Permit Support Document 0
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i RECEIVE])
City of Tigard • CO\I\[UNIT\' DEVELOPAIENT DE(RTNIs N
`_ ~ Request for Permit Action 11111
JUL 10
q 208
TIGARD 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718=2439 •� ww.tigard or. ei 'I TIGARD
BUILDING DIVISION
TO: CITY OF TIGARD
Building Division
13125 SW Halt Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPernuts@tigard-or.gov
FROM: ❑ Owner ► Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: f
INVOICE TO: fHumness or Indit,da e) / ;x' (_ ! - 61. t I '1^a rcariCee,/,(C rt.
Mailing Address: ki C t,a..d"f'. ,
City/State/Zip: I ' ,./,r� 0
Phone No.: 56 (V Lt -...22'
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
►� CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES(attach copy of original receipt and provide explanation below).
ID INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: .5 ,w�I < – 4.7
Site Address or Parcel#: / Lf14'15— S 4.44; .1 "LG
Project Name: FCC .c., g_5 CeP Y-vi .� (-
Subdivision Name: Lot#: -----
EXPLANATION: ..CO c. e- { ,--r~. 6 7
Signature: L �! --, - Date: G�
Print Name: --- '� /1'Z�i x
Refund Policy
I. The city's Community Development Director,Huild ng Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected,
• Not more than 8CP s of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended
is Not more than 80's of the application or permit fee for issued permits prior to any inspection requests.
2 111 refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 34 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to S's Admin: Date B• Route to Records: Date — - B%..4 '''.4"..
Refund Processed: Date iV B' 4P Invoice Processed: Date B.
Permit Canceled: Date ' ,a t<1.— B. ` arcel Ta:Added: Date B
I`:\Huilding\Fonns\RopennitAction_tt 2,114 doe
Building Permit Application V , /z/i f '
Fire Protection System FOR OFFICE use ONLY
` �! s, t /
City of Tigard Date/13 6[L/l r / Permit No.: % r �" —� I
!IN q 13125 SW Hall Blvd.,Tigard,OR 97223Ql 21111 Plan Review
i Phone: 503.718.2439 Fax: 503.598.1960 .iti tDate/B Other Permit:
TI G A R D Inspection Line: 503.639.4175 f t r }x c1.t Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov ;1 i'Y U t r.v Notified/Method: Supplemental Information
OF ORC REQ1xI I� ITA AB2FAMUXWLAI
❑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 CONS RII�ON '`- work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
1=1Accessory building ❑Multi-family Number of bedrooms:
❑Master builder • ❑Other: Number of bathrooms:
JOB SITE INFORMATION LOCATION Total number of floors:
Job site address: 15495 SW Sequoia Parkway New dwelling area: square feet '
City/State/ZIP:Portland,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:PCC 225 Common Area Covered porch area: square feet
Cross street/directions to job site: '" .' Deck area: square feet
Other structure area: square feet
REQUIRED 1A `A,, Ok CI►ER.CIAL- $CitgCF±LIST'
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
D CRIPTIO 1 OF' ORK_ work indicated on this application.
Relocate sprinkler heads for new ceiling grid Valuation: $$700.00
Existing building area: square feet
New building area: square feet
❑ PR PER.'I`Y'-OWNER ❑ TENANT, Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
., A P3,.I€C:a [` 'a.COTA� A
._ . . . ., =t Al TICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Max Colley licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham St jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)684-2928 Fax::( )
E-mail:m.colley@wyattfire.com
COAT` RACTOR It>IJIL IN' ,,,,, I.)T FEES
Business name:Wyatt Fire Protection ':. 16tierte erlOfeesritedrri
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.:64077 Total permit fees:
/`r-
Amount received:
Authorized signature:.. ' •_js�
This permit application expires if a permit is not obtained
Print name:Max Colley Date:6/28/18 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board. I
I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(I I/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 3 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:
Ty .of System(C mplete A,B,C car 1) s appl ble)
.A.) Com ercial Spunkier
Sprinkler Type ® Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group Light
Density 0.1
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 700
B) Type I ,*o d Fire Supp ression�Syste n
Hood Project Valuation: $
C)`P €e ► r
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
t�esident Sri er tan 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.
„r...... . . ...... . . m_, , ..- i k rt C[i r*- rmit F . _,. _.,,_,,,_. . ._ _,,,,,_ _. ., , .
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: $
W:\Mas\002 PERMIT APPLICATIONS\Tigard App.doc 2
IliCity of Tigard E `�' I Ln permit No.:
4 13125 SW Hall Blvd.,Tigard,OR 97223? 1,-$ °° ,
Phone: 503.718.2439 Fax: 503.598.1960 Date Received:
T �. t) Inspection Line: 503.639.4175 AR
li2 8 2018
Internet: www.tigard-or.gov By:
;; . .,se 1 -; �i APs
FIRE SPRINfagiegkliffikVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: PCC 225 Common Area Occupancy: Light
Job Address: 15495 SW Sequoia Parkway Type of Construction:
Suite:
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: 3
Type: SSP Hazard: Light Density: 0.1
I, Max Colley, Wyatt Fire Protection Oregon Construction Contractors Board No. 64077
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits,beams,partitions, walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop (exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads(see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
In addition, I understand the following is required:
• Submit(3) copies of a sketch showing the area of work within the building's structure.
• Building fire protection system permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature: / .-- Date: 6/28/18
Print Name: Max Colley ..-------
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