Permit CITY OF TIGARD
FIRE PROTECTION SYSTEM PERMIT
' `' COMMUNITY DEVELOPMENT Permit #: FPS2010 00047
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/30/2010
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 140
Subdivision: Lot: 0
Project: Winzler Kelly
Project Description: Add (1) new pendent sprinkler and relocate (4) sprinkler heads.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300
Permit Fee COM 04/30/2010 $67.23
PORTLAND, OR 97224 12% State Surcharge - Building 04/30/2010 $8.07
PHONE: 503 - 624 -6300 Plan Review - Fire Life Safety - COM 04/30/2010 $26.89
Contractor:
CROSSFIRE SPRINKLER CO
17400 SE 82ND DR
CLACKAMAS, OR 97015
PHONE: 503 - 210 -5506
FAX: 503 - 210 -5538
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type:
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 $102.19
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1085.00
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: Permittee Signature: Q/lL /97,9,02_, (`770 '
Call 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.
04/29/2010 16:53 5032105538 CROSSFIRE PAGE 02/03
Permit Application Building P pp ><on ('
Fire Protection System 2 .: .17 ,- , ., 1 " ` s.'` 4" i_ r- r��.. . - ,. 1 � , l
City of Tigard R iv a I ," d /o D Pe,taitNo.: _ i /I — 0 409
_ " 13125 SW Hall Blvd., Tigard, OR 97223 APR 2 9 ?NO Plan Revi �.9 /0 — � /
Phone: 503,63.9,4171 Fax: 503.598.1960 DatefBv: Other Perm . OW [�
1
'">
, ., i∎ Seepage'2for
i; Inspection Cane: 503.639.4175 Date Ready /By:
, 4 " t Internet: www,tigatd- or.gov CITY OF DIVISION Notified/Method: SuppleurenMl information
DIVISION
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Perm fees* are based on the value of the work performed.
El New construction ❑ Demolition Indicate the value (rounded to the nearest dollar) of all
® Addition/alteration/replacement ❑Other: equipment, materials, labor, overhead, and the profit for the
,r , r " ' , i r V , it -F { - ; work indicated on this application.
- ..._.� ,_..- family . Valuation: $
1- and 2 dwelling ® Commercial /industrial
❑ Accessory building ❑ Multi - family
Number of bedrooms:
❑ Master builder El Other:
Number of bathrooms:
_ s «.. . :- 1 { .'
.?..7- ' t a
�.'c. .' . -r �,,
, a " . ,:..,z L .'-. Total number of floors:
: '` `Sk t t _ r , �+i - i i - ,,. ', ,,, wh: r _ ..: -: „ , . .' I 1 3 M , .a+.;?.r.
Job site address: 15575 SW Sequoia Pkwy New dwelling area: square feet
City/ State/ZIP: Portland, OR 97224 Garage/carport area: square feet
Suite/bldg. /apt no.: 140 Project name: Wlnzler Kelly Covcrod porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
zn ' r 1 r -- ' 5 1 �e nr ^r
Subdivision: Lot no - Permit fees* are based on the value of the work performed.
Indicate the value (pounded to the nearest dollar) of all
Tax map /parcel no equipment, material labor, overhead, and the profit for the
equ , ! ri " . '"-, `� "'` ' 1 w � 1t t� " r r5 work indicated on this application.
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Add (1) New Pendent Spriidlder & Relocate (4) Sprinkler Heads Valuation: $$1,055.00
Existing building area: square feet
New building area: square feet
�, ,"""" ,^-e, c : r- ::: '� '"'.`.,'.." 1,.:,,, s "�` 7.r .. r'a ' j .
- :: — �`"I , ,: Number of stories:
Name: PacTrust Type of construction:
Address: 15350 SW Sequoia Pkwy - Suite 300 Occupancy groups:
City / State/ZIP: Portland, OR 97224 Existing:
Phone: (503)624 6300 Fax: ( ) _ New:
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Business name: All contractors and subcontractors are required t 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 tho
applicant is exempt from licensing, the following reasons
City / State/ZIP:
apply:
?bone:( ) Fax : :( )
E-mail:
', "^_'_ , +, i,-.. % y �n , r `� , -e1'n_,L^' „�."..e,z;i ^ f..,_ -. +1..Ia, ; ' ' y ^ L...-..: t a > ki ,,� ti j � "^S
t ,
Business name: Crossfire Sprinkler Company Win"''° " " __n in
Permit fee:
Address: 17400 SE 82° Drive
State surcharge (12% of permit fee):
City/State/ZIP: Clackamas, OR 97015
- FLS plan review (40% of permit fcc):
Phone: (503) 210-550y' � Fax: (503) 210 -5538 (Due . on . . • lication.
4 CCB Iic.: 1747 411lb i Total permit fees:
PAIIIIIir Amount received: o0S , /9
,Authorized signature: Ati•
Al This permit application expires if a permit is not obtained
Print name: 1'lpaothy A Bishop Date: 4/30/2010 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building industry
Service Board.
r:'Buildin \PS- PumitAp aloe 10!01/09 aaa- 46t3T(luoz /coM wE s)
04/29/2010 16:53 5032105538 CROSSFIRE PAGE 03/03
City of Tigard: Fire Protection Permit ChcckJist
Page 2 - Supplemental Information
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1.) p New 2.) Modification to sprinkler heads only:
El Addition ® 1 -10 heads: No plan review required.
® Alteration ❑ 11-t- heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
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r. " +rn �f�h.., —, .i�aLA...., -,�. Ott. .---''`-- �.. - .•..__.. r..- _.. T
El Wet ❑ D
Additional Stand .i • es
Information: Hazard Grou• Li. ht
Densi .10
Des'.:, Area 1500
I( Factor 5.6
S • rinklex Project Valuation: $ 1085.00
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. - : 7 7.a, 37 � y, �'.v .!».: !aw�. , � _��',`� .. -r �.r;'C`°`" _i.`.'7•: ,:`";f" « ?.-= 5:m+�u•�..:::..c
Hood Project Valuation:
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}rn i.S »fit � 1 rHr�` s i r r t ,Ti4�rr}'E��, 1a {{'T�� {•,r
Submittal shall Batt- Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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S• uareFootage: Permit Fee: •
0 to 2,000 $198.75
r 2,001 to 3 600 $246.45 :: c
3 601 to 7,200 $310.05
7 201 and _reater $404.39��
Sprinkler Project Square Footage: sq. ft.
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, 'uu+ehn j , f 4_ lx L
v, +- e.r -L[ :?u- _ � ,,, 1 _.�u :h boa ._... �. a,.a ., c. _.__.n. ,» ... ,.:x?..,. .- _t�..J.. _n, - ... ,ti .._
Project valuation subtotal see A, B & C above :
Permit fee based on •ro'ect valuation see fee schedule :
Permit fee based on s.uare foota:e see D above : $
State Surchar:e 12% of .ermit fee : $
FLS Plan Review 40% of • ermit fee :
TOTAL $
Plan review requires a completed application and 2 sets of plans at submLittal. Plan review fees are required at submittal.
C: \Documents and Settings \ CAD \My Documents \ Permits \aid pemvt,doc 10/01/092