Permit q CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IN
! 2 , COMMUNITY DEVELOPMENT Permit #: FPS2010 -00091
G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2010
Parcel: 1S135BA00100
Jurisdiction: Tigard
Site address: 10205 SW WASHINGTON SQUARE RD
Subdivision: WASHINGTON SQUARE TOO Lot: 0
Project: Thirsty Lion
Project Description: Adding (1) and relocating (1) sprinkler head.
Owner: FEES
PPR SQUARE TOO LLC Description Date Amount
BY THOMSON PROPERTY TAX SERVICES,
Permit Fee COM 08/18/2010 $51.09
2235 FARADAY AVE STE #0 12% State Surcharge - Building 08/18/2010 $6.13
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
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 $57.22
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
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 alii
or direct questions to OUNC by calling 503.246.6699 or 1 :1 I _ 2344.
Issued By: � — - e igriature: �r _add,
Call 503.639.4175 by 7:00 a.m. for an inspection that busine - day.
This permit card shall be kept in a conspicuous place on the job site until .mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System �� FOR OFFICE USE . '
11114 City of Tigard a Y � � Date Received Other Permit: .`U� / I
1 3125 SW Hall Blvd., Tigard, OR 972 r �O 4 , (J Tr Permit
Plan Review ill I
'�� p
Phone: 503.639.4171 Fax: 503.598.1960 \( 1� DateBy /1�� I(� — [1' 73
TIGARD Inspection Line: 503.639.4175 P�, J ���^ Date Ready/By: 3uris: ee Page 2 for
Internet: www.tigard - or.gov i\ 1 � ClV Notified/Method: a Supplemental Information
`( ® G
TYPE OF WO REQUIRED DATA 1= AND 2 FAMIL\ 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
V<Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
`. C ATEGORY OF CONSTRUCTION , work indicated on this a p p lication .
❑ 1- and 2- family dwelling Kommercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
30B SITE INFORMATION AND' LOCATION Total number of floors:
Job site address: /0 7 5 w vk.i JJ,.., 5Q , iD New dwelling area: square feet
City /State /ZIP: - (*41 ( i O2 917,Z-7- Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: o _ f r L.10,4 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL 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.
„ lb j �,4._ 1 S pI L D ivi� � 1.104...0___ Valuation: $ Z 7.
WO , , / /5 'R , 17 e�tlit � ' ' ' i K . t D Existing building area: square feet
pc_oc -r e He5 € DI AJ/M a Roo 1,/ New building area: square feet
❑ PROPERTY OWNER ❑ TENANT' ' - '" ' ' ' Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( ) New:
.w `_ -
y �
PLICANT = 0 PERSON � NOTICE
Business name: ,.i-- eiom 7 ' 4 _-_ 7 2 , 2 All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State /ZIP: applicant is exempt from licensing, the following reasons
a pply :
Phone: ( ) Fax:: ( )
E -mail:
C ONTRA C TOR _ BUILDING, PERMIT FEES*
Business name: v� r4, r e,- � `� L' I"� ' � r- G ` Y 7o (Please refers; jee sclied ile) ' .
q� ,; / p Permit fee: S. - I Jq
Address: 9 2� ! /y 5 SN-r at) F -in � 5.-r,
/ q State surcharge (12% of permit fee):
City /State /ZIP: O Die, 9 7Z
FLS plan review (40% of permit fee):
Phone: (5Z)3) 4 _ Z9 a Fax: (a � -96s (Due upon application.)
CCB lic.: & Total permit fees: cs-7. ).)_
Authorized signature: Amount received:
v ` This permit application expires if a permit is not obtained
Print name:c / / 41 —1 J Date: 6 /�"rj "`c within 180 days after it has been accepted as complete.
v * Fee methodology set by Tri-County Building Industry
Service Board.
L \Building\Permits \FPS- PermitApp.doc 03/23/06 440- 4613T(11 /02 /COM/WEB)
:f- . .�
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
1.) ❑ 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:
Additional description of work:
T:ypeof'Sysiem „(Complete A B C oir D as applicable), £ a ,
A.). Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I Hood Fire Suppres System t T z , , , , �r , r : _ ._ , . . ,1 z,K.-.0
Hood Project Valuation: $
C )Fire Alarm, r�
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
q'i z �
D )d Residential Sprinkler (Stand A1one System) z =�# _ , . t
y.. � . , ,4 � ,.�.,��_ ���� �, „ �� .� . �.�: � '�
Square Footage: Permit Fee: t
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50 k
. 7,201 and greater $381.50 ���
Sprinkler Project Square Footage: sq. ft.
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.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
http: / /www.ci.tigard.or.us /city_ hall /departments /cd /dots /FPS - PermitApp.doc 2
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Tigard, OR 97223
(503) 684 -2928
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FIRE PROTECTION, INC.
_ 9095 S.W. Burnham
, Tigard, OR 97223
(503) 684 -2928