Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00104
Date Issued: 09/23/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 200
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: Health Net
Project Description: Adding (1) horn strobe to conference room.
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Description Date Amount
BB# 73- 1771- GK1130, CBRE, PO BOX 2096 Permit Fee - COM 09/17/2010 $69.92
WARREN, MI 48090 12% State Surcharge - Building 09/17/2010 $8.39
PHONE: Plan Review - Fire Life Safety - COM 09/17/2010 $27.97
Contractor:
SAFE TECHNOLOGY GROUP INC
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360 -699 -2130
FAX: 360 - 719 -1527
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: B 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: Yes Alarm Type: Automatic
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $106.28
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 1200
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. o�
Issued By: 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 f3 1.; L.,' - e
Fire Protection System FOR OFFIC\ USE O!N1..1`
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City of Tigard V � 1 Received eived : ,'( i• Permit No.: j�r
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13125 SW Hall Blvd., Tigard, OR 97 N ■ Plan RevietvlL 6 ^ AI/ � � ' —
Phone: 503.639.4171 Fax: 503.598.1 60 Q Q Dat eB : t./ Other Permit: `
S� PI ttiEi� . dpi u t
Inspection Line: 503.639.4175 '� \C) `1 c %o Date Rea. :y: Aid HI See Page 2 for
I l G A Ii D
Internet: www.tigard ,cJ Q� O \V \ Notifed/Method:q / /0 0 Supplemental Information
TYPE OF WORKV \ '' 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.
CI 1- and 2- family dwelling 0 Commercial/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: 13221 SW 68 Parkway New dwelling area: square feet
City/State /ZIP: Tigard OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: b`-' Project name: Health Net 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.
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.
Add 1 horn strobe in conference room Valuation: $$1,200.00
Existing building area: 600 square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing: B
Phone: ( ) Fax: ( ) New: B
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Safe Technology Group Inc. All contractors and subcontractors are required to be
Contact name: Jason Sweet licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6400 NE Hwy 99 Suite G375 jurisdiction in which work is being performed. If the
City /State /ZIP: Vancouver WA 98665 applicant is exempt from licensing, the following reasons
apply:
Phone: (360) 699 -2130 Fax: : (360) 719 -1527
E -mail: sales@safetechnology.net
CONTRACTOR BUILDING PERMIT FEES*
Business name: Safe Technology Group Inc. (Please refer to fee schedule)
Permit fee: '
Address: 6400 NE Hwy 99 Suite G375
City /State /ZIP: Vancouver WA 98665 State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (360) 699 -2130 Fax: (360) 719 -1527 (Due upon application.)
CCB lic.: 173731 Total permit fees: i UW
Authorized signature: /.0.IN/\e--.. Amount received:
T his permit application expires if a permit is not obtained
Print name: Jason Sweet Date: 9 -16 -10 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Indus
Service Board. , •
1:\Building\Permits \FPS - PermitApp.doc 10 /01/09 440.4613T(1I /02/COM/WEB) 1p /, ,—
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 Sprinlder
❑ 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: 1 $
C.) Fire Alarm
Submittal shall Battery Calculations ET Yes
include: Individual Component Yes
Cut Sheets
Fire Alarm Project Valuation: $ /_t
D.) Residential Sprinlder (Stand Alone System)
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 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.
\ \Safcserver \d$ \SAFE \Forms \Use thcse forms \Permit Apps \Tigard \ FPS-PermitApp.ckc 10/01/09
CITY OF TIGARD FEE AND PAYMENT HISTORY
n
� p 13125 SW Hall Blvd., Tigard OR 97223
• 503.639.4171
TIIGARD
FPS2010 -00104 - 13221 SW 68TH PKWY 200, TIGARD, OR 97223
Revenue Payment
Fee Descr Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Permit Fee - COM 2300000 -43104 $69.92 $69.92 $69.92 9/17/10 Check 179498 $0.00
12% State Surcharge - Building 1003100 -24001 $8.39 $8.39 $8.39 9/17/10 Check 179498 $0.00
Plan Review - Fire Life Safety - COM 2300000 -43108 $27.97 $27.97 $27.97 9/17/10 Check 179498 $0.00
Totals for Fees $106.28 $106.28 $106.28 $0.00
Receipt # Payment Method Check # Pavor: Receipt Date Receipt Amount
179498 Check 1041 Safe Technology Group 09/17/2010 $106.28
Inc.
Total Payments: $106.28
Balance Due: $0.00