Permit a CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1 COMMUNITY DEVELOPMENT Permit #: FPS2009 -00082
T GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2009
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Spec Space
Project Description: Alteration of (6) fire sprinkler heads for TI.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Permit Fee COM 09/01/2009 $62.50
PORTLAND, OR 97224 12% State Surcharge - Building 09/01/2009 $7.50
PHONE: 503 - 624 -6300
Contractor:
FIRESTOP CO
3203 NE 65TH ST. #2
VANCOUVER, WA 98663
PHONE: 360 - 718 -8604
FAX: 360 - 718 -8603
Type of Use: COM
Class of Work: FPS Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard:
Density: Design Area:
K Factor:
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $70.00
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1500
Residential Square Footage:
Fire Alarm Valuation:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. • • • . 'II be done in accordance with approved plans. This permit will expire if work is not sta =• within 180 days of
issuance, o • work is suspe • ed for more the 180 days. ATTENTION: Oregon law requires you to follow the ru adopted by the Oregon
Utility N• 'cation Center. Thos. - . e se forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You r - •btain . copy of the rules
or dire questions to OUNC b (ling 5• •.6699 or 1.800.332.2344.
Issue. 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
Fire Protection System RECEIVED i.t)I, OFFICE USE ( /NI.)
City of Tigard RRee ed Permit No.: n�� p l
11111 13125 SW Hall Blvd., Tigard, OR 97 3 Plan Review O S4� /0f+
Phone: 503.6 39.4171 Fax: 503.598 1 ?_Q09 Date/B : Other Permit: ea P(90,9-40/
i- .i ` ti r� Inspection Line: 503.639.417 Date Ready/By: r ® See Page 2 for
Internet: www.tigard or.gov CITY OF TIGARD Notifted/Method: Un Supplemental Information
BUILDING DIVISION
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 or the
CATEGORY OF CONSTRUCTION work indicated on this application.
dwelling Valuation: $ /
y g ❑ Commercial/industrial
//, 7
❑ 1- and 2-family
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floo .
Job site address: I (0 (QS 5 '7 7- A (A— - Z a 0 New dwelling . - square feet
City /State /ZIP: - f - 4 - 1 -c DI`- qi 22,t4 Garage/carps area: square feet
Suite/bldg. /apt. no.: ,. Zoo Project name: pBc., 1(o8- S pEL Covered • rch area: square feet
Cross street/directions to job site: Dec : ea: square feet
• • er 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
/j f , DESCRIPTION OF WORK work indicated on this application.
P (fit- F-1 rt_ P.-1 - 04 Oro 5(.35- }'E✓"- Valuation: $ 500
Existing building area: square feet
New building area: square feet
X PROPERTY OWNER I ❑ TENANT Number of stories:
Name: J (A_ L 1 r cti Se Type of construction:
Address: I53S0 LO S ( )t a • 1 l/ tn.> �/ 4300 Occupancy groups:
City /State /ZIP: po r--} ( Q e 9 7 Z- Z N Existing:
Phone: (S=3) ( O Z Li - ( p 3O0 Fax: (SC.3) 6, 2`_ 7 7 New:
XI APPLICANT )0 CONTACT PERSON NOTICE
Business name: Fe � l-,,,� ( r) pl ,i y All contractors and subcontractors are required to be
Contact name: Q I C- &—k-8-`--- licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 32 ® h -t L $cf jurisdiction in which work is being performed. If the
City /State /ZIP: `/ / LJ/1 (386 / 3 applicant is exempt from licensing, the following reasons
P h o n e : ( , ) ^] ( 8 ^ S w Lf Fax :: ( - 7 1 8 , B(0 03
E-mail: A. (et`. g 4- , ....„- f D ) C . co el-
CONTRACTOR BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
Permit fee: (SJ
/ .
Address:
4:, Wl �C___ State surcharge (12% of permit fee): Il
City /State /ZIP: °
FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application)
CCB lic.: Total permit fees: 70 . oc)
Amount received:
Authorized s' at
p, This permit application expires if a permit is not obtained
Print name: I Date: .-- l .- O / within 180 days after it has been accepted as complete.
` • Fee methodology set by Tri-County Building Industry
Service Board.
I:\ Building \Permits'FPS- PennitApp.doc 03 /23/06 440- 4613T(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 Xf 1 -10 heads: No plan review required.
;MirAlteration El 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 I
Density •I ZdvD
Design Area
K. Factor
Sprinkler Project Valuation: $ 50 v
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: $
D.) Residential Sprinlder (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.
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