Permit w CITY OF TIGARD
FIRE PROTECTION SYSTEM PERMIT
n
_ 3 COMMUNITY DEVELOPMENT Permit #: FPS2010 -00058
1 i c Date Issued: 06/02/2010
IT IGAR., 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 450
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: ACE American Insurance
Project Description: Adding and altering (45) sprinkler heads for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 Permit Fee - COM 05/25/2010 $134.48
12% State Surcharge - Building 05/25/2010 $16.14
PHONE: 503 - 624 -6300 Plan Review - Fire Life Safety - COM 05/25/2010 $53.79
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: 5
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .10 Design Area: 1500
K Factor: 5.62
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $204.41
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 5388
Residential Square Footage: 0
Fire Alarm Valuation:
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 • .rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility = ification Center�T.f ose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir ct questions to OUNC by • . lin. 50.. 46.6699 or 1.800,332.2344. r
Iss -d By: / % / � / Permittee ignature:
,v
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.
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Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Ti and RECE I •J g Received
13125 SW Hall Blvd., Tig ard, OR .3 Date l U itite5+� tV— (X.�l�° �p = Plan Review . tl) !'� it �� L � 0 7 Phone: 503.639.4171 Far: 503.598.1960 Date,By: OchPermer PNoerm.: it: I Ins Line: 503.639.4175 MAY 2 5 [010 D ate Read / v: / lurk: : TIGARD Y h / ( / -_ .l ee Page 2 for
ard - or. ov Notified/A I /
Interne[: waw.ti
g g r 1� .a �`\ Supplemental Information
CITY OF TIGARD .7
TYPE �I DIVISION 1.4.7/ REQUIRED DATA: 1- AND 2-FAMILY DWELLING
❑ New construction ❑ Demolition 1 Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Addition/alterationireplacement ❑ 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: S
'
t
❑ 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: 4).19 39 3 1 1 (, c4U AVE'. New dwelling area: square feet
City /State /Z1P: �-- a c ) f). W q 199.1. i Garage /carport area: square feet
Suite Idg.!apt. no.: (.i < A , Project name: ACi A e; ertn -tuns 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.
■ /} _ 1 , ` i Valuation: $ 5
. U .. e �
f
lo �n - (' �CJ , 38g .00
Cad de o rni 5 hetd, 5 � 1 ,,(� pr b3 TT-. 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:
XOPPLICANT ❑ CONTACT PERSON
NOTICE .
Business name: A-a r (le, = All contractors and subcontractors are required to be —
�/ licensed with the Oregon Construction Contractors Board
Contact name: I
N 'I� A n ,/,
� 1 l ��r�a " "�
under ORS 701 and may be required to be lcensed in the
Address: (u � 7 q , � I /Ana jurisdiction in which work is being performed. If the
„1 I op, 0E 7 AVC
/� (7
applicant is exempt from licensing, the foowing reasons
oek
City/State/ZIP: 1 (� I' (J
apply:
Phone: ( 3 (� - 4 090 Fax: : (5c8 C , labs
p` �p ,
E-mail: e { Z✓lt)..t in �" �r crai.
&TRACTOR BUILDING PERMIT FEES*
Business name: V e. InC. (Please refer ta fee sehedule)
n I /����, I Permit fee: I3L(. L-( y
Address: 7"1 �' 7): (lr�l Ay) -
T o c _ l �� (}i /� !x a) State surcharge (12% of permit fee): /to t t'
City!StatelZlP: t � „ - " (
FLS plan review (40% of permit fee): r -
Phone: c - Fax: (5:1'3)62 ) , 145 (Due upon application.) ),)%
CCB 'ie.:69 '11 7 3 � 1 Total permit fees: '1,.3 t vi
/
Amount received: . * t/
Authorized signature: — ,
*I ii This permit application expires if a permit is not obtained
Print name: Re t ' o rbfO � Date: / 1 `7/ 10 within 180 days after it has been accepted as complete.
�JJ * Fee methodology set by Tri- County Building Indus
�/ Service Board. n
I BuddingTermitsFPS- Permit.4pp doe 03 23;06 440-46 13T/1 1 02COh1,1l7;Bj C �
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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 U 1-10 heads. No plan Ievicw required.
Alteration 0 11 + heads: Plan review required.
❑ Repair Jf
Number of sprinkler heads: 'l
Additional description of work:
Type of System (Complete. A, B, .0 or D as applicable):.
A.) Commercial Sprinkler
I ❑ Wet ❑ Dry
Additional Standpipes r/J
Information: Hazard Group L {OLyyr
Density . I o
Design Area I F,OO
K. Factor 6. 62 p �}
`,
Sprinkler Project Valuation: $ 3t,S. 03
B.) Type 'I - Hood Fire Suppre System
Hood Project Valuation: $
•
C.) Fire Alarm
Submittal shall Battery Calculations _ ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
•
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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): j $ �1� ?Z 0X
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.',B iinK'Perrj s`,FPS- PermitApp.doc 2