Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00073
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/29/2010
Parcel: 1 S 136DD05300
Jurisdiction: TIGARD
Site address: 11850 SW 67TH AVE, STE# 210
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
> Project: American Family Insurance
Project Description: Relocate (3)_pendent heads and add (3) pendent heads.
C 7/2/2010: REPRINTED TO CORRECT SITE ADDRESS.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee - COM 06/29/2010 $59.16
PORTLAND, OR 97224 12% State Surcharge - Building 06/29/2010 $7.10
PHONE: 503-624-6300 Plan Review - Fire Life Safety - COM 06/29/2010 $23.66
Contractor:
AFP SYSTEMS INC
19435 SW 129TH
TUALATIN, OR 97062
PHONE: 503 -692 -9284
FAX: 503 - 692 -1186
Type of Use: COM
Classof Work: ALT Type of Const: IIIB
Occupancy Grp: B Height: ft
Stories: 2
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
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: 750
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: Permittee Signature: ,,q9 (J4/ "9/ / e/19
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 .
� Y" o din Wo ,',t r:w+ 1 v �aA n,� y i , j F�,, p �bn RA � �, r t�
Fire Protect to System CE JE� ; x a re + b `rr ; r ti p g r o R O � icr �lsl t o�r, �' ��a.r r� � ; t r;� ,'r y
a q Received
a, ( A ,iGa ;.,CI of Tl AI d , ' ` �9' :1,, , rec L
7 °. 13125 SW Hall Blvd , Ti g ard ;OR 97223a U 2' 9 in rian Rehet
It p L Q ( A' OlherPermit. gri
Phone 503 63 Fax 503 598 Datel6 . ®. '�� .��� � �� �
, , u . Inspection tine: 503:639,4175 CI OF Date Rcady y June: El Sc e Page 2 for • „Pttt`Aw:tttf�, ., 11te r n e t2 Ww w.t i g atd' or . g u 4 TIGA Notifled/Mei od: Supplemental Information
B UI LD ING •DIV ISI�
hl
TYPE OF WORK REQUIRED_DATA; 1 AND2 FAb11GY DWELLING
:Q New construction [� Demolition Pennit are:based on the value of the work performed.
- Iadicate:the value'(rounded to llie nearest dollar) of all
dditiolt/olteration/replacemenl ❑` equipment, materials, labor, overhead, and the profit.for the
CAT EGORY OF CONSTRUCTION,. n t his p cation.
work i dtcnted o this a pN
Valuation: $
• 0 1- and2- faniily'dwelling [ oinmerciatftndustrial
❑ Accessory Minding D:•Multi omily
N. timber of bedrooms:
Master. builder D Olher: Number of bathrooms:
JOB SITE INrORd1ATIIONANJ3 LOCATION : Total number of floors: •
Job site address, / /I3o a -,) 4, 7 Ncw:dwelling area: square feet
City /State/ZIP: ; a _ op Gara /carport area: square feet
(� p
. Stine/bldg./apt, .r 4t�
1 Pr 1' t� r lNtit1 t4)., cn ,.,t r v24 .,Covered porch area: square feet
Cross street/direc . " r . site: � "" Deck area: square feet
Otherstructure area: square feet
REQULRED bATA COMMERCIAL -USE CHECKLXST
Subdivision: 1 Lot ito.: Pennµ fees* are based on the value of the work perfonned.
lndicate'the value (founded-to the nearest dollar) of all
Tax map /parcel no:: egmpincnt,;materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK ` work indicated on this application. .
:z
1�rj7 ....t
T-.r Vala S 75 v U
q t� p S .:f6 . Existing building arca: �f( tw o square feet
� New building area: j '50 0 square feet •
'- PROPER'T'Y OWNER I ;.. 4 Q TENANT ,< Nuuiberofstories: 1) .
Name: PN,0 P Type of:construction:
Address: Occupancy groups:
•
City /State /ZIP: Existing: '
Phone: ( ) • ' 'Fax :+.(. ) :New:
• �-APPLICANl' _ , 0 CO PERSON `-
a ; . i,._. ., a NOTICE ,
Bgsmess mr»e � . S y,�. _ All contractors
an subcontractors ate regmred to be
Contacfnanie: \ o _ . licensed' with the Oregon Construction Contractors Board
t 1 4 . ' 1 x1. PU: under ORS 701 and may be•required to be licensed in'.tlic
Address:' ` yid Jurisdiction m which Werk is bemk.perfomiedi if the.
Cit /Slate /ZIPa apphcant.is:exempt from licensing, the following reasons
y - c .t =i/ Ic"rlti� apply:
.:Phone: ( ) I ) ' J 1 I Fax:.: ( ) t I Z ii yl
'E -nail - : t- Ct. ! R'r.SyS C' t / r.
