Permit CITY OF TIGARD
FIRE PROTECTION SYSTEM PERMIT
lire-, COMMUNITY DEVELOPMENT Permit #: FPS2010 -00069
Date Issued: 06/24/2010
TIG Ark D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S110DC00700
Jurisdiction: Tigard
Site address: 11205 SW SUMMERFIELD DR
Subdivision: Lot: 0
Project: Summerfield Golf Cart Storage
Project Description: Adding (10) sprinkler heads.
Owner: FEES
TIGARD RETIREMENT RESIDENCE LLC Description Date Amount
600 UNIVERSITY ST STE 2215
SEATTLE, WA 98101 Permit Fee - COM 06/24/2010 $59.16
12% State Surcharge - Building 06/24/2010 $7.10
PHONE: Plan Review - Fire Life Safety - MF 06/24/2010 $23.66
Contractor:
METRO SAFETY & FIRE INC
PO BOX 33650
PORTLAND, OR 97068
PHONE: 503 - 231 -2999
FAX: 503- 256 -4691
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: 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 $89.92
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 796
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 ..:,:.:. 44.
Issued By: `- Permittee Signature:
7
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.
Building Permit Application ���� cF �,,GG uc m Y
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Fire Protection System rte 04 i I i 541 OR OI 1 ICI IJS ONI 1 r ; �i 1
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City of Tigard �� � �� a ateB e a j f%/ �1r Permit No.: - _MO , e
I,, q 13 125 SW Hall Blvd., Tigard, OR 97223 , � 1G � C3 Plan Review
, : . Q � � Date
/B B
Inspection Line: 503.639.4175 C1 Other Permit:
Phon 503.639.4171 Fax: 503.598.1960
1 -1t I ) ,�`J Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov Vw2 Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: I- 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 iiia Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / Z o 5 5 54 .mm`ir -COQ/ Dv New dwelling area: square feet
City /State /ZIP: Ti 6 L pee, ei 7 ze g Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 5 24T & i G e, Covered porch area: square feet
Cross street/directions to job site: R Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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.
/ c r 4,c _, � Valuation: $ 7� � j
®
/'� ) �/ ��9 •Cjr /g�9'1 #44,041 *I �j /�� Existing building area: square feet
f TiCrn /X- f... — olle ✓ .� y /w . f •;a,. cL, g
New building area: square feet
[PROPERTY OWNER I • 2 TENANT . Number of stories:
Name: / / g ie ote r irok e es , p- Type of construction:
Address: /i ZQ,s 5• f� �Q/ p Occupancy groups:
City /State /ZIP: I- & 1 4 e, ? Z_ 7 a Existing:
Phone: (!J p ) $7Q - 73g Z Fax: (f ) New:
.APPLICANT a CONTACT PERSON - NOTICE .
Business name: /rty Xerfely ,L " Th All contractors and subcontractors are required to be
Contact name: ? ®N ?hers under with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: ) 4/3z y f4.. ..... , / jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: rotitr IL OIiZr '77z Z J apply:
Phone: (S!3) Z 31' z 99 f Fax: : (103) -Z d._ L' I
E -mail:
- CONTRACTOR BUILDING PERMIT FEES *.
Business name: f 7 to , ,3 � � !tG (Please refer to fee schedule)
/, j ' Permit fee:
Address: it/52,y $ S Alfa
City /State /ZIP: �,e/� � t .07 Z 33 State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (A 151 L 4 I e Fax: (s q) Z-5 y� qi (Due upon application.)
CCB lic.: ‘ 34 5f r ! - / L1- Total permit fees: , , 4/01 Authorized signature: /� t ^ Amount received:
A . t i„.. This permit application expires if a permit is not obtained
Print name: k, v Date: 6A v/hs 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(I1 /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be clone:
1.) ❑ N w 2.) Modification to sprinkler heads only:
Ad dition 010 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 1
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: $ 7f.5.
•
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): $
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.
I:\ Building \Pemits \FPS- PcrmitApp.doc 10/01/09 2 •