Permit -� ` A is FIRE PROTECTION SYSTEM PERMIT
> CITY OF TIGARD
t `` COMMUNITY DEVELOPMENT Permit #: FPS2009 -00095
' ' „ `M Date Issued: 10/28/2009
TEGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 150
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Scheller Financial
Project Description: TI relocate (7) heads, add (6).
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 Permit Fee - COM 10/14/2009 $62.50
12% State Surcharge - Building 10/14/2009 $7.50
PHONE: 503 - 624 -6300 Plan Review - Fire Life Safety - COM 10/14/2009 $25.00
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:
Occupancy Grp: B Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm Svstem:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $95.00
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1560
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 1.800.332.2344.
Issued By: o g ^ - w ^ Permittee Signature: ,
/
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
/ Fire Protection "' 1 CEIVED ' System 1 ` 1
y F OR O F F I('E USE OI . 1 , •
City of Tigard Received
III • J b P erwt'vo. r
13125 SW W Hall Blvd., Tigard, OR 9 7223 OCT 1 4 2009
D ate /Bv t S20 r,,, r� G S
Plan Review t �� ether Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date /Bv: ���in i /, ig�
T t A R p' Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /B uris:
Internet: www.tigard -or. ov Notified Mfethod: See Page 2 for
g BUILDING DIVISION 1 lq S Supplemental Information
• TYPE OF WORK REQUIRED D&TA. 1 A,ND 2 -FA IILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value ( rowded to the nearest dollar) of all
0 Addition/alteration /replacement ❑ Other:, equipment, materials, labor, overhead, and the profit for the
work indicated on this application.
CATEGORY OF CONSTRUCTION aPP
El 1- and 2- family dwelling lgisCommerciallindustrial Valuation: $
❑ 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: Iea'Oq c ( , New dwelling area: square feet
'
City /State /ZIP: (-*% Ln� 0 R .0 7.9.1_I Garage /carport area: square feet
f !� n
Suite ldg. /apt. no.: 150 Project name: ruUQ. Cp-fliel Covered porch area square feet
Cross street/directions to job site: 5ale.II6( iDa a 1 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 (rotnded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
A 7 (Ind
DESCRIPTION OF WORK om- work indicated on this application.
Np 1occk. ! heads ( 6 Tor naz I. Tr. Valuation: SI, 5 (e0. 06
Existing building area square feet
. New building area: square feet
❑ PROPERTY OWNER 0 TENANT . Number of stories: A-
Name: Type of construction: •Z(
Address: Occupancy groups:
City /State /ZIP:
Existing:
Phone: ( ) Fax: ( )
New:
g APPLICANT ❑ CONTACT PERSON
� NOTICE
Business name: )e_ ' i ri «, plc. All contractors and subcontractors are required to be
Contact name: HeAcA 1 YrAiro c ij T f C' p e o _fer licensed with the Oregon Construction Contractors Board
I •\ z under ORS 701 and may be required to be lensed in the
Address: ItJlq 5 c t 7'a A jurisdiction in which work is being performed. If the
• ,� _ ( ` O n f a n applicant is exempt from licensing, the following reasons
f ,
City /State /ZIP: &19.0 1I^^ ^^ V P1 Ok7 �l �,p apply:
E Phone: — ` // 1 - 10 f7- r Fax: : (J✓v' (0a " 10 FA
E -mail: h e'loh @ del"I c�QIre . corn
CONTRACTOR .BUILDING PERMIT FEES*
� 1, � , �. - { (P lease refer to lee schedule
'
Business name: Del-c` r `(e- t � nC.
I'7'5 5 , y9 � Ai Permit fee: 64 5° Address: [. y l I / A N" State surcharge (12% of permit fee): i 50
City /State /ZIP: 'PO r4 anal OR - / 9 4 FLS plan review (40 %ofpermit fee): V
Phone: (F03 Coao - "{V,9.I.J Fax: 31 <4(90.— I06g (Due upon application.) 5,00
CCB lit.: C I 7(J Total permit fees: 5
/ Amount received:
Authorized signature: A This permit application expires if a permit is not obtained
Print name: 'Heid'� C�.f.0 lo`n(� I Date: I0I Ne5)..009 * within 180 dais after it has been accepted as complete.
Fee methodoloev set by Tri County Buildine Industry
Service Board.
i' .' Buildine 'd'ermitsTPS- PermoApp. doc 03/23/06 440- 4613T(11.02,CO6bWEB)
City of Tigard: Fire Protection Permit Checklist .
Page 2 - Supplemental Information A
Describe work to be done: •
1.) • New 2.) Modification to sprinlder heads only:
_Addition ❑ 1 -10 heads: No plan review required.
V Alteration )g` 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 13
_Additional description of work:
Type of System (Complete A, B,•C or D as applicable): •
A.) Commercial Sprinkler
Wet ❑ Dry .
Additional Standpipes MA .
Information: Hazard Group L — ► --
Density •
Design Area .. . , . . .
K. Factor 6.(o a.
Sprinkler Project Valuation: $ 0500.00
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $ )J/A
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ NA-
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 I $292.50 .
7,201 and greater $381.50'
Sprinkler Project Square Footage: M /fC sq. ft.
Fire Protection Permit Fees .
Project valuation subtotal (see A, B & C above): $ l � � 00 . •
Permit fee based on project valuation (see fee schedule): $ (ea
Permit fee based on square footage (see D above): I $ //A ' :- ,
• State Surcharge (12% of permit fee): $ 1 , 6
FLS Plan Review (40% of permit fee): ! $ a5 , 0
TOTAL:$ C1 0 .
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. 0
!: '\Building \Permits \FPS- Per^iiAA.pp.coc 2