Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit 4: FPS2009 -00115
T 1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/15/2009
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9595 SW WASHINGTON SQUARE DR B12
Subdivision: Lot: 0
Project: True Religion Blue Jeans
Project Description: Add /relocate approximately (17) fire sprinkler heads.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 Permit Fee - COM 12/10/2009 $112.96
12% State Surcharge - Building 12/10/2009 $13.56
PHONE: Plan Review - Fire Life Safety - COM 12/10/2009 $45.18
Contractor:
WYATT FIRE PROTECTION INC.
9095 SW BURNHAM
TIGARD, OR 97223
PHONE: 503 - 684 -2928
FAX: 503- 684 -9657
Type of Use: COM
Class of Work: ALT Type of Const: IIB
Occupancy Grp: M Height: ft
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: Design Area:
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Tota $171.70
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 3565
Residential Square Footage:
Fire Alarm Valuation:
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 -0100. You may obtain a copy of th ,
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
1 �
Issued By: Permittee Signature:
sd �Ul� J � / �/ /
Call 503.639.4175 by 7:00 a.m. for an inspection that • • siness day.
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 RECEIVED Receive FOR OFFICE USE ONLY
11 City of Tigard Date /13 /�� _ j Permit No.: "/ 0.69.-6,0 - ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r
Phone: 503.639.4171 Fax: 503.598.1960 DEC 10 2009 DateBy: l� OS Other Permit:
Inspection Line: 503.639.4175 Date Ready :Y: r luris: 0 See Page 2 for
TIGARD Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: la . `ic V ` / Supplemental Information
[ m
RI DIVISION `
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.
Valuation: $
❑ 1- and 2- family dwelling mmercial /industrial
111 Accessory building 111 Multi-family Number of bedrooms:
I=1 Master builder 1=1 Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9s� 5 ,5N /4 -2 �� 5q 7� New dwelling area: square feet
City/State /ZIP: /1 ! / 0 e � 9 7 . . 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 'fiwe'R oD jeill✓j Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: 1 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.
7^ Valuation: $ 3 5 5 `"�'
/4 14 x r l 7 $��i N� i
,( 6 - ` j �t 7" 5P/Ice Existing building area: square feet
/ v ! / � t 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: L G f 4 -`Q� All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: /� ' -7 (Please reschedule) !�
I/`� 6 /f` rr� ��� t���° ( refer Permit fee: //05 -
Address: 90 95 $ P � ,e �� i
City /State /ZIP: l�1 04._ ' `l ZZ State surcharge (12% of permit fee): / `J��O
F LS plan review (40% of permit fee): i/ / g
Phone: (50 6 4 - Z /Z , Fax: ( 5 -03) 6E:34 — 96 S 7 (Due upon application.) 7 .
CCB lic.: &40 O 77 Total permit fees: / 7! . 70
/ Amount received:
Authorized signature: f! ����
/ J ��--��
Print name: This permit application expires if a permit is not obtained
� t 6 LI / /U Date: !Z - 9 - w i t hin 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Indus
Service Board. \ � � ( C1
1:\ Building \Permits \FPS- PermitApp.doc 03/23/06 440- 4613T(I 1 /02 /COM/WEB) r. t r . • 4
'L Q,k-I'
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Deseribework to be'dorie: '
1.) D New 2.) Modification to sprinkler heads only:
D Addition LI 1-10 heads: No plan review required.
1 —.Alteration 'i-4-1+ heads: Plan review required.
El Repair
Number of sprinkler heads:
Additional description of work:
.
Type of System' (Complete A, B, Or,D as applicable): ,
A) Commercial Sprinkler
Wet fl Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.yT 1 Hood Fire'SuppresSion'SyStem "
Hood Project Valuation:
C)" Fire Alarm
Submittal shall Battery Calculations fl Yes
include: Individual Component LI Yes
Cut Sheets
Fire Alarm Project Valuation: $
Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Fire Protection
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.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
http://www.cLugard.or.us/city_hall/departments/cd/docs/FPS-PermitApp.doc 2