Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
o COMMUNITY DEVELOPMENT Permit #: FPS2009 -00103
j C rR )7' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/25/2009
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 200
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: HealthNet
Project Description: Add /relocate (28) fire sprinkler heads.
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Description Date Amount
PO BOX 2096
WARREN, MI 48090 Permit Fee - COM 10/27/2009 $134.48
12% State Surcharge - Building 10/27/2009 $16.14
PHONE: Plan Review - Fire Life Safety - COM 10/27/2009 $53.79
Contractor:
A PROFESSIONAL FIRE SYSTEMS CO
17273 S STEINER ROAD
BEAVERCREEK, OR 97004
PHONE: 503 - 632 -4353
FAX: 503- 632 -4835
Type of Use: COM
Class of Work: FPS Type of Const: IIB
Occupancy Grp: B Height: ft
Stories: 2
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: Design Area:
K Factor:
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: 5154
Residential Square Footage:
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 if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility • • • : • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or •' ect questions to 0 • • • Ilin• 503.246.6699 or 1.800.332.2344.
I sued By: Permitte� Signature! 01
Call 503.639.4175 by 7:00 a.m. for an inspection that bu-mess 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.
i
Building Permit Application / —06/ t'2
Fire Protection System EC FOR OFFICE USE ONLY
Received ®gi�
City of Tigard r� l Date/B /t0 Permit No.: ( a �.� ' /O 3
��
Ilig
13125 SW Hall Blvd., Tigard, OR 97223 I 2 1 LW Plan Review��
Phone: 503.639.4171 Fax: 503.598.1960 . 0ate/B /Mak � `� Other Permit:
T I G A R D Inspection Line: 503.639.4175 T1 A i a�e Ready y1 �+' H See Page 2 for
Internet: www.tigard or.gov Cl' VF AN V . tilied/Method: l �� Supplemental Information
,DING • / iet
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.
ID 1- and 2- family dwelling ® Commercial /industrial Valuation: $
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 13221 SW 68 Parkway New dwelling area: square feet
City /State /ZIP: Tigard, Or 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: ace Project name: Health Net of Oregon Covered porch area: square feet
Cross street/directions to job site: SWHampton 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's & relocation of pendant fire sprinklers - TI Valuation: 555,154.00
Existing building area: X square feet
New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 4
Name: Health Net of Oregon Type of construction:
Address: 13221 SW 68'" Parkway Occupancy groups:
City /State /ZIP: Tigard, Or 97223 Existing:
Phone: ( ) Fax: ( ) New:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: A Professional Fire Systems Co All contractors and subcontractors are required to be
Contact name: Brian Renhard licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 17273 S Steiner Road jurisdiction in which work is being performed. If the
City /State /ZIP: Beavercreek, Or 97004 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 632 -4353 Fax: : (503) 632-4835
E -mail: brianr @aprofire.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: A Professional Fire Systems Co (Please refer ro fee schedule)
Permit fee:
Address: 17273 S Steiner Road
City /State /ZIP: Beavercreek, Oregon 97004 State surcharge (12 %of permit fee):
FLS plan review (40% of permit fee):
Phone: (503) 632 -4353 Fax: (503) 632 -4835 (Due upon application.)
CCB lic.: 41650 tt1i..ki1 ti Total permit fees: 204.41
Authorized signature: ' / Amount received: 204.41
This permit application expires if a permit is not obtained
Print name: Brian Renhard Date: 10/23/09 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- 4613T(11/02/COM /WEB)
W
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) El 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: 28
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 Light Hazard
Density .1
Design Area
K. Factor 8.0
Sprinkler Project Valuation: $ 5,154.00
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 $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): $ 5,154.00
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: $ 204.41
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
\ \ SERVER\ Users \ barb \My Documents \FPS- PermitApp- TIGARD.doc 10/01/09 2
RECEIVED
OCT 2 7 2009
PROFESSichmakr GAIN
A Professional Fire Systems Co FIRE SY IVISION
STEMS g
dba Pacific Fire Sprinkler ` { " "`
17273 S. Steiner Road
Beavercreek, Oregon 97004
LE l l ER OF TRANSMITTAL = .
To: City of Tigard Date: 10/23/2009 IJob#
13125 SW Hall Blvd RE: Permit - Health Net of Ore
Tigard, Or 97223
We are sending you Ei Attached n Under a separate cover via the following:
n Shop Drawings ❑ Prints ❑ Plans n Samples
Copy of letter n Chg.Order n Specifications I I Cert Payroll
Document Type Copies Date Document Type Copies
Plans 3
permit app 1
permit fee 1
E. For approval nApproved as submitted nResubmit copies for approval
In For your use nApproved as noted El Submit copies for distribution
nAs requested El Returned for corrections EReturn corrected prints
nFor review /comment OOther
fFOR BIDS DUE
REMARKS:
Barbara Robey / Admin. Assistant
A Professional Fire Systems
Billing: 503 - 632 -4353