Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
II I COMMUNITY DEVELOPMENT Permit #: FPS2011 -00043
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/25/2011
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 300
Project: Food Sales West Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Fire alarm modification, (1) horn strobe
Contractor: T & L COMMUNICATIONS INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 87387 15350 SW SEQUOIA PKWY #300
2800 NE 65TH AVE SUITE A PORTLAND, OR 97224
VANCOUVER, WA 98661
PHONE: 360 - 737 -9725 PHONE: 503 - 624 -6300
FAX: 360 - 737 -9648
FEES
Description Date Amount
Specifics: Permit Fee - COM 03/24/2011 $67.23
12% State Surcharge - Building 03/24/2011 $8.07
Type of Use: COM Plan Review - Fire Life Safety - COM 03/24/2011 $26.89
Class of Work: ALT Type of Const: Info Process /Archiving - Sm Sheet (up to 03/24/2011 $2.50
Occupancy Grp: Height: ft 11x17)
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 $104.69
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,100.00
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, • ' - 's suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon • Utility 'otification Center. Those rules are set forth in OAR 952 - 001 -0010 throw • e - - • •090. You may obtain a copy of the rules
or • • ect questions to OUN . li • • 503.232.1987 or 1.800.332.2344.
• I -sued By: 1 I Permittee Signature: w �
/
Call 503.639.4175 by 7:00 a.m. for the next available inspec on 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 FOR OFFICE USE ONLY /yq�
of ad Date/B Review
— �I Permit No.: / oS p�Q! / —ezo 3
. • 13125 City SW Hall Tig Blv Ti OR 972
Phone: 503.718.2439 Fax: 503.598.1960 Plan
Date/By: Permit:
T I GARD Inspection Line: 503.639.4175 Date Ready/By: nuns: 0 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ ew 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 111 Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this applicatio
El 1 - and 2- family dwelling Commercial /industrial Valuation: $��'
❑ Accessory building I=1 Multi-family Number of bedrooms:
1:1 Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I ( ( S S s(.) 7Y'' Ave ' re � � New dwelling area: square feet
City /State /ZIP: ' I C l,r a o Garage /carport area: square feet
Suite/bldg. /apt. no.: 3 0(-) 0 J Project name: - - 2 -cx x ; Sc JS - 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.
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.
Valuation: $ 1 I IN Y �
CX>
- tm J4 tarin/ f
Existing building area square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
0 APPLICANT 0 CONTACT PERSON NOTICE
Business name: /����
�" L �eJbttiVltcJl/ll C,.I- C C)t., S All contractors and subcontractors are required to be
Lac. licensed with the Oregon Construction Contractors Board
Contact name: I_ Q ✓ Y �/ Ru S V `a under ORS 701 and may be required to be lensed in the
Address: PO A d n 9 '1 c jurisdiction in which work is being performed. If the
C applicant is exempt from licensing, the following reasons
City /State /ZIP:
l,J -t c0 (..)(../ £ j - A 1c1C /
� �- U apply:
Phone: (3W j 1 3 - 2 - )-j - Fax: : (SCO) `73'7 -'7 (r7 Li c9
E -mail: O .. lC e e + I CUD, ,A ,,�} I ce_t� cv 4 S . cam
CONTRACTOR BUILDING PERMIT FEES*
-----1 (Please refer to fee schedule)
Business name: d---L_ Ct)144 tA, ()liltCet -1 S
Address: 0 gU & ✓ .- - 1 Permit fee:
City /State /ZIP: State surcharge (12% of permit fee):
V C aJ t ' {` �� �� / FLS plan review (40% of permit fee):
Phone: (3 o) - 7 3--/ _ C/ -7 -7 S Fax: (3( r) 3 `7` b 1 6 (Due upon application.)
CCB lic.: 1—) B - 7 I Total permit fees: p
g Amount received: �a I� /
Authorized signature: /
�(,. J This permit application expires if a permit is not obtained
Print name: Lctrv- y �v � S ,, Date: 3._ act_ I * 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 02/01/11 440- 4613T(I 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:
El Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration El 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
El Wet El 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
Submittal shall Battery Calculations El 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- PermitApp.doc 02/01