Permit FIRE PROTECTION SYSTEM PERMIT
J e CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00036
ti Date Issued: 04/16/2010
id AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 460
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: AM Trust North America
Project Description: Relocating (15) fire sprinkler heads.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - COM 04/14/2010 $86.06
PORTLAND, OR 97224
PHONE: 503 624 -6300 12% State Surcharge - Building 04/14/2010 $10.33
Plan Review - Fire Life Safety - COM 04/14/2010 $34.42
Contractor:
DELTA FIRE INC
14795 SW 72ND AVE
PORTLAND, OR 97224
PHONE: 503 - 620 -4020
FAX: 503 - 620 -1058
Type of Use: COM
Class of Work: ALT Type of Const: IIB
Occupancy Grp: B Height: ft
Stories: 2
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 0
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:
Total $130.81
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1800
Residential Square Footage: 0
Fire Alarm Valuation: 0
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 the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:
A/9/)>/1 Perm ittee Signature: �j . �. 'J'"'L • i��` �.
CaII 503.639.4175 by 7:00 a.m. for an inspection that business 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 RE t I `
. . FOR OFFICE U SE ONLY
. CI of Ti and Received 2
`, g APR 14 2010 Date/By: 4! / 4 / / / Permit No.: / ' - p5 Sae DGIO 39
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DateBy: t' • t` 4_1 /�� Other Permit: to 6900 Meek
T I GAR D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for c'
Internet: wwtiv.tigard- or.gov BUILDING DIVISION No od: y i 51/0 Supplemental Information
fi - ✓ter w l4_
TYPE OF WORK _ . . - RE UIRED DATA; 1- AND 2 F DWELLLNG
❑ 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 CON work indicated on this application.
❑ 1- and 2- family dwelling Commercial /industrial Valuation: S
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND. LOCATION Total number of floors:
Job site address: ft 109 5 w (off. ?C t (�111�C1� New dwelling area: square feet
City /State /ZIP: I0 fk1G.rd 0 P q 1 ` . . Garage /carport area: square feet
-r � J� L
Suite/bldg. /apt. no.: 14(DO f Project name: Tea rei Tatar' 1e — ACATIOs�' Covered porch area square feet
Cross street/directions to job site: C• . Deck area: square feet
Other structure area: square feet
RE DATA :COMMERCIAL -USE CH
Subdivision: 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.
�e.I0C ltna l � h Ta p . I eel. T.T. Valuation: S
Existing building area square feet
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:
X4PPLICANT ❑ CONTACT PERSON .
NOTICE .
Business name: • De\krA ' e C
"Y1C- All contractors and subcontractors are required to be
1
Contact name: C- Lo . I �,, . ��' licensed with the Oregon Construction Contractors Board
C c, eX `L ,e 1r1 t � t !� ca _1 o under ORS 701 and may be required to be lcensed in the
L\ C Address:' SW ian (�A/ve. jurisdiction in which work is being performed. If the
City /State /ZIP:
cAkaYnd, l Jp, `"1 7 (-' '-t applicant is exempt from licensing, the following reasons
Phone: 603 ,,/'- -14 ao Fax: (503) ( O— 1O6c
E -mail: he1!`i�cs e ' t• . ' • ��
CONTRACTOR -BUILDING PERtiIIT FEES*
Business name: �Pl l _e
t (Plea
r C. _
Permit fee: 4 1 8 1
Address: I I.t 79 6 � ( �U
-ran kw.
v
1 State surcharge (12% of permit fee):
City /State /ZIP: Poc4la�nd Of\ q 4
co � FLS plan review (40 %ofpermit fee):
Phone: 603 L ao - t1O Q.O Fax: i 0a0. 106AK (Due upon application.)
CCB lic.: ( ' 1, CI Total permit fees:
" ' _ Amo unt received: if /50. t r
Authorized signature: j(401,t
' I L This permit application expires if a permit is not obtained
Print name: K'P�td;t 3C • 1► \ / Date: within 180 days after it has been accepted as complete.
� ' Fee methodology set by Tri- County Building industry
Service Board.
I:\ Building \Permits\FPS- PertnitApp doc 03/23/06 440- 4613T(1I /02 /COM'WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 -.Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
`& Addition ❑ 1 -10 heads: No plan review required.
Alteration ' 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: Ito
_Additional description of work:
Type of System (Complete A, B, -C or D as applicable): .
A.) Commercial Sprinkler
❑ Wet ❑ Dr<
Additional Standpipes AVA
Information: Hazard Group • ' •
Density ,k0
Design Area 1 b(3°
f1 Factor h.69 a
Sprinkler Project Valuation: $ Tro,DO
B.) Type I - Hood Fire Suppression System •
Hood Project Valuation: $ !V /Pc
C.) Fire Alarm
Submittal shall Batter- Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ Nwk
D.) 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 3292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: IV' bk... sq. ft.
•
Fire Protection Permit Fees - •
Project valuation subtotal (see A, B & C above): $ � i5QO. 00D .
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $ Al/A
State Surcharge (12% of permit fee): $
FLS Plan Review (40% of permit fee): 1 $
TOTAL: $ I SI. • .
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 tire suppression
engineer, or NICET level "3" technicians.
I:A Building \ Pen-nits \FPS_PernirApp.doc 2