Permit .111i CITY OF TIGARD PROTECTION SYSTEM PERMIT
""k3'''°It COMMUNITY DEVELOPMENT Permit #: FPS2010 -00059
I CARD: 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/27/2010
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 200
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: CNA Insurance
Project Description: Fire alarm
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 Permit Fee - COM 05/27/2010 $91.44
12% State Surcharge - Building 05/27/2010 $10.97
PHONE: 503 - 624 -6300 Plan Review - Fire Life Safety - COM 05/27/2010 $36.58
Contractor:
STANLEY CONVERGENT SECURITY
SOLUTIONS INC
15495 SW SEQUOIA PKWY STE 100
PHONE: 503 - 968 -3353
FAX: 503 - 968 -3398
Type of Use: COM
Class of Work: ALT Type of Const: IIB
Occupancy Grp: B Height: ft
Stories: 4
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $138.99
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 2000
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 • • ark is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit otification Center. rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or ,irect questions to OUNC • • calling 503.246.6699 or 1.800.332.2344.
I ued By: I diAMAk, Permittee Si. nature: -Of
Call 503.639.4175 by 7:00 a.m. for an inspection that bu • • -ss 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 0 V,VV FOR OFFICE USE ONLY
City of Tigard Date/By: / � /, �
III Date/By: r Permit No.: lt�/ `r 9
° 13125 SW Hall Blvd., Tigard, OR 97223 ZG14 Plan Re view
_
Phone: 503.639.4171 Fax: 503.598.1960 M PS ' 6� � � Q Date /B : i/► � � ' �, � Other Permit: 4 Pao�o -- X99
T I G A R D Inspection Line: 503.639 l� '� Date Ready /By: I _ Juris: 10 See Page 2 for
Internet: www.tigard - or.gov hr OF Notified/Method. p /( Supplemental Information
C
TYPE OF W09p..-- /Cs O
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 ® Commercial /industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12909 SW 68 PARKWAY /6 New dwelling area: square feet
City /State /ZIP: PORTLAND, OR 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: 200 Project name: CNA INSURANCE 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.
INSTALL SIX ADDITIONAL STROBES AND FIVE HORN STROBES ON Valuation: $ 2
EXISTING FIRE SYSTEM Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: PACIFIC REALITY ASSOCIATES Type of construction:
Address: 15350 SW SEQUOIA PARKWAY Occupancy groups:
City /State /ZIP: PORTLAND, OR 97224 Existing:
Phone: (503)624 -6300 Fax: (503)624 -7755 New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: STANLEY SECURITY SOLUTIONS All contractors and subcontractors are required to be
Contact name: GARY TAUSCHER licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15495 SW SEQUOIA PARKWAY, SUITE 100 jurisdiction in which work is being performed. if the
City/State/ZIP: PORTLAND, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 968 -3355 Fax: : (503) 969-3398
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: STANLEY SECURITY SOLUTIONS (Please refer to fee schedule)
Permit fee:
Address: 15495 SW SEQUOIA PARKWAY, SUITE 100
State surcharge (12% of permit fee):
City/State/ZIP: PORTLAND, OR 97224
y ' FLS plan review (40% of permit fee):
Phone: (503) 968 -3355 Fax: (503) 968 -3398 (Due upon application.)
CCB lic.: 161567 Total permit fees: r Q
Authorized signature: Amount received: if g(l ,
L. --_ R This permit application expires if a permit is not obtained
Print name: STEVE M HOUSE Date: 5/26/2010 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 03/23/06 440-4613T( I I/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:
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.
c:\ Documents and Settings \gmtlo26 \My Documents\ TIGARD ITS- Pemiiu \pp 129092\ CI AMISRICAN.doc
I
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Building Division
Over- The - Counter (OTC) Building Permit
Tl e n ii Check List
Description of Project: ti r lkL NP--(AA
GENERAL INFORMATION
Class of Work:* TtL 1 Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* First floor: N: S:
Type of Construction: �` Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: Total sq ft.: • N: S:
Stories: +11/4" Note: Combine total floor area for E: E:
Height: all floors above third floor and Roof Construction:
Floor Load: add to the third floor s . ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinker: S . Handicap access:
Smoke detector: Protected corridors:
Fire alarm: Y Parking spaces ( #):
Notes:
Total Valuation: $ Z.,
INSPECTIONS FEES DUE
Footing /foundation Firewall $ CI (' , 4'T Permit Fee
Post /beam structural Smoke detector $ Inten State Surcharge
Shear wall Misc. inspection $ Plan Review Fee
Masonry Approach /sidewalk $ ' r' T) FLS Plan Review Fee
Framing $ Additional Permit Fee
Insulation . Sprinkler rough -in $ Additional Plan Review Fee
Gyp board Fire alarm $ Metro Construction Excise Tax
Suspended ceiling Sprinkler final • $ School Construction Excise Tax
Final inspection $ Misc. Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ ( ca Total Fees Due
•
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other. (use for fences, decks, retaining walls, signs, awnings
or canopies); REP = repair.
•
I: \Building \Forms \OTC - BUP.doc 08/19/08