Permit . .
... .
A .
CITY OF T BUILDING PERMIT
PERMIT #: BUP2004 00535
r � i � n DEVELOPMENT SERVICES DATE ISSUED: 12/10/2004
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S112DD -00200
SITE ADDRESS: 15618 SW 72ND AVE
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,000.00
Remarks: Fire sprinkler TI, modification of (17) heads.
Owner: Contractor:
PACIFIC REALTY ASSOCIATES WYATT FIRE PROTECTION INC.
15350 SW SEQUOIA PKWY #300 -WMI 9095 SW BURNHAM
PORTLAND, OR 97224 TIGARD, OR 97223
Phone: 503 - 624 -6300
Phone: 684 -2928
Reg #: LIC 64077
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 11/12/2004 $62.50 Sprinkler Final
[TAX] 8% State Surchari 11/12/2004 $5.00
[FLS] FLS Pln Rv 11/12/2004 $25.00
Total $92.50
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 than 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 these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
.
Issued By: .,�p
Permittee
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day
I S tl8 SW LZNF
Fire Protection System
Buddin Permit Anplicati
� fn' n ';v FOR OFFICE USE ONLY
City of Tigard A � Date/B /1 iffA l, il -Ile 55S/
13125 SW Hall Blvd., Tigard, OR 97223 ,, U I ' OA Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 hrcl; I Date Date/By: 7 -Qy v f f Other Permit:
Inspection Line: 503.639.4175 1 `' y F'' � � Ready/By: /
sP �� - �. _ _ Meth i See Page 2 for
Internet: www.ci.tigard.or.us •\iN t ,' - ,' ' Noti
' fied /ed/Meth9El: � /� 0 7� 1� // ® Co Supplemental Information
y , il A`'.�,e,' 1,,t 6 e, O�� �s V"K, \ \3)Q 01 lid
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
12:1Addition/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 N.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: S(cite "1 cot \ • New dwelling area: square feet
City/ State/ZIP: c'TIpf\J t O Garage/carport area: square feet
Suite/bldg. /apt. no.: I Project name: 2,10 \f aO n/i 50 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIALrUSE 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.
- Few NT -oV e)iteN + Valuation: $ �J ` DOD . 60
Existing building area: j square feet
New building area: square feet
• . ❑ PROPERTY : OWNER 1 ❑ TENANT Number of stories: .
Name: Type of construction: 5 N
Address: Occupancy groups: 13
City/State/ZIP: Existing: x
..LS
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON .
NOTICE ° . . .
Business name: (se& C,N �fio� 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
Business name: ac ft F rP� Pvviec1hoo -- 1_1\1 CJ BUIL DING PERMIT FEES* -
Address: q S \ \ V P)V Y N 1 ' 1
•, \ Please refer to fee schedule
City/ State/ZIP: 11( 0 Y) O ff. q - . - Z3
� Fees due upon application
Phone: `vJlf7j 4 . IA Fax: (S A.. • A to 1
CCB lic.:
�o ; � Amount received
Date received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: l c./ A y' . Date: I l . 17-. • Fee methodology set by Tri -County Building Industry
Service Board.
i:\ Building \PcrnitstFPS- PermitApp.doc 12/03 440.46I3T(II /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 .2 heads: Plan review required.
❑ Repair
Number of sprinkler heads: \1
Additional description of work:
Type of System (Com s fete 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: $ 2 ()C0 D
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: 1 $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ 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.
Project Valuation Subtotal (A, B & C): $ Z, (y.y) . ��
Permit fee based on valuation (see attached chart): $ (�2 . S()
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $ Cj . 0
FLS Plan Review 40% of Permit Fee: $ Z. �j . 0 0
TOTAL: $ Ct Z . c, n
Plan review requires a completed application and 3 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.
i:\Building\Forms\FPS Checklist.doc 12/29/03