Permit (6) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
a COMMUNITY DEVELOPMENT Permit#: FPS2019-00139
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/25/2019
T t[�r1 R C7 9 Parcel: 1 S 134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD
Project: Providence Subdivision: None Lot: None
Project Description: Fire alarm. Adding(2)heat detectors,(2)smoke detectors,(1)monitor module,and(4)relays to bring existing
system up to code for elevator upgrade.
Contractor: COCHRAN INC Owner: PROVIDENCE HEALTH&SERVICES-ORE
7550 SW TECH CENTER DR#220 ATTN: REAL ESTATE&CONSTRUCTION
TIGARD, OR 97223 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-234-6564 PHONE:
FAX: 503-238-2098
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/25/2019 $91.44
12%State Surcharge-Building 11/25/2019 $10.97
Type of Use: COM Plan Review-Fire Life Safety-COM 11/25/2019 $36.58
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 11/25/2019 $5.00
Occupancy Grp: B Height: ft 11x17)
Stories: 2
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: Automatic
Pull Station Required: Smoke Detectors Req: Yes
Battery Calcs Provided: Cut Sheets Required: Yes
Total $143.99
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,000.00
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 ado.ted by the Oregon
Utility Notification Center. Those rules are s: forth in OAR 952-001-0010 through OAR 952-001-0090. You may obta., a copy of the rules
or direct questions to OUNC b •Iling 5,13.232.1•,:7 or 1.100.33 .2344.
Issued By: e / Permittee Signature: f _
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 complet)'on of the project.
Approved plans are required on the job site at the time of each inspection.
Buildint Permit Application
Fire Protection System // FOR OFFICE USE()NI 1 �j /� )7
City of Tigard _ ec•
Bea l' /1- L / /// t y, !—,4• !�,
Y
III N 13125 SW Hall Blvd.,Tigard,OR 97223 . ,r_, , .- "Review
i i t tv Q Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 1 Date/By: j)"" 1.2- t' 7
t t Ci A K 1) Inspection Line: 503.639.4175 \' „t Date Ready/By: /G . funs: H See Page 2 for
Internet: www.tigard-or.gov Noy y' t=i ..,,,,,-....fie ethod: L' ` / `( .4 Supplemental Information
❑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
, � �`
�� work indicated on this is application.
ss:
Q I-and 2-family dwelling EI Commercial/industrial Valuation: $
Accessory building ElMulti-family Number of bedrooms:
Master builder El Other:
Number of bathrooms:
Total number of floors:
Job site address: 12442 SW S c h o l 1 s Ferry Rd New dwelling area: square feet
City/State/ZIP:Tigard, OR 97223 i°/wreAfC62'c c Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:-Fri-elm-co r up-g-il 'Cc Covered porch area: square feet
• Cross street/directions to job site: S c h o 11 s Ferry Rd Deck area: square feet '
Other structure area: square feet
,," t1 r
34 g
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
I? TON OF WORK Slikwork indicated on this application.
Add heat (2) heat detectors. (2) smoke detectors, Valuation: $ 2, 000
(1) monitor module, and (4)relays to bring existing Existing building area: square feet
system up to code for elevator upgrade. New building area: square feet
Number t
PROPERTY"4('iR :,,,,.._,,y,.‘4,„ um er ofsones. 2
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
Business name: Cochran Inc All contractors and subcontractors are required to be :,,
Contact name: Gary E ade s licensed with the Oregon Construction Contractors Board ' '
under ORS 701 and may be required to be licensed in the
Address: 7550 S W Tech Center Dr jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: Tigard, OR 97223 a
Ppy:
Phone:(971) 250-1273 Fax: :( )
E-mail: GEades@Cochraninc . com
Business name: Cochran Inc
Permit fee: $91.44
Address: 7550 SW Tech Center Dr
State surcharge(12%of permit fee): $10.97
City/State/ZIP: Tigard, OR 97223 FLS plan review(40%of permit fee):
Phone:(9 7:0 250-1273 Fax:( ) (Due upon application submittal.) $36:58 _
CCB 1ic.: 72942 Total permit fees: $138.99
. Amount received: I
Authorized signature:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Gary Ead s Date: 11/5/19 *
Fee methodology set by Tri-County Building Industry
.'Y Service Board.
I:\Building\Permits\FPS-PermitApp_03I016.doc 440-46131(11'021COM,W EB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
4 rrrla
k to be done K'
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: 9
® 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 x❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
4 ° x! ,
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
B.) Type Hood Fire Sup.
gr Hood Project Valuation: $
C.
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: I $ 2, 0 0 0
siderttia�' �€ 't HF
--4.7 ._._..4 '.a Ata, _. r nw .-. rz " 12€4,•,, 4
Square Footage: _ Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 _ $310.05 #
&WA .-'14aaaai.r. /f.'7 �SW ,_$ ',:44,3,0g.'
7,201 and greater $404.39
Sprinkler Project Square Footage: sq.ft.
.'
Project valuation subtotal (see A,B & C above): $ 2,000
Permit fee based on project valuation (see fee schedule): $ 91.44
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $ 10.97
FLS Plan Review (40% of permit fee): $ 36.58
TOTAL: $ 2,138.99
I:\Building\Permits\FPS_PermitApp_031016.doc 2