Permit IN �, CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
; COMMUNITY DEVELOPMENT Permit #: FPS2011 00047
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2011
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 130
Project: Yecuris Subdivision: Lot: 0
Project Description: Modification of approximately (27) sprinkler heads for new tenant.
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 04/05/2011 $145.24
12% State Surcharge - Building 04/05/2011 $17.43
Type of Use: COM Plan Review - Fire Life Safety - COM 04/05/2011 $58.10
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg Sheet (over 04/05/2011 $2.00
Occupancy Grp: S -2 Height: ft 11x17)
Stories: Info Process /Archiving - Sm Sheet (up to 04/15/2011 $3.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
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 $225.77
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $6,500.00
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 • • • • • • a copy of the rules
:::: t :: estbons d t• • oby calling 503.232. 344.
s � Permittee Signature:
Call 51 .639.4 0, : 7:00 a.m. for the next available inspection date.
This permit card shal • p 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.
BuildinE Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY / y�jR)
City of Tigard DateB Ai A.... 24)9 Peunit Nu.. ..... AN/ i
4i p i
13125 SW Flail Blvd., Tigard, OR 97223 A _ 5 - Plan Review Other Permit.
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : — / •
o
TIGARD Inspection Line: 503.63 8.4175 D ate ed /Me y: J luris: S See Page 2 for
Internet: www.tigard-or.gov oV C ITY OF T IGARD Notifi ed/Method: Supplemental Information
R T. irj nrk,;.: t , .
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
yl Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
ID 1- and 2- family dwelling Commercial/industrial
Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
11 Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I C 0 5 5 SW SG Q U O T A P k W 4 New dwelling area: square feet
City/State /ZIP: PC 1 (-.A.N 'Z. / 6 R i 9 " 7 1 - 2 - 4 Garage /carport area: square feet
Suite/111dg /apt no.: i 3 6 Project name: yEcV TZ \ S 'C" , -i . Covered porch area: square feet
Cross street/directions to job site: rj, E . GO 12 N E 1Z OF S 14 Deck area: square feet
'7 Z A-5.1 A V.: 4 6 A )2- b 1 NA. L LAN E 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.
A. V $ O'd
D D REL,CATE i RE s P 12i 1�k S -t-, , 1 54a .
A cL o /Vt O D A 1 t - TENAOT IMP: Existutg building area: g I 1 g 9 square feet
New building area: square feet
KPROPERTY OWNER ❑ TENANT Number of stories: '1
Name: FAc I F, C- (Z E A cry A SSaC I A TES ( Type of construction: 1t-
Address: 1 S 3 ; S, w * S& Q LJ a IA pk 1� Y Occupancy groups:
City /State /ZIP: Po -T LA ft) D 0 R t 9) 22_ 4- Existing: B `.) S -Z
Phone: (SO3) 6L4 ID 36--6 Fax: (503) G 2 - L_ -- 71 55 New:
AAPPLICANT ❑ CONTACT PERSON NOTICE
Business name: F. S - b ? Gp . ) 1,i_ G All contractors and subcontractors are required to be
Contact name: gag 6 E N licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 3.2_, 3 N E. 6 S n T ST , + S P, 2 jurisdiction in which work is being performed. If the
City /State /ZIP: VA NC&V V G � / A / A.. '1 % (D G 3 applicant is exempt from licensing, the following reasons
apply:
Phone: ( 0 ) --11 Q j .- 9“,) O ¢ Fax:: ( 340) 1 19 - g Go 3
E -mail: 196)2, •Elie' stop c . C ►r
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule]
Business name: SAME As A go J Permit fee:
Address:
State surcharge (12% of permit fee):
City /State /ZIP: FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
,CB lic.: 18 3 2- '7 q permit fees:
l q Authorized signature:
Amount received:
Th is pe rmit application expires if a permit is not obtained
Print name: 1 _4 3 8e- KT D . 6-1LE 0 Date: 4/ J' 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 10 /01/09 440- 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.
$1 Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: ?7 ( N E W
Additional description of work: E E o V E R�
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
e Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor 5 , �p
Sprinkler Project Valuation: $ 4, 507),
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 2 sets of plans at submittal. Plan review fees are required at submittal.
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