Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2011 -00050
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/04/2011
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 150
Project: Immunology Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project Description: Adding and relocating (13) 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 04/12/2011 $112.96
12% State Surcharge - Building 04/12/2011 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 04/12/2011 $45.18
Class of Work: ALT Type of Const: VB Info Process /Archiving - Lg Sheet (over 05/04/2011 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm Sheet (up to 05/04/2011 $2.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .20 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $175.70
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $3,800.00
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 ay o tain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.80(5—..
Issued By: rmittee Signature:
Call 503.639. 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.
Buildine Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard
Received
DateB : IMF
Permit ^` _ -L,��
.mr' 13125 SW Hall Blvd., Tigard, OR 97223 �O Plan Review r �n
Phone: 503.639.4171 Fax: 503.598. o wer P erm i t. � 1 W
\��/ DateB : , t ,ri ,
T [ G A R D Inspection Line: 503.639.4175 c ++ Date Ready '. y: su ns: % Se P
Internet: www.tigard - or.gov � O Notified/Me od: ✓ &tit � e age 2 for
• A ` , Supplemental Information
TYPE OF WORK REQU ' I D DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Del llt C *100 \ \1\5 ° �, Permit fees* are based on the value of the work performed.
,,}} '� Indicate the value (rounded to the nearest dollar) of all
Addition/alteration/replacement ❑ Ot !` `' equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling CEt Commercial/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: 15 8 2_ 5 W '72_ Pl m A v G, i 5 - m 1 S O New dwelling area: square feet
City/State/ZIP: 1' o rj, r LA N b ` o . q 7 2- Z q- Garage /carport area: square feet
Suite/bldg4apk no.: f 5 Project name: SMN1 V N 0 LA G Y his %/1„, Covered porch area: square feet
Cross street/directions to job site: /� 1 - - IN d Deck area: square feet
C--11. it N�� o F 7 2.. n 4 V il PP &MA)6 J Other structure area: square feet
F6?t.P1 11-6 — g v 0 t'S . A REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
��� N Valuation: $ S Q a
r l-±
A DD �4-7V /Vo / �€(,o c it Tr F ) n-c s K L S i
Tb A CCo M D f) A TE TEAM N (i /' X-C VEM E1 J 1 Existing building area: 51 square feet
New building area: square feet
ig. PROPERTY OWNER ❑ TENANT Number of stories:
Name: M c 1 fl c:.- P4. A t-T V / S So C (/i TE S r L P . Type of construction: I I I- g
Address: is 3 S O S (i1/ S f CC V 0 1 A Pi< WI If 3 Occupancy groups: g 4, 5- 2
City/State /ZIP: 100 i t- L k. ry b, Cr ft. . oil 2-2- ei— Existing: T, I , = $ l 0 Z 7 5 ci , F-}-.
Phone: ( Sd 3) , 2 4 - (a 3 073 Fax: (5o3 ) k.2.-41- - 7 7 S > New:
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 1 1 I t E s - Tr, P Lp . All contractors and subcontractors are required to be
g� N licensed with the Oregon Construction Contractors Board
Contact name: o under ORS 701 and may be required to be licensed in the
Address: 3 20 '7, N E 6 5 S l . , S p. . jurisdiction in which work is being performed. If the
City/State /ZIP: VA N C a V V 61 WA . (O 6 applicant is exempt from licensing, the following reasons
apply:
Phone: 660) 1 8- e, o 4 I Fax.. (36D) - 7 / S - 8 c c 3
E -mail: h 0 6. l v e c k ® -FIYe 5 to P c o, C-el to
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: S e A S A i/ e 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.: I 8 ' Z 1 1 Total permit fees:
Authorized signature: X - i � `'u` -�� Amount received:
This permit application expires if a permit is not obtained
Print name: go R 6727 p , 70 Date: 9- /C I I' 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 10/01/09 440- 4613T(I1 /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: 133 (N
Additional description of work:
LSE Frr
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
4 Wet ❑ Dry
Additional Standpipes
Information: Hazard Group 0, H 114 6.H T •
Density • Lo 1 (=.
Design Area N (.k
K. Factor c 6
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 2 sets of plans at submittal. Plan review fees are required at submittal.
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