Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00158
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2010
TIGARU Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15895 SW 72ND AVE 250
Project: Diagnostic Male Medical Subdivision: OREGON BUSINESS PARK III Lot: 40
Project Description: Add (2) sprinkler heads and relocate (1) for TI
Contractor: DELTA FIRE INC Owner PACIFIC REALTY ASSOCIATES
14795 SW 72ND AVE 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 PORTLAND, OR 97224
PHONE: 503 - 620 -4020 PHONE: 503 - 624 -6300
FAX: 503 - 620 -1058
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/16/2010 $75.30
12% State Surcharge - Building 12/16/2010 $9.04
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: 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 $84.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,400.00
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 • copy of the rules
or direct . t • ens to b NC by calling 503.232.1987 or 1.800.332.2344.
/ /
Issu;.. By: / Permittee Signature: / � I
Call 503.639.4175 by 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.
Fire Protection System
Building Permit ApplicationE _ FOR OFFICE USE ONLY
City of Tigard DEC 1 6 2010 Date/By: d ia. iee io /95A,'o— 2c /581
Permit No.:
I N 41 - N 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review / !/
Phone: 503.639.4171 Fax: 503.5 OF TiGARD Date /By: Other Permit: e, a`p
Inspection Line: 503.639.4175 VI 1 ® c p11 Date Ready /By: Juris: ® See Page 2 for
T I G A RD D'�� .71Q�V
Internet: www.tigard - or.gov BUILDING Notified/Method: Supplemental Information
' "--im k ,� YPE OF '" y i ' - f I UIRED DATA 1 A i 2 FAMILY DWEI.LI GW
� ,..�.�....:. ,.. ., s, - -..., c.,. 'z�..,,, �,.. -rte- - e.,.,��. , .. ,..,va.,..
❑ 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 for the
, ,l i r E '' , work indicated on this application.
'k CATEGORY aF CON3TRUC7'aION
❑ 1` and 2- family dwelling ® Commercial /industrial Valuation: $
12 Accessory building El Multi-family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
' 4 JOB SITE I YFORMATION AND LMC�ITION ', Total number of floors:
Job site address: 15895 SW 72 Ave. New dwelling area: square feet
•
City/State /ZIP: Portland, OR 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: Ste. 250 Project name: Oregon Business Park III Covered porch area: square feet
Cross street/directions to job site: Diagnostic Male Medical Deck area: square feet
Other structure area: square feet
RT Q IILE) AATA WMIVIERCIA47VA ISFE 4 --
.. _. iz r. , �,x,, .,Ac .., � � »;,rK .. , gym,. .
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
e , .,T;;* 4 % DESCRIPTION OF WORK ` v h 0 ,, work indicated on this application.
� a .,, e l - �� ,..�� Y-� ,.....
Add 2 Sprinkler Heads & Relocate 1 Head for New T.I. Valuation: $$1,400.00
Existing building area: square feet
New building area: square feet
S x� t ROPE OWNER * ' „R » y < TENANT Number of stories:
e . „ is ' ,A. r, f "e,L.
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
v . , ®eAPPLICANT x �, .,,,. , ; i: 0 CONTACT E RSON , . -� < .,..
., e �,. -, NOTICE 4;00, , s b -
Business name: Delta Fire, Inc. All contractors and subcontractors are required to be
Contact name: Heidi Scarbrough licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 14795 SW 72 " Ave. jurisdiction in which work is being performed. If the
City/State /ZIP: Portland, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 620 -4020 Fax: : (503) 620 -1058
E -mail: heidis @deltafire.com
r CONTRACTORt* : is , - ' ? BUI PERMIT F g i o
Business name: Delta Fire, Inc. -.. - - ;. -. (P <tea se,refer to feesche f -„ t. ,,:.. xt
Permit fee: 7c. x
Address: 14795 SW 72 Ave.
State surcharge (8% of permit fee):
City/State /ZIP: Portland, OR 97124
FLS plan review (40% of permit fee): __
Phone: (503) 620 -4020 Fax: (503) 620 -1058 (Due upon application.)
CCB lic.: 64174 Total permit fees: - W. 3 q
AA) ` Amount received:
Authorized signature: I /
This permit application expires if a permit is not obtained
Print name: Heidi Scarbrough f te: 12/16/2010 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I: \Building \Permits \FPS - PermitApp.doc 03/23/06 440- 4613T(11/02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
D es c n; le; wor k `to be `/> ..,..
1.) ❑ Ne 2.) Mo to sprinkler heads only
® Addition p heads: No plan review required.
❑ Alteration 11-11+0 eads: Plan review required.
❑ Repair
Number of sprinkler heads: 3
Additional description of work
�T e of S s tem , Com fete B, C or, D as apphcabt0 i ' .. r4
3'P (,,,mm l?
� ''., �4 '4� `, , Obi �"� "c. , v / \ � i Z 4
A) Commercia Sprin ,` F , '
® Wet ❑ Dry
Additional Standpipes NA
Information: Hazard Group Light
Density 0.10
Design Area 1500
K. Factor 5.62
Sprinkler Project Valuation: $ 1,400.00
B }'Type I : Ftre Su"ppr'es System « .. ��_ ' r ,., 5 .: k , ..._
Hood Project Valuation: $
1 F4t Flreb .� -', - F is m V # i f y '' ' sa g t, / ��
Submittal shal Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D }- %Rerden Spnukler VStand Alone System) ,, , *. a a �; ��
Square Footage: Perm Fee: �i x ,
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 Footag sq. ft.
.s t. \ .. ,. ,
Fire ,Protection Permt.t .Eees e: s , ,.�. ,,r,t., ; , ,` `
Project valuation subtota ( se e A , B
P & C above): $
eymit fee based on pro valuation (see fee schedule): $
Permit fee based on square footage (see Dr above): $
State Surcharge (8 o p ermit fee): $
FLS Plan Review (40% of perm fee): $
TOT AL: $
Plan review requires a completed application and 2 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.
440- 46!3T(l l /02 /COM/WEB)
I: \Build \Permits \FPS - PermitApp.doc 03/23/06