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Permit IN q CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 11 . COMMUNITY DEVELOPMENT Permit #: FPS2011 -00029 TtGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/17/2011 Parcel: 2S113AC00101 Jurisdiction: Tigard Site address: 16655 SW 72ND AVE 300 Project: Food Sales West Subdivision: PACTRUST BUSINESS CENTER Lot: 0 Project Description: Alteration of (11) fire sprinkler heads. 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 03/17/2011 $123.72 12% State Surcharge - Building 03/17/2011 $14.85 Type of Use: COM Plan Review - Fire Life Safety - COM 03/09/2011 $49.49 Class of Work: ALT Type of Const: Info Process /Archiving - Lg Sheet (over 03/17/2011 $2.00 Occupancy Grp: Height: ft 11x17) Stories: Info Process /Archiving - Sm Sheet (up to 03/17/2011 $5.50 11x17) 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 $195.56 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 you to follow the rules adopted by the Oregon Utility Noti . •• - - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direc •uestions to OUN cal' • 50 232.1987 or 1.800.332.2344. Issued =y: / / , . ` Permittee Signature: 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. Building Permit Application Fire Protection System REC EIVE I FOR OFFICE USE ONLY City of Tigard MAR OF DateB y - n /� a ( Permit No.. / Aoi 1 �O� IN - ' 13125 SW Hall Blvd., Tigard, OR 97223 ev AY Phone: 503.718.2439 Fax: 503.598.1960 CITY - Tl 9 Plan Date/By: ieww ? I6 it / l/ Other Permit: T 1 GA RD Inspection Line: 503.639.4175 BUILDI N V / - . G�RD D ate ReadyBy: Juris ® See Page 2 for Internet: www.tigard or.gov D IV LSioNI Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. l Indicate the value (rounded to the nearest dollar) of all 7yAddition /alteration/replacement ID Other: equipment, materials, labor, overhead, and the profit ft o e /// CATEGORY OF CONSTRUCTION work indicated on this application. ID I_ and 2- family dwelling El Commercial/industrial Valuation: $ ❑ Accessory building ID Multi-family Number of bedrooms: 11 Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floor Job site address: /� I. to ( 5S S (/ '7 Z /3%-,.- � New dwelling ar- :: square feet City /State /ZIP: ,p, Ala / 06,z 9'7 2.7J4 Garage /carp• area: square feet Suite/bldg. /apt. no.: 1 Project name: ,r S a l es ( ( Covere• torch area square feet Cross street/directions to job site: De 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. Tax map /parcel no.: Indicate the value (rotnded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. )d- G 1 p e I " f' Valuation: $ 1S069 - � ` (c �v►` GC ✓ D T Existing building area y'-' square feet r ri. New building area: square feet ,A PROPERTY OWNER I ❑ TENANT Number of stories: Name: ea- ws {- Type of construction: - Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: g APPLICANT ❑ CONTACT PERSON NOTICE Business name: r ..---e..4 p I W • All contractors and subcontractors are required to be Contact name: �e��f! C/t/ licensed with the Oregon Construction Contractors Board � under ORS 701 and may be required to be licensed in the Address: '3 3 / V � 69 S` r , : Z , . jurisdiction in which work is being performed. If the City /State /ZIP: 5 Q 6 (0 3 applicant is exempt from licensing, the following reasons Am,/ Ci O w.i1L C! ,r apply: Phone:( - t � q t Fax:: (3C4 'j t - 8 (, 03 E -mail: L GLi /' e-t..51—e p Go • 449--1` -- •( CONTRACTOR BUILDING PERMIT FEES* Business name: 2 i \fie./ 5 r n co (Please refe t o fee schedule) Permit fee: Address: City/State /ZIP: 5W - " - State surcharge (12% of permit fee): FLS plan review (40% ofpermit fee): Phone: ( ) Fax: ( ) (Due upon application.) _ CCB lic.: ire 32, Total permit fees: 4 /7 . 7p Authorized signature: Amount received: P3r&k-1 This permi t application expires if a permit is not obtained Print name: A I J A - Date: 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 02/01/2011 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 ❑ 1 -10 heads: No plan review required. ❑ Alteration 7011+ heads: Plan review required. ❑ Repair Number of sprinkler heads: - 2-1<./ Additional description of work: f,t Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler Wet ❑ Dry Additional Standpipes 0 Information: Hazard Group Density �J Design Area K. Factor 5. Sprinkler Project Valuation: $ 'j �© ' B.) Type I - Hood Fire Suppression System Hood Project Valuation: $ C.) Fire Alarm Submittal shall Battery Calculations • es include: Individual Component • Yes Cut Sheets Fire Alarm Project Val : tion: $ D.) Residential Sprinkler (Stand Alone Syste Square Footage: ' -rmit 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 : prinkler Project Square Footage: sq. ft. Fire Protection Permit Fees Pro' - ct valuation subtotal (see A, B & C above): $ Permit fe; • ased on project valuation (see fee schedule): $ P rmit fee based on square footage (see D above): $ State Surcharge (12% of permit fee): $ FLS Plan Review (40% of permit fee): $ TOTAL: $ Plan r - *ew requires a completed application and three (3) sets of plans at submittal. Plan eview fees are required at submittal. I: \Building \Pemvts \FPS- PemritApp.doc 02/01/2011 2