DEVELOPMENT Permit #: FPS2012 -00139
f Date Issued: 08/20/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 y �
N Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY S
Project: Spec Space Subdivision: 2004 -015 PARTITION PLAT Lot: 1
Project Description: Modification of (8) fire sprinkler heads for TI. 10/2/12, reprinted to correct project name from Gentle Dental to Spec
Space•
Contractor: AFP SYSTEMS INC Owner: SN PROPERTIES PARTNERSHIP
19435 SW 129TH AVE 1121 SW SALMON ST
TUALATIN, OR 97062 PORTLAND, OR 97205
PHONE: 503 - 692 -9284 PHONE:
FAX: 503 - 692 -1186
FEES
Description Date Amount
Specifics: Permit Fee - COM 08/20/2012 $53.78
12% State Surcharge - Building 08/20/2012 $6.45
Type of Use: COM Plan Review - Fire Life Safety - COM 08/20/2012 $21.51
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
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 $81.74
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $560.00
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 qu to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: Ce Signature: ({
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.
111 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 00139
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/20/2012
Parcel: 2S 115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY S
Project: Gentle Dental Subdivision: 2004 -015 PARTITION PLAT Lot: 1
Project Description: Modification of (8) fire sprinkler heads for TI
Contractor: AFP SYSTEMS INC Owner: SN PROPERTIES PARTNERSHIP
19435 SW 129TH AVE 1121 SW SALMON ST
TUALATIN, OR 97062 PORTLAND, OR 97205
PHONE: 503 - 692 -9284 PHONE:
FAX: 503 - 692 -1186
FEES
Description Date Amount
Specifics: Permit Fee - COM 08/20/2012 $53.78
12% State Surcharge - Building 08/20/2012 $6.45
Type of Use: COM Plan Review - Fire Life Safety - COM 08/20/2012 $21.51
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
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 $81.74
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $560.00
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 Notific. '• • - - • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire •uestions to OUN .y ,: ing 503.232.1987 or 1.800.332.2344.
Iss =d By: 1 / ,,t , Permittee Signature: r
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.
Buildi
ng Permit Application
Fire Protection System FOR OFFICE USE ONLY
of Tigard
Dat ■
4O 0 dm PermitNo.: rAj� -00/39
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' C Phone: 503.639.4171 Fax: 503.598.1960 Date/B Other Permit:
I l G n RD Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF 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.
El l- and 2- family dwelling �Commercial/industrial
Valuation: $
El Accessory building 11 Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: �00 S it/ P� : Vic,... U w y , New dwelling area: square feet
City/State /ZIP: � and I Of, 1� t Z_/ Garage /carport area: square feet
Suite/bldg. /apt. no.: 5 r Project name: • G' enkp� P Q ,� ` Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
c W& a: c N W y c id Qr/ (lv d . 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.
Valuation: 5e $
Existing building area: 5560 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: Il F' ? G/ 5' 1 ' L► All contractors and subcontractors are required to be
Dr-) Contact name: r f tii p) loa.-7 licensed with the Oregon Construction Contractors Board
// '' ,, � A V G'( 14. under ORS 701 and may be required to be licensed in the
Address: ig 1 3 5 5 (4j MC lin v& jurisdiction in which work is being performed. If the
City /State /ZIP: ILA i 011. N IA Tt oaz- / /� applicant is exempt from licensing, the following reasons
�7 4 � (5 /) CA 7- 1I & apply:
Phone: (593) Z Fax:
E-mail: 40`1 & aqs yS cowl
/ � 6 n CONTRACTOR /� BUILDING PERMIT FEES*
c o Business name: t; i' r'e' / - V . fes l U- 6+a,� i- a 9 (Please refer to fee schedule)
Address: "I es'
/ P � �� R Permit fee:
Of
City /State /ZIP: ?_Of `�' &17-2 Z Zf FLS plan review surcharge (12 % of permit fee):
n � z ew (40% of permit fee):
Phone: (503) ga Lill Fax: (W5 ) Vt� n - ( �g,5 - g' ._ (Due upon application.)
CCB lic.: 7 5 - 3 L` Total permit fees: 7
Authorized signature: �(
Amount received: . /
T his permit application expires if a permit is not obtained
Print name: r L fri Date: ICI WIZ. within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\PermitsWPS- PermitApp.doc 03/23/06 440.4613T(I1 /02/COM/WEB)
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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.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
•
Sprinkler Project Valuation: $
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 Sprinlder (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50 f
3,601 to 7,200 $292.50
7,201 and greater $381.50
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 2 sets of plans at submittal. Plan review fees are required at submittal.
I:\ Building \Permits \FPS- PemmitApp.doc 06/25/08 2
-� J
_ \ AFP Systems, Inc.
I �� Automatic Fire Protection
C o 19435 SW. 129' Avenue
Tualatin, OR 97062
v SYSTEMS w (503) 692 -9284
� C'� a 2 (503)692- 1186
F I
TRANSMITTAL
TO: City of Tigard DATE: 8/17/12
Attn:
SUBJECT: Gental Dental, Job ID 12129
• (X) ENCLOSED ( ) PLEASE FORWARD
( ) SUBCONTRACT ( ) EXECUTED (x) FOR APPROVAL
(x) DRAWINGS- 3 sets ( ) APPROVED ( ) FOR SIGNATURE
( ) CALCULATIONS ( ) APPROVED AS () FOR YOUR USE
( -) CHANGE ORDER ( ) NOTED () FOR CORRECTION
( x) PRODUCT DATA ( ) UNAPPROVED ( ) FOR PAYMENT
( ) LIEN RELEASE ( ) PLEASE RETURN
( x) PERMIT APPLICATION
( ) PERMIT CHECK FEE
( ) O & M MANUALS •
( ) Fed EX label
REMARKS: Please review for approval.
Sin rre
David King
AFP Systems, Inc.
(503)692 -9284
(503)692 -1186 Fax
• OR CCB# 67534
WA CCB #AFPSYSI *091BZ
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