Permit 3t ro a t .a r
} , „ r ss CITY OF TIGARD
FIRE PROTECTION SYSTEM PERMIT
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; COMMUNITY DEVELOPMENT Permit #: FPS2009 -00092
.i. Date Issued: 10/21/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
n, . K , ; . Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15495 SW SEQUOIA PKWY 190
Subdivision: Lot: 0
Project: Columbia Soft
Project Description: Add /relocate heads for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - COM 10/09/2009 $77.99
PORTLAND, OR 97224 12% State Surcharge - Building 10/09/2009 $9.36
PHONE: 503 - 624 -6300 Plan Review - Fire Life Safety - COM 10/21/2009 $31.20
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: IIIB
Occupancy Grp: B Height: ft
Stories:
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 $118.55
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1462
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: Ai Permittee Signature: t 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.
s
Building Permit Application RECEIVED f
Fire Protection System FOR OFFICE USE ONLY
City of Tigard OCT 0 9 2009 Re T, Permit No.: :
_ _ PJ •rG .:l: t =
1111
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie �
C Phone: 503.639.4171 Fax: 503.598.19On OF TIGARD Date /B : . �, 15 v ( Other Permit:
T I GA R D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready ,, ®See Page 2 for
Internet: www.tigard- or.gov NotifiediMeth. J I� A Supplemental Information
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.
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $
I=1 Accessory building I=1 Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 15495 SW Sequoia Parkway New dwelling area: square feet
City/State /ZIP: Portland, Oregon 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: 190 Project name: Columbia Soft 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: 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.
Add/ Relocate Fire Sprinkler Heads Valuation: $$1,462.00
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: PacTrust Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Crossfire Sprinkler Company All contractors and subcontractors are required to be
Contact name: Timothy A Bishop licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 17400 SE 82 Drive jurisdiction in which work is being performed. If the
City/State/ZIP: Clackamas, Oregon 97015 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 210 5506 Fax: : (503) 210 5538
E- mail: timothy @crossfiresprinkler.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: Crossfire Sprinkler Company (Please refer to fee schedule)
Permit fee: (0 )5 77q
Address:
State surcharge (12% of permit fee): 7. 0 i 31,0 p
FLS plan review (40% of permit fee): °� '1 . 00 ( �a
Phone: ( ) Fax: ( ) (Due upon application.) 3 (
CCB lic.: 174746 Total permit fees: 5 . I `D sJ
Authorized signat e: Amount received: CI C 0
This permit application expires if a permit is not obtained
Print name: Timothy A Bishop Date: 10/6/09 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building \Permits \FPS - PermitApp.doc .10/01/09 440-461 3T(1 I /02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe workto be done: f = y'
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: 13
Additional description of work:
Type of Sys (Complete A , B , C or D apphcable)i'
9 4 �7R Y� tzt
A) Commercial Sprinkler
Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $ 1462
.'Hood Fire Suppression °System
Hood Project Valuation: $
■C ), F <re Alarm; , r
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
it
D ); Restdential (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): $ 1462
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.
http: / /www.tigard- or.gov /city_ hall /dcpartmcnts /cd /dots /FPS- PermitApp.doc 10 /01 /2)