Permit CITY OF TIGARD ARE PROTECTION SYSTEM PERMIT
14
COMMUNITY DEVELOPMENT Permit #: FPS2010 - 00153
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2010
T i G ARI1 Parcel: 2S 113AA00300
Jurisdiction: Tigard
Site address: 16316 SW 72ND AVE B3
Project: A & I Distributors Subdivision: OREGON BUSINESS PARK I Lot: 0
Project Description:
Contractor: FIRESTOP CO Owner: PACIFIC REALTY ASSOCIATES
3203 NE 65TH ST. #2 15350 SW SEQUOIA PKWY #300
VANCOUVER, WA 98663 PORTLAND, OR 97224
PHONE: 360- 718 -8604 PHONE: 503 - 624 -6300
FAX: 360- 718 -8603
FEES
Description Date Amount
Specifics: • Permit Fee COM 12/14/2010 $338.92
12% State Surcharge - Building 12/14/2010 $40.67
Type of Use: COM Plan Review - Fire Life Safety - COM 12/14/2010 $135.57
Class of Work: ALT Type of Const: IIIB
Occupancy Grp: S -2 Height: ft
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: EXHAZ1
Density: .30 Design Area: 4000
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 $515.16
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $25,000.00
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 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 -0090. You may obtain a copy of the rules
or direct qu- •• • to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued =y: 4 / • Permittee Signature: '
Call 503.639.4175 by 7:00 a.m. for the next available inspecti 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
�4- (2- W. ∎ Q
4 11/ ■_--_ A. _A . iii.. _ Z .
Fire Protection System ��►,� FOR OFFICE USE ONLY
City of Tigard � Received ) y Permit No.:
�� Date /B •: I, ' 1 0 J� t, . i./ 0...._. I • L5
13125 SW Hall Blvd., Tigard, OR 9722 ,v Q
II
Phone: 503.639.4171 Fax: 503.598.l9..0 46.1%\ D a n Revie t 2 i O /4096!0 00
Date /By: t . O ther P ermit: /
Inspection Line: 503.639.4175 ate Read /B Juris: ® See Page 2 for •
I
TGARD p C� Y Y: �
Internet: www.tigard- or.gov �`' Kl otified/Method: tap° 110 6. - � ,t ��� 'TVS) Supplemental Information •
O �
TYPE OF WORK q 0 II REQUIRED DATA: 1- AND 2- FAMILY DWELLING
El New„construction I=1 Demdllll'on Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Ad dition/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 Commercial /industrial
Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFO MATION AND LOCATION Total number of floors:
Job site address: /4 31 tP 5 6 ,1 - 7 7A) 4-vo, New dwelling area: square feet
City /State /ZIP: / k-kb c2,2_ 7 7 7.Z, A. Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 4 kivil 1' v,sr /180ro/25 Covered porch area: square feet
Cross street/directions to job site: (_ Deck area: square feet
yy�� , l -VI)
_ Other structure area: square feet
(\ c \ / REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: dtl
1 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 n WORK /,/ �- work indicated on this application.
fob /FY 6x rirn . p,Rt 2,g_miKC sysl e Valuation: $ 2 S (D OO
Tv 4c -i 1 - n mot _ t . Existing building area: square feet `
/ G/�K1J C` / � i'47V G New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: � Aergd1T- Type of construction:
Address: /S3S0 Sr,J c Op IA. hew/ Occupancy groups:
City /State /ZIP: ,� l 02 9 ?nip / Existing:
Phone: (3) 624'4300 Fax: ( )
New:
❑ APPLICANT LI CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: 8/2 (JC g Pt 4i SON 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: Jp - Nj' 2 W'al r,� � ) 503^320 --3z applicant is exempt from licensing, the following reasons
Phone: ( 503) 6 ga0 • 33 (o t► J apply:
Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule,
Business name: rigSSoro, Permit fee:
Address: 3 W 3 Ng - 6 '•
City /State /ZIP: olive tm u 9866 State surcharge (12% of permit fee):
9 v 9 / FLS plan review (40% of permit fee):
,
Phone: (340) 2, Fax: ( ) (Due upon application.)
CCB lic.: !g 3 Z7 ei Total permit fees: 5 1 5 I T
TTT
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: /3i2 (lee' FienZ Date: (21 1 jO within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I:\BuildingPermits \FPS- PermitApp.doc 10/01/09 440- 4613T(1 l /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 ❑ 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 - H:ood 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 g :eater $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 a`re at submittal.
•
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