Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2020-00032
Date Issued: 03/10/2020
G A R l:: 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1 S136DA02500
Jurisdiction: Tigard
Site address: 11090 SW 68TH PKWY
Project: Red Rock Creek Commons Subdivision: RED ROCK CREEK COMMONS Lot: 1
Project Description: Installation of fireline,underground,fire vault,&fire hydrant.
Contractor: LAUZON CONTRACTING LLC Owner: COMMUNITY PARTNERS FOR AFFORDABL
13577 SE VVILLINGHAM CT HOUSING
CLACKAMAS, OR 97015 6380 SW CAPITOL HWY, STE 151
PORTLAND,OR 97239
PHONE: 503-482-5445 PHONE: 503-293-4038
FAX: 503-482-5446
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/05/2020 $363.10
12%State Surcharge-Building 03/05/2020 $43.57
Type of Use: COM Plan Review-Fire Life Safety-COM 03/05/2020 $145.24
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 03/05/2020 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 03/05/2020 $23.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
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 $577.41
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.19 r 1.800.3 344.
Issued By: erm • lure: r /
eg,„_ / L V V
Call503.639.4175 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 Applicatio �y�y
Fire Protection Syste R�`t� ED IOR of Fl(l: LSI:ONI,I
City of Tigard FEB 2 7 2020 Received _ .. h N�/,
;�i 13125 SW Hall Blvd.,Tigard,OR 97272�24�,, . PlanR vi �/' �•,.,(�� �d rWv
• Phone: 503.718.2439 Fax: 503.598.f19{�r OF rD Date/By: MAN/ 3 -`]f� * fl-(, 1
iic .,i,it Inspection Line: 503.639.4175 '3UILDINGDI DIVISION DeteReMIYey: 5(b/ S See Page 2for
Internet: www.tigard-or.gov
ltlla U V Q �./ oti6ed/Metho (/((( ` Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
cONew construction ❑Demolition Permit fccs*arc based on the value of the work performed.
ttt///��— 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: $ I d a.
Number of bedrooms:
ElAccessory building Multi-family
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:I (d 70 51✓0 68 ��KW y New dwelling area: square feet
City/State/ZIP: / rAq U// 6K Garage/carport area: square feet
Suite/bldg./apt.no.: Project name /0 cc/6 K.,6 �' Covered porch area: square feet
Cross street/directions to job site: 0 M n'O N 5 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.
Valuation: $
S�-s�a7!/q�7OA ee 6 /4-e. �ticidc��rd t&ii .
/
Firms Vat f ,f i {I rc by ar,7tRt Existing building area: square feet
New building area: square feet
P1]A PROPERTY DOWNER ,.(s/ l 0 TENANTL, Number of stories:
Name. OIhA1t{n1 'F7_ ktrt nrf �!--litr io,f)/_, l -)(1- to Type of construction:
Address:G 3 to 5 4t/ Ty El IAI y �jUCTE l�I Occupancy groups:
City/State/ZIP: p o{ x T I o 9 7 a 3 9 Existing:
Phone:( SII 3 . '73 9 3 Fax:( ) New:
A APPLICANT ❑ CONTACT/ PERSON NOTICE
/4 Business name: t4z 0 C 4'/1 1{r cA ci�n ' (•G u , All contractors and subcontractors are required to be
Contact name:/ fir— h S /C licensed with the Oregon Construction Contractors Board
` under ORS 701 and may be required to be licensed in the
Address/3 f 7 55(1)� /i�r,l( Fj Cexur-f- jurisdiction in which work is being performed.If the
City/State/ZIPG/, r KJ 7 //7� Og 1761/ S` applicant is exempt from licensing,the following reasons
Q , p p p p /(� (, apply:
Phone:( { I O )/9Y / 6 es ( a Fax::( )(iO $t. �G (0
E-mail) tvl7a NI'0/ cfC ?/7 G-. ( 6/1/I
late to6t . uzo✓ce nlv`9e4vY, et vt„ BUILDING PERMIT FEES*
Business name: L u L(zc�1 C '�� -i C i2 l l.•c( (Please refer rofee schedule)
Address .C.� to
Permit fee:
City/State/ZIP: ( i i State surcharge(12%of permit fee): •
— q // FLS plan review(40%of permit fee):
Phone:( ) tl f I Fax:( ) (Due upon application submittal.)
CCB lie.:(. -3 3 / Total permit fees:
Amount received:
Authorized signature:
,�//)) /' This permit application expires if a permit is not obtained
Print name: C Q,(,�(/spt (ice s K/ Dater i UZ 0 within 180 days after it has been accepted as complete.
/ * Fee methodology set by Tri-County Building Industry
Service Board.
I:tBuilding\Permits\FPS-PttmitApp 031016.doc 440-4613T(11/02/COMWEB)
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 requited 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: $
I:\Building\Permits\FPS_PermitApp_03101 G.doc 2