CON TRACTOR ": r, IT FEES °
Business ma
BUILDINGP
ERM
nia:
[� {� ,� r :`(PleiuC reN rd rc rrhrdale� - .. ... 1 1 . ! , '9 A"- `J `� 1 Permit fee.
Address: -
Statesnrcharge,(12 %of penult fee):
City /State/ZIP:
.FLS plan; re (40% of permit fee):
Phone: ( ) (, )_ ('7 I :Fax: ( ) �so Z .-f L-5-t, (Due upon application)
CCB tic :: i �'
? Total permit fees:
5 !r i
Authorized signature : 'tiw Amount received:
This permit appllcation.expires if permit is not obtained
Print name; ; t .,(;� - Date: C 1� _-)p within 180 days after it has been accepted as complete.
‘1.0,_ -� * Pee'melhodology set byTri- County Building Industry
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Service Board.
I:\ BuildiegU4rmititFPS •PermiIApp.doc 03/23/06 440.46131(1)f02/COWWEB)
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City of Tig Fire Protection Permit Checklist
Page 2 -- Supplemental Information
Describe wotic t bedone. •
1.) ❑ New. 2.) Modification to sprinkler heads only:
❑ Addition 154 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: •3
Ad ti nal description of work:
o n czc,[J�
Tyke of Syste � Cor n plete ; A ,, B , C or D a a
A) Coinnnerctal Sprrnklle r
(]
Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. 'Factor
Sprinkler Project Valuation: $
B.) .TXPe I Hood Frre:Suppresston System
Hood Project Valuation: 1 $
C.) Fire Alar><n
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
CutSheets
Fire,Alarm Project Valuation: $
D) Resrdential Sprinkler (Stan Alone Syste •
Square Footage: Permit Fee:
()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 Ptotecuon Permit Fees
Project Valuadon subtotal (see A, B & C above): $
Permit fee based on project valuation -(sec fcc 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 coinpleted' application and 2 sets of plans at submittal: Plan: review fees are required at submittal.
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T:\ Building \Pen s \FPS -Pcm App.doc 06/25/08 2
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Building Division
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Over-The-Counter (OTC) Building Permit
TIGARD Check List
Description of Project: TT (S . .
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••••,...„..,,,,,„:„....5:-,,,,,,,,,,,: ,, - ,..,
• Class of Work:* L.,1 Floor Areas (sq. ft): '' - ct, Exterior Wall Construction:
' N S:
Type of Use:* ' First ,,. _ .floor : ‘44.,... :
----,.., .,..., , ,
Type of Construction.: . .4 Second floor: : ''', ct: W: .
Occupancy Group Third floor: i ,... :. _ ,. ., ,t ,., o erungs Protected Y/N
Occupancy Load: ?:
'- Total sq ft.: N S:
Stories: 0-- *1 ▪ Note: Combine total floor area for r,g'.,,.. E: E: _
`.-''
Height: N all floors above third floor and
' T • 4 P". Roof Construction:
44, _
Floor Load: add to the third floor s . ft. . z " ;4,,
Fire Retardant: , ,,K
Basement: Basement: '• .0_°
-...,_...,-4 46 - '''' Area Separation Rated:
...
Mezzanine: AO Garage: .
M. Occu. Separation Rated:
' - r'''''''"'•• (=.-- '`'Y's" . " TRE“fifffi'EM7 ;7`Z ,.,) , ...k.M* ..,-i'
k, ',4: - • • - RE . . .4„..,____.....k4.,
Fire. sprinlder: • Yr" ) t: '' Handicap ac-cess:
Smoke detector: '"!..`:.''',.!.-::,';.„ Proteeted Corridors:
. . - . • .
Fire alarm: _ it -....:--,...,., Parking'spaces (#):
Notes: .
•
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er) .
Total Valuation: $ ---(_-)
. .
r etz,...7 1 ., x , i ,v,mo z za,
Footing/foundation Firewall $ 51, 1 Permit Fee
Post/beam structural Smoke detector $; - 7 ; 10 .State Surcharge
Shear wall Misc. inspection $ f Plan Review Fee
Masonry Approach/sidewalk 2........ (:(-:, FITS Plan Review.Fee
Framing $ Additional Permit Fee
Insulation Sprinkler rough-in $. Additional Plan Review Fee .
Gyp board Fire alarm $ S Metro Construction.Excise Tax
Suspended ceiling Sprinkler final $ School Construction Excise Tax
Final'inspection • $ Misc. •Fee.
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
• $ Other:
$ e)9,7Z-- Total Fees Due
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foundation IPA RIW:aprotection Cttitilligatfkkg 12qp'PTI:
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I: \ Building\ Forms \ OTC,BUP.doc 08/19/08