Permit CITY OF T FIRE PROTECTION SYSTEM PERMIT
s y n TIGARD
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00143
� •
13125 SW Hall Blvd Tigard OR 97223 503.718.2439 Date Issued: 11/17/2010
TiGARD Parcel: 2S101 DB00100
Jurisdiction: Tigard
Site address: 7320 SW HUNZIKER RD 320
Project: Golsan Scruggs Subdivision: Lot: 0
Project Description: Adding (6) sprinkler heads to existing system.
Contractor: FIRESTOP CO Owner: HILLTOP BUSINESS CENTER LLC &
3203 NE 65TH ST. #2 HUNZIKER LLC
VANCOUVER, WA 98663 9430 NW KAISER RD
PORTLAND, OR 97231
PHONE: 360 - 718 -8604 PHONE:
FAX: 360- 718 -8603
FEES
Description Date Amount
Specifics: Permit Fee - COM 11/17/2010 $83.37
12% State Surcharge - Building 11/17/2010 $10.00
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type:
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 $93.37
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
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 yo 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 0 ,9 . You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1' • .8a i — • •
Issued B Permittee Signature:
_as.=
Call 503. •.y 7:00 a.m. for the next available inspection date.
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
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Fire Protection System FO OFFICE: USE ONLY"
City Tigard T1 and ` DateReceived B Permit No:
13125 SW Hall Blvd., Tigard, OR 97223 Aging= Permit �I z 1�
C Phone: 503.639.4171 Fax: 503.598.1960 Nov 11 201 Date/B Review Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By: ®See Page 2 for
Internet: www.tigard- or.gov i C � �. 1 Y o �`�p,RD Notified/Method: Supplemental Information
TYPE OF W011 I LDlit D,vIS7IQN
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 do9,a0 of all
Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. /
Valuation: S �X�
❑ 1- and 2- family dwelling Commercial /industrial / 106;-2
i f
CI Accessory building CI Multi-family Number of bedrooms: ///
CI Master builder 1:1 Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: '1 - Z S c-) 14,,,,,,k, �k... t..--- New dwelling area square feet
City /State /ZIP: Gk, ✓Gl Q i ��.� 2.-Z-3 Garage /carpo area: square feet
Suite/bldg. /apt. no.: 4 Project name: G5-G, 1 `i e v s, Covered p rch area: square feet
Cross street/directions to job site: Deck area: square feet
OtTistructure 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.
1 i Valuation: 5 . 1L1
5 S Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER R TENANT Number of stories:
Name:
G.. c> l st � S c',,r ��S Type of construction:
Address: S Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax:( ) New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: ,, p (....c L L (.. All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
` x , `� under ORS 701 and may be required to be licensed in the
Address: .c 2.- fkae S-tt . S F., Ji 2_._ jurisdiction in which work is being performed. If the
City /State /ZIP: l / (J ?� applicant ant is exempt from licensing, the following reasons
Phone: (SC'l') 1 1 p . �(� j C(/0 ii Fax:: (360) -1 1 CJ - C� 6,0 S
E -mail: cj QC.-(. ^ ..� ,, ,r•, S �V co .. co ..,,
CONTRACTOR BUILDING PERMIT FEES*
(Please refer tofeeschedule)
Business name:
SC .t e_ Permit fee: Y 3 3 7
Address:
State surcharge (12% of permit fee):
City /State /ZIP: o
FLS plan review (40% of permit fee):
-
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.: l 3 2, • Total permit fees: (U cri)
Authorized signature: (_� , / .-- Amount received: t' C 3 „ 3 - 7 ,
This permit application expires if a permit s not obtained
Print name: p within 180 days after it has been accepted as complete.
( � L i /J r.� Date: t .- it)
Fee methodology set by Tri- County Building Industry
Service Board.
1:\Building\Permits'FPS- PermitApp.doc 10/01/09 440- 4613T(11/02/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 Si, 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair r
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: $
D.) Residential Sprinkler (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.
I: \Building \Perrnits \FPS- PcmutApp.doc 10/01/09 2
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