Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2009 -00107
T t GA:RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/12/2009
•„, Parcel: 2S112AD01000
Jurisdiction: Tigard
Site address: 7007 SW CARDINAL LN 105
Subdivision: Lot: 0
Project: Spec Space
Project Description: Less than (10) heads modified on existing sprinkler system.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - COM 11/12/2009 $67.23
PORTLAND, OR 97224 12% State Surcharge - Building 11/12/2009 $8.07
PHONE: 503 - 624 -6300
Contractor:
FIRESTOP CO
3203 NE 65TH ST. #2
VANCOUVER, WA 98663
PHONE: 360 - 718 -8604
FAX: 360- 718 -8603
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: 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 $75.30
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1100
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 start:: ithin 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the ru •s ao.epted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You -y obtain a opy of the rules
or direct questions to 9UNC by calling 503.246.6699 or 1.800.332.2344.
I /
Issued By: C ( '�' tC ; I ;� t , j t 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 System RECEIVED F014 OFFICE USE ONLY
Ci ty of
Received
Date /Bv: C-.,G 1 Permit No.: l V :j2coq CO 4111 Tigard
a 13125 SW Hall Blvd., Tigard, OR 97223 NOV 1 2 2009 Plan Review Other Permit.
Phone: 503.639.4171 Fax: 503.598.1960 Date /B :
Inspection Line: 503.639.4175 Date Ready /By: ® See Page 2 for
T 1 G A RD p CITY OF TIGARD Notified Method: Supplemental Information
Internet: www.tigard- or.gov BUILDING DIVISION
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
'A ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this appli 4tion.
Valuation: d�
❑ 1- and 2- family dwelling commercial /industrial l l
// `` Number of bedrooms:
❑ Accessory building ❑ Multi- family
❑ Master builder Number of bathrooms:
❑ Other:
JOB SITE INFORMATION. AND LOCATION / „, - Total number of floors:
Job site address: ,--- 70( 7 - 7 S, (,_ LC, vd t Yom. - C_-_�. New dwelling area: square feet
v 4
City /State /ZIP: Po '- / Q f< 9 - 7 Z-7-,q Garage/carport ar square feet
Suite/bldg. /apt. no.: OS 1 Project name: P c � ( � 7_3"l — � .s � Covered pore area: square feet
�
Cross street/directions to job site: Deck ar :: 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.
Valuation: S
l�0 F' Sprr 141�.� S� -•e.� 't moo.
y
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER • 0 TENANT • Number of stories:
Name: Pa C t tl c..- S + Type of construction:
Address: (S"3 3) 'S' (.L) e._ (ti U t o`. Pk ,) .. Occupancy groups:
City /State /ZIP: ( ---�( - „ , c _Z
57 Existing:
Phone: ( 6.2 2-4 '" (cOoz) Fax: �joj3 �&Z C - 1SS • New:
. • ❑ APPLICANT ❑ CONTACT PERSON - . NOTICE
Business name: �� ,,e - 0 (o . All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: i..\ t t o c A �� under ORS 701 and may be required to be licensed in the
Address: 3 -2_,C)-3 w E GAS 1-, 5f. 4 2 jurisdiction in which work is being performed. If the
�� applicant is exempt from licensing, the following reasons
Cr
City /State /ZIP: -1\.) � U ,, g , - - apply:
Phone: (3 1 (B ' B .... 6 2 c / � Fax: : ( -7 /�- 6 O3
E -mail: A (, 6 .... ) _r fL-J I G d, GZ, . Lc, .,.
CONTRACTOR . . . . BUILDING PERMIT FEES* . .
. (Please referlo fee schedule)
Business name:, �-e-.- Permit fee:
Address:
State surcharge (12% of permit fee):
City /State /ZIP: FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.: / Z -7 9 - Total permit fees:
Amount received:
Authorized signature: I This permit application expires if a permit is not obtained
�7 Qj within 180 days after it has been accepted as complete.
Print name: �� Q„�, Date: L j ` / G_�� ( * Fee methodology set by Tri- County Building Industry
Service Board.
1\Buildin \Permits \FPS- PermitApp. doc 10 /01/09 440 -46 3T(11!02 /COM/WI/B)
. ,
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Descnbe work to be done
1.) 0 New 2.) Modification to sprinkler heads only:
0 Addition , t-10 heads: No plan review required.
LI Alteration 11+ heads: Plan review required.
0 Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Comp1ete A, B, C or D as apphcable)
A) oininerciafSpnhk1er
0 Wet flDry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B) Type 1 HoodFire Suppression System
Hood Project Valuation:
•
Submittal shall Battery Calculations LI Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: $
4:':
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 Protction 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.
1: \ Building\ Permits \ Permit Forms 10-01-09 \ FPS-PermitApp.doc 10/01/09 2