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Permit CITY OF TIGARD f • FIRE PROTECTION SYSTEM PERMIT q COMMUNITY DEVELOPMENT Permit #: FPS2011 -00038 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2011 Parcel: 2S110AA00300 Jurisdiction: Tigard Site address: 14145 SW 105TH AVE Project: Pacific Health & Rehabilitation Center Subdivision: Lot: 0 Project Description: Fire alarm: Adding (1) smoke detector at fire alarm panel. 4/6/11, reprinted to add additional device and increase valuation. Contractor: HI TECH SYSTEMS INC A CORPORATION OF WASHI Owner: TIGARD INVESTMENT GROUP LLC 512 NW CARTY RD BY EYRING REALTY INC RIDGEFIELD, WA 98642 1777 N CALIFORNIA BLVD #300 WALNUT CREEK, CA 94596 PHONE: 360 - 887 -7062 PHONE: FAX: 360 - 887 -7065 FEES • Description Date Amount Specifics: Permit Fee - COM 03/23/2011 $51.09 12% State Surcharge - Building 03/23/2011 $6.13 Type of Use: COM Plan Review - Fire Life Safety - COM 03/23/2011 $20.44 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: Yes Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: No Cut Sheets Required: No Total $77.66 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: Residential Square Footage: 0 Fire Alarm Valuation: $400.00 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 • ' n 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 d' ct questions UN • c- ing 503.232.1987 or 1.800.332.2344. I ued By: i Permittee Sign ure: /IL�� /LLB 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. CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 11 4 COMMUNITY DEVELOPMENT Permit #: FPS2011 00038 -TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2011 Parcel: 2S110AA00300 Jurisdiction: Tigard Site address: 14145 SW 105TH AVE Project: Pacific Health & Rehabilitation Center Subdivision: Lot: 0 Project Description: Fire alarm: Adding (1) smoke detector at fire alarm panel. Contractor: HI TECH SYSTEMS INC A CORPORATION OF WASH Owner: TIGARD INVESTMENT GROUP LLC 512 NW CARTY RD BY EYRING REALTY INC RIDGEFIELD, WA 98642 1777 N CALIFORNIA BLVD #300 WALNUT CREEK, CA 94596 PHONE: 360- 887 -7062 PHONE: FAX: 360- 887 -7065 FEES Description Date Amount ` r Specifics: Permit Fee - COM 03/23/2011 $51.09 12% State Surcharge - Building 03/23/2011 $6.13 Type of Use: COM Plan Review - Fire Life Safety - COM 03/23/2011 $20.44 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: Yes Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: No Cut Sheets Required: No Total $77.66 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: Residential Square Footage: 0 Fire Alarm Valuation: $200.00 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 questions to OUNC by calling 503.232.1987 or 1.800. . 44. Issued By: - ermittee Signature: Cal - fit 5 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. Sr�1ote Mc, rc Building Permit Application Fire Protection System FOR 01 1 1( V. 1 SF ON 1.1 City of Tigard Received : M == Permit No.: <^ 05 i f f_ aY 2 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review II . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: f I G A R D Inspection Line: 503.639.4175 Date ReadyBy: Iu See Page 2 for Internet: www.tigard - or.gov Notified/Method: ��� Supplemental Inform ation TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ 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 CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1- and 2- family dwelling jar ommercial/industrial Valuation: $ ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: j LI j LL5 �\n.) 103' 1 " 6 t- c c - New dwelling area: square feet City /State /ZIP: T t ct y - . 