Permit III V CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
0. COMMUNITY DEVELOPMENT Permit #: FPS2010 00085
T r �� R. r_) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2010
Parcel: 2S112DD00400
Jurisdiction: Tigard
Site address: 15912 SW 72ND AVE B17
Subdivision: OREGON BUSINESS PARK I Lot: 17
Project: JOHN CRANE INC
Project Description: Add /relocate approximately (20) sprinkler heads as needed for TI.
Owner: FEES
PACTRUST Description Date Amount
15350 SW SEQUOIA PKWY SUITE 300
Permit Fee COM 08/06/2010 $80.68
PORTLAND, OR 97224 12% State Surcharge - Building 08/06/2010 $9.68
PHONE: 503 - 624 -6300 Plan Review - Fire Life Safety - COM 08/06/2010 $32.27
Contractor:
WYATT FIRE PROTECTION INC.
9095 SW BURNHAM
TIGARD, OR 97223
PHONE: 503 -684 -2928
FAX: 503 -684 -9657
Type of Use: COM
Class of Work: ALT Type of Const: IIIB
Occupancy Grp: B Height: ft
Stories: 1
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 $122.63
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 rules
or direct questions to OUNC by calling 503.246 nr 1 :00.332.2344.
//
Issued By: / Permittee Signature:
=�'
Call 503.639.4175 by 7:00 a.m. for an inspection that busi - ss day.
This permit card shall be kept in a conspicuous place on the job site unti completion of the project.
Approved plans are required on the job site at the time of each inspection.
.Builciiing Permit Application
Fire Protection System � , O . --) FOR OFFICE USE ONLY •
1_ ' L ,
li City of Tigard ` � 'l � 1
� Received 0 6 4 Permit P
I - Date/B : 0 r SO OQ 5
1 3125 S W Ha Blvd., Tigard, OR 972 2j Plan Review ' ���
Phone: 503.639.4171 Fax: 503.598.199A 6 2�1� Date/B : ,� 1 1 0 Other Permit: q 1 646...,00/ 7d
TIGARD Inspection Line: 503.639.4175 Date Ready/By: ®See Page 2 for
Internet: www.tigard or.gov ; - • q Notified/ ��_ Supplemental Information
Wr it– v na �i 1 � _t
TYPE OF WOW(' ` - 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
Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling 'ommercial/industrial 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: 1 v:7) / z, j j 7z 'O ,41.- New dwelling area: square feet
City/ State/ZIP: ! l a 2 J_ og__ / —72-11- Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: J0141,1 ANN, 1 4c. Covered porch area: square feet
Cross street/directions to job site: 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
/ n DESCRIPTION OF WORK work indicated on this application.
14 D % Rr ,\ cm----r �eg ,q1 , d ! /,4/ d � y Valuation: $ I Z� c ''v
hi-C.-A-05 �� / /c ` �� / � i ✓ ) �!/tE Gi .- Existing building area: square feet
�it /�- S �� 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:
- 0–APPLICANT ❑ CONTACT PERSON NOTICE
Business name: -- 6 1 A/ 7 A - G7(9X — 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
apply:
Phone: ( ) • I Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: i,c/'f 4 T� � �gr T S - - oAj (Please refer ro fee sc/hedule)
D 9 5 c5 A V / �- Permit fee: gQ.
Address: Y 7:30/Zvi-Am C o
City / State/Z1P: � 6 � 2 7 Z'z _ State surcharge (12% of permit fee): l , �p D
/ FLS plan review (40% of permit fee): 2 a a
Phone: (5 6[34_ - Z9 2 s Fax: (Gj j)3) 6 - 965-7 (Due upon application.) 01 e
CCB lic.: &z 07 -' Total permit fees: /a 2. to 3
Authorized signature: Amount received:
T his permit application expires if a permit is not obtained
Print name:v6 - j r- j am Date: 1 t3 --6, l within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits \FPS- PemdtApp.doc 03 /23/06 440- 4613T(1I /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
-- Alteration j41+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: -
Additional description of work:
A Q !' Gq-i A PIP- • 0- /2 /N /(L — Hi
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: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
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 $292.50
7,201 and greater $381.50
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.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
htt p: / /wuw.ci.tigard.or.us /city_haq/ departments /cd /docs /FPS - PermitApp.doc 2