Permit le v CITY TIGARD BUILDING PERMIT
.
"' COMMUNITY DEVELOPMENT DATES ISSUED: 77/ 2008
TidARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 101 AD - 00100
SITE ADDRESS: 12725 SW 66TH AVE 100 ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 034 JURISDICTION: TIG
PROJECT: EXECUTIVE CENTER
Project Description: Installation of (1) fire sprinkler head.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 300.00
Owner: Contractor:
LYNN J. WERTZLER METRO SAFETY & FIRE INC
12725 SW 66TH AVE #106 PO BOX 33650
TIGARD, OR 97223 PORTLAND, OR 97068
Phone: 503 - 526 -1331 Contact #: PRI 503 - 231 -2999
FAX 503 - 256 -4691
Reg #: LIC 63651
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 12% State Surch 7/18/2008 $7.50
[BUILD] Permit Fee 7/18/2008 $62.50
Total $70.00
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 than 180 days. ATTENTION: Oregon law requires you to follow the , le - dopted by the
Oregon Uti ' _ ' cation Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You ay obtain a copy
of thes; ules or dire ques '. • s to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss ed 7 ' / I d /i
By: /it , Permittee Signature: Y 9 '
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 e project.
Approved plans are required on the job site at the time of each inspection.
I
Building Permit Application , ECE V f l 4
F Protection System Q a e y ; FoR OFFICE us o> Y� := J , '
City of Tigard JUL $ 20 Received ( ,� y p 490 2 f%
1 O ,,,_ _ Q
Date/By:
Permit No.:
° 1 3125 SW Hall Blvd., Tigard, OR 97223 CITY OF TICARttt Review
: a . =x Phone: 503.639.4171 Fax: 503.598.1960 Other Permit
tell
;11 G A' R D Inspection Line: 503.639.4175 r j , t' /B Jur ® See Pa 2
Internet: www.tigard- or.gov BUILDING DIVISI , t e ethod: r� Supplemental et Info tion
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
i2 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: $
El Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
O.
Job site address: ' 2.11S S , to , (2(1 AFtl e New dwelling area: square feet
City /State /ZIP: - T►g b (Di 1 Garage /carport area: square feet
•
Suite/bldg. /apt. no.: 1 00 Project name: EY, 0 1- tv . T 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.
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.
. - ZoSTA -ic C 1) 1 SS° StAivbMLb 5 pc.), Ni • 511e1e.. Valuation: $ 2 00. co
I►� UN P� +Ec k 6 t C Existing building area: square feet
New building area: square feet
❑ PROPERTY ,OWNER ❑ TENANT Number of stories:
Name: L■ NO '' • (,J ER-TZ. leg— Type of construction:
Address: 1 2 - 7 ZS S t 0 , 6 1.0 1 ASE S , l Occupancy groups:
City /State /ZIP: "rt 9 Oa.. 9 7 223 Existing:
Phone: ( 513) neer silo — (3 3 ( Fax: ( S - 03) S — ! 74 S New:
❑. APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 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: 14e111-0 .5. A- F =NC (Pleaserejerwer fee
. l � ( Permit fee:
Address: 1 LI'3 Z ari 3', E - ,S•{ pyLV State surcharge (12% of permit fee):
City /State /ZIP: P y L,-0t) 0s q Z 3 3 - (40% FLS plan review (40 /o of permit fee):
Phone: (SD3) '31 Z cI 9 5 • Fax: ( ) (Due upon application.)
CCB lic.: (P ass- { Total permit fees:
Authorized signature: --
Amount received:
This permit application expires if a permit is not obtained
Print name: 61. c ' W iij Date: '7 -- i Q - 0-8 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
1:\Building\Permits \FPS- PermitApp.doc 03/23/06 440- 4613T(11/02/COM/WEB)
1
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe w ork 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:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: 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 $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 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: $
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.
1:\ Building \ Permits \FI'S- PermitApp.doc 2