0 It ` q / L2, `' I Garage /carport area: square feet Suite/bldg. /apt. no.: J r Project name: r. cx rM ty-, e l �� � y � Covered porch area square feet Cross street/directions to job site: 1 "" ` Deck area: square feet C, 60 f (G.. 1... CijA . I ©S 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. Ate, ern 9 w t re_ b MO it e— c kekec O r Valuation: $ '� --------- Existing building area square feet (xt r; t c‘.10 -Ton .pavte l Q c 0 regoo 64 -cAfc., F ■ Ce. frct ss6 ct L : .,f vi , i„ }' v New building area: square feet ❑ PROPERTY OWNER I ENANT Number of stories: 1 Name: PeLt:.l ∎C, NeAA,1" 43 te.‘A. )t t`' }<AA-1 U ,l\ Type of construction: Address: ' , U 6- ow 105 5+ . .: Occupancy groups: City /State /ZIP: t c& rd, ©(Z c 7 �2 ` II Existing: Phone: (O ) ( ( - IN 4 t-{ Fax: (E;D 3) c, LL " 7 L C) ‘ New: .7APPLICANT ,J- CONTACT PERSON NOTICE Business name: VA t T-eC. Lt �/- vin, All contractors and subcontractors are required to be Contact name: p C.) VA 1 licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be lcensed in the Address: i, iv L.) f ILA jurisdiction in which work is being performed. If the ` vC 9 applicant is exempt from licensing, the following reasons City/State /ZIP: u Gj -}� ► ` � j� apply: Phone: (�1A) S 167 ( ....\,3 e _, /� WP -e Fax: : 3 (D) tIc 7 76 4 6 _ o \--k e � l) Q E -mail: 0 d 5�m A.:-A .0 ) "� CONTRACTOR BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: I V, -rec.,Y 1_ I „S�S' 4'nS Permit fee: L o q Address: S Z I V 6_(.4..- `, } Y UL � 3 n State surcharge (12% of permit fee): C. 1 City/State /ZIP: Ilk � ,, .. i L k fck GL 8 (o Li FLS plan review (40% ofpermit fee): ,�j� N Phone: 3( ) g�s -70 C 1..... Fax: (XO) Vey -70 (,5 (Due upon application.) ✓�' CCB lic.: 1 9 lac o Total permit fees: ?7, ( c Authorized signature: Amount received: 1 This permit application expires if a permit is not obtained Print name: 5' l �7 4 Ar - dye Date: 3/"7 -3 /i within 180 days after it has been accepted as complete. * Fee methodology set by Tri -County Building Industry Service Board. I:\BuildingtPermib \FPS- PermitApp.doc 02/ 01/2011 440-4613T( I 1/02/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 - Hood 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 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 three (3) sets of plans at submittal, Plan review fees are required at submittal. I:\ Building \Perm is \FPS - PermitApp.doc 02/01/2011 2 CC Community Development RECO TIGARD Request for Permit Action Ci JUL 6 6 20 11 Ril TO: CITY OF TIGARD /V / S O Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov FROM: n Owner n Applicant Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) N t5 2 1'' , - ; ' .5/ 6 i-e. (Nis n Mailing Address: vV ` La V 1R I, ` City /State /Zip: Ill A tae.. L Jc* /J b I 1- Phone No.: S6 0 qgj 7 70 c'2, PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( •): CANCEL PERMIT APPLICATION. V 1 0 , • __ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ifl ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). p t 9 jc `�p Permit #: 66A01 / 0003 .; S Address or Parcel #: ( i io 5 COr + ijl� Project Name: -I 6 c 6.01-eTl-f /Li i '117ot Clic Subdivision Name: Lot #: EXPLANATION: W re-�l Q�.c_— 1, r PS %,C) I 1-- DC 7 • Signature: ��' ' a /�j � � do '� Date: a 11 I sir Print Name: C-0 ' t -62 `A./ i Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rte to Sys Admin: Date 7 ii1 ' lai 7 Rte to Bld: Admin: Date •ff0Am B 'Val Refund Processed: Date A/A111111 B jo fil Invoice Processed: Date B Permit Canceled: Date d7/ // By e- Parcel Tag Added: Date By Receipt # t/ i'f', ' Dated /P /// Method c Amount $ 77, 6 6 I:\ Building \Forms \RegPermitAction.doc Rdy 07/26/07