Permit r
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
ill COMMUNITY DEVELOPMENT Permit #: FPS2010 00095
131 25 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/12/2010
TIGARD Parcel: 2S101DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Subdivision: FARMERS INSURANCE Lot: 0
Project: Triangle Pointe
Project Description: New spinkler system.
Owner: FEES
TRIANGLE POINTE LLC Description Date Amount
901 NE GLISAN ST #100
PORTLAND, OR 97232 Permit Fee - COM 08/31/2010 $220.56
12% State Surcharge - Building 10/12/2010 $26.47
PHONE: Plan Review - Fire Life Safety - COM 08/31/2010 $88.22
Permit Fee - COM 10/12/2010 $583.48
Contractor: 12% State Surcharge - Building 10/12/2010 $70.01
PATRIOT FIRE PROTECTION INC FLS Plan Review 10/12/2010 $233.40
4708 NE MINNEHAHA ST
VANCOUVER, WA 70822
4 PHONE: 360- 699 -4403
FAX: 360- 699 -4485
Type of Use: COM
Class of Work: ALT Type of Const: IB
Occupancy Grp: B Height: ft
Stories: 5
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
Density: .1 Design Area: 969
K Factor: 11.2
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $1,222.14
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 99000
Residential Square Footage: 0
Fire Alarm Valuation: 0
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: Permittee Signature: ,. / .1. :; 11. ;.... ,,, - _ ,...,,,
I
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 FOR. OFFICE•USE O
flfl Received
City of Tigard f ' Y� r_ - DateB : t
Permit No.: n eS AL l0 • cc y
° 13125 SW Hall Blvd. Tigard OR 97223 Plan Revie�• „ ,
C ' Phone: 503.639.4171 Fax: 503.598.19( �`- "' , td � _ Date /Bv: 0 Other Permit:
T I G A It Ins Line: 503.639.4175 Date Ready :y: ,,. ® 0 See Page 2 for
Internet: www.tigard- or.gov AUG 31 2 010 Notified/Method: /Q 4g- /a ' t, S Supplemental Information
_ .... �
TYPE OF WORVFY C: -''i'" tlli REQUIRED DATA: 1- AND 2- FAMILY DWELLING
f�1 W "•1 °•t \tom idly tvl �' " Permit fees* are based on the value of the work performed.
❑ New construction • El �Demolrtton p
7 J Indicate the value (rounded to the nearest dollar) of all
I4 ddition/alteration / replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
111 1 -and 2- family dwelling Nommercial /industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
111 Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ` "S'c'Z SI..■..) p 6.63.-t-44 P� �/ New dwelling area: square feet
City /State /ZIP: T (FA D 1 v K. G(�ZZ " [/ Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: g_ ,0—.)e.... LE Pmt pip 7 F 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.
k •-,,,
, — PPr- , V i (P IL)F \,•/ mti K/ EPA. t Valuation: * $
cv SZ &iv.' r,--,c_ E ---i c ee l i)LT Existing building area: square feet
New building area: square feet )
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups: Q FF1 L•E
City /State /ZIP: Existing: Lt 4-11 }4Z
Phone: ( ) Fax: ( ) New: ` ` 1 /
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: P c ` c-: "-re-«1 V i,„_, ( r All contractors and subcontractors are required to be
Contact name: �� Cc., LL, t licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 4, Es poJ t E`.) ki A\ b-- !/,.,. C ` jurisdiction in which work is being performed. If the
City /State /ZIP: U,uuC - C.-)it\ l �' i (9 1 applicant is exempt from licensing, the following reasons
�— apply:
Phone: C Z ( 0 / �Ill tl ' I' Fax e,90 )) 62CIe —Z J Ljc✓ 518 5 �✓ ' x-
E -mail: a . (i IC , E` t 11E" N /� W (2,6
CONTRACTOR BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
Permit fee:
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:: . 70 g2 Z • _ • Total permit fees: x "3 3 5, 15
Authorized signature: Amount received:3�1 r (4
This permit application expires if a permit is not obtained
Print name:
/J - , 1 - .. �,�(�_ t �� Date: ( l..J 0 ( 0 within 180 days after it has been accepted as complete.
�
* 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)
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City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe wor o be done:
1.) E "<ew 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 1
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.
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