Permit 1111, yn
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00155
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2010
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE# 220
Project: ACS Subdivision: FARMERS INSURANCE Lot: 0
Project Description: Sprinkler addition to second floor.
Contractor: PATRIOT FIRE PROTECTION INC Owner: TRIANGLE POINTE LLC
4708 NE MINNEHAHA ST 901 NE GLISAN ST #100
VANCOUVER, WA 98661 PORTLAND, OR 97232
PHONE: 360- 699 -4403 PHONE:
FAX: 360 - 699 -4485
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/14/2010 $123.72
12% State Surcharge - Building 12/14/2010 $14.85
Type of Use: COM Plan Review - Fire Life Safety - COM 12/14/2010 $49.49
Class of Work: ALT Type of Const: IIB
Occupancy Grp: B Height: ft
Stories: 5
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
Density: 0 Design Area: 0
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 $188.06
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $5,000.00
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
issu e, or if war is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uf y Notification Cente . Tho - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
o direct questions to OUNC . calling 50•. :2.1987 or 1.800.332.2344. -
sued By: If P Satre:
e
Call 503.639.4175 by 7:00 a.m. for the next available ins.. • ion 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.
• B>Oding °Permit Application
'1 ,,S ) • r rotes ion System ` FOR OFFICE IC E LSE ONLY '''
% Rece "
Cit III q y of Tigard A gyp\ Datc/Bc I f 111 1� T 17 -via _ CTO (5 S
13125 SW Hall Blvd., Tigard, OR 1 PI Rev ^ 7 . � �s r /..�
Permit N,.:
C Phone: 503.639.4171 Fax 503.5 .19 C A� rr Date/By: , / , L �L other Permit: p� i CU(� c�1
T I G A R D Inspection Line: 503.639.4175 '�\v 0� Date Rea ■. J111/S' la See Page 2 for
Internet www.tigard-or.gov r\ p r O \� \� No . edAtethod4. 4- A �abi i� Supplemental Information
V V w r
TYPE OF NVOILW REQ . l 1 _ TA: 1- AND 2-FAMILY DWELLING
❑ New construction ❑ Demolition Permit t are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
h' Addition/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 t(Commercial/industrial Valuation: $ 5- C � . )
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other; Number of bathrooms:
JOB SITE INFORI%IATION AND LOCATION Total number of floors:
Job site address: 1 j . Z < J 614.TH p Kwy New dwelling area: square feet
City/State/ZIP: 7i(4- A Z i c E 9, Z 3, Garage /carport area: square feet
Suite/bldg. /apt. nol Project name: t Covered porch area square feet
Cross street/directions to job site: AL S /A 0 0 t-rl 0 i\-1 Deck area square feet
Other structure area: square feet
REQUIRED DATA: COM ERCLYL -LTSE CHEC.`KLIST
Subdivision: I 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 WORK work indicated on this application.
A( e l l tJ k L E 2 a T� 1J ek ( G E (L, i r.)4— Valuation: $
Pz lk" C X CS 1 ij / S'f Ga,\ Existing building area: square feet
! New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups: L l ex 4.4-1 g -1)
City/State/ZIP: Existing: b rf✓ ( c- E
Phone: ( ) Fax: ( ) 0 r---Pc---c_
New:
diCIPPLICANT �-- n � 1 ❑ CONTACT PERSON NOTICE
Business name: Pi., a DT t-12� � (--c- no Li J 1 R kJ C-, All contractors and subcontractors are required to be
Contact name: �� G O LL( 0....J S licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address :.470 a w r l k j N (31,4A K A <7 , jurisdiction in which work is being performed. If the
City/State/ZIP: Uja t..J , `r 4 t C Ce applicant is exempt from licensing, the following reasons
apply:
Phone:&73) ZZZ— - j C( I Fax::c3(pp) `o cc'( 44C3s'
E -mail: .1 �� I� pY E. CO Cr \
p
CONTRACTO BUILDING PERMIT FEES*
Business name: P� l 1� 1(=T F E 1 K..5� 1 dJG , (Please referroe schedule)
Permit fee:
Address:
State surcharge (12% of permit fee):
City /State/ZIP:
FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.: 7 c2, Z Total permit fees: /tr oc
Authorized signature: Amount received: $/ vG
This permit application expires if a permit is not obtained
Print name: ..c...1.1 IV S Date: (2/10A (5 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
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 ap i licable):
A.) Commercial Sprinkler
g Wet ❑ Dry
Additional Standpipes
Information: Hazard Group LlG-I -4T Z
Density 1 , C.)
Design Area
K. Factor l 1 s Z
Sprinkler Project Valuation: _ $ A
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: 1 $
C.) Fire Alarm
Submittal shall Battery Calculations lations ❑ Yes
include: Individual Component El 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.
http: / /www.tigard- or.gov/ city_ hall /departments /cd /dots /FPS-PerrnitApp.doc 10/01/09