Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1 11 - : - COMMUNITY DEVELOPMENT Permit SS: FPS2010 -00093
Date Issued: 09/23/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 600
Subdivision: LINCOLN CENTER/FIVE LINCOLN Lot: 0
Project: Axium
Project Description: Fire alarm
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
Permit Fee COM 08/31/2010 $134.48
CALIFORNIA ST 49TH FL 12% State Surcharge - Building 08/31/2010 $16.14
PHONE: Plan Review - Fire Life Safety - COM 08/31/2010 $53.79
Contractor:
CAPITOL ELECTRIC CO INC
11401 NE MARX STREET
PORTLAND, OR 97220
PHONE: 503 - 255 -9488
FAX: 503 - 257 -7121
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: B Height: ft
Stories: 6
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: Yes Alarm Type: Automatic
Pull Station Required: No Smoke Detectors Req: No
Battery Calcs Provided: Yes Cut Sheets Required: Yes •
Total $204.41
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 6000
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: �J / Permittee Signature: 04 / �.P �,� 77 d
� lY 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 RECEIVES FOR OFFICE USE ONLY Received �j t
City of Tigard Date /By: 2) J� /� Permit No.: AdjaQ(Q 9 3
13125 SW Hall Blvd., Tigard, OR 97223 ( e� u Plan Review t ,
10 /p �
OC /
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: . Other Permit: �u ��O
lur is: ® See Page 2 for
TIGARD Inspection Line: 503.639.4175 Date Rea /By: g
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Q /a �� �� Supplemental Information
BUILDING DIVISION ,/ I/�y
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
® 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 ® Commercial/industrial Valuation: $
11 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: 10200 SW Greenburg Rd. (Five - Lincoln) New dwelling area: square feet
City/State /ZIP: Tigard., OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Suite 60 Project name: Axium T.I. 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: 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
DESCRIPTION OF WORK work indicated on this application.
Install Fire Alarm Horn /Strobes & Strobes in Suite 600 Valuation: $6000
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Shorenstein Realty Services Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 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:( ) Fax::( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: Capitol Electric Company, Inc. (Please refer ro fee schedule)
Permit fee: 134.48
Address: 11401 NE Marx Street
State surcharge (12% of permit fee): 16.14
City/State /ZIP: Portland, OR 97220 0
FLS plan review (40% of permit fee): 53.79
Phone: (503) 255 -9488 Fax: (503) 255 -1966 (Due upon application.)
CCB lic.: 48748 Total permit fees: 204.41
Amount received:
Authorized signature: L y 1/1
This permit application expires if a permit is of obtained
Print name: Dan Wilson Date: 8/23/2010 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I:\BuildinePermits \FPS- PermitAppdoc 03/23/06 440- 46 13T(l l /02 /COM /WEB) .6e/
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 ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work
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 ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 4,600
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): $ 6,000.00
Permit fee based on project valuation (see fee schedule): $ 134.48
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $ 16.14
FLS Plan Review (40% of permit fee): $ 53.79
TOTAL: $ 201.41
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 NICFT level "3" technicians.
U: \FA Jobs \zz100944 -45 Axium, 5Lincoln- 600\ 1 FPS- PertnitApp.doc 2
PERMIT FEE DOUBLES IF WORK HAS STARTED WITHOUT BENEFIT OF PERMIT
40 CALCULATE TOTAL FEE
PERMIT FEE CALCULATION (REFER TO TABLE)
$ 6,000.00 ROUNDED VALUATION
$ 91.44 (BASE FEE FOR FIRST $ 2,000.00 OF VALUATION)
+ $43.04 ($ 10.76 PER $ 1,000.00
$134.48 (SUBTOTAL A)
x 1.52 $1.52 (PLAN REVIEW CHARGE = 40 %, STATE SURCHARGE = 12 %)
$204.41 TOTAL DUE FOR THIS PERMIT
EXAMPLE