Permit (112) CITY OF TIGARD III FIRE PROTECTION SYSTEM PERMIT
2 COMMUNITY DEVELOPMENT
Permit#: FPS2018-00121
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2018
T f A ft. Parcel: 1 S 134AD06200
Jurisdiction: Tigard
Site address: 10565 SW NIMBUS AVE 100
Project: Progressive Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: A
Project Description: Fire sprinklers. Relocating(125)sprinklers for TI.
Contractor: FIRE ONE FIRE SYSTEMS INC Owner: DIETRICH, NANCY BISHOP
PO BOX 734 ROBINSON, JERRY CHRISTOPHER TRUST
OREGON CITY, OR 97045 ROBINSON, LYNN ET AL
9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: 503-557-9050 PHONE:
FAX: 503-557-9268
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/09/2018 $242.08
12%State Surcharge-Building 10/09/2018 $29.05
Type of Use: COM Plan Review-Fire Life Safety-COM 10/09/2018 $96.83
Class of Work: ALT Type of Const: VA Info Process/Archiving-Lg$2.00(over 10/09/2018 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 10/09/2018 $10.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: ORD1
Density: .10 Design Area: 1500
K Factor: 05.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $379.96
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $15,255.00
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 952-0 You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.8000..3332 2344.
Issued By: y Permittee Signa ure: / C_..
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 off rlcE USE oNLN
City of Tigard Reeeiveyd //,�,//f % /.05 Of UO(11
111 g C L' ' r Date/Bg,,,,/,.2//,--
/ Permit No.: p
11111 13125 SW Hall Blvd.,Tigard,OR 97223 `-)`'' , 0 1.-1�@ Plan Review Other Perm!OC U����
C- Phone: 503.718.2439 Fax: 503.598.196Q. Date/By: '� -
T I G A It D Inspection Line: 503.639.4175 Date Ready/By: /(7.7.4/#‘:/.43.C.," S See Page 2 for
. " ..` otified/Method: Supplemental Information
Internet: www.tigard-or.gov --
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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling 14 Commercial/industrial Valuation:.
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ( 0 s /1 New dwelling area: square feet
:
City/State/ZIP: 1 i( 1 i-a c7-, 1 ( i2-: _t:✓�.1 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: L., ç.,j2 f--`,�, Th- Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
N((15 et Sc(?�.�'e. .\i ,l4cd{`3 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
DESCRIPTION OF WORK work indicated on this application.
A4. Valuation: $ rteL
- . 5 mac,
'N[t Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER yt TENANT Number of stories:
Name: \)oL' Type of construction:
Address: j�;j �J:-c.:r /•_!‘r-N..ej v._ Occupancy groups:
City/State/ZIP: r )L.,,01-,,'2_j) ` Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON NOTICE
Business name: t e_t3 t ry, F._, L i. S ,y- -,..,,,Ls. fit-t___. All contractors and subcontractors are required to be
Contact name: f•-&.,c E) -7�
licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
c.
r
Address: t e, 13,,,,.... 731--{ jurisdiction in which work is being performed.If the
�� j� applicant is exempt from licensing,the following reasons
City/State/ZIP:
apply:
Phone:(rl2\ ` ) 1 )
4.--. ...,�`j(� Fax::6623 5 '2 ,-�Z_�;
E-mail: \r\\ rL `q-vi-, .cy-Aq• .'J i''`i
CONTRACTOR BUILDING PERMIT FEES*
' (Please refer to fee schedule)
Business name: .
A''��_ f��� ,5 v=1 — Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP:
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: ) Lt V F Total permit fees:
SO
Amount received:
Authorized signatur : ��c
J This permit application expires if a permit is not obtained
within-'/ within 180 days after it has been accepted as complete.
Print name: _ Sj .&Ct ‘—‘..t.-75-) Date: l -), >7
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pen its\FPS-PennitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be 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: 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
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 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: $
1:\Building\Permits\FPS_PermitApp_031016.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10565 SW NIMBUS AVE 100, TIGARD, November 29, 2018 at
OR, 97223 9:08:19 AM
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00121
Inspection Type: Inspector:
999 Sprinkler final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor