Permit !t CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
` ` , ' COMMUNITY DEVELOPMENT Permit #: FPS2011 -00100
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/09/2011
Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 610
Project: New York Life Subdivision: Lot:
Project Description: Adding (12) heads and relocating (9) sprinkler heads.
Contractor: AFP SYSTEMS INC Owner: LINCOLN CENTER LLC
19435 SW 129TH BY SHORENSTEIN PROPERTIES LLC
TUALATIN, OR 97062 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 692 -9284 PHONE:
FAX: 503 -692 -1186
FEES
Description Date Amount
Specifics: Permit Fee - COM 07/28/2011 $102.20
12% State Surcharge - Building 07/28/2011 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 07/28/2011 $40.88
Class of Work: ALT Type of Const: IB Info Process /Archiving - Lg Sheet (over 07/28/2011 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: 12 Info Process /Archiving - Sm Sheet (up to 07/28/2011 $3.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
Density: 0 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 $160.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,625.00
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 No • • . in - • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir; questions to OU by - g 03.232.1987 or 1.800.332.2344.
Issued By: ' Permittee Sign.ture:
Call 503.639.4175 by 7:00 a.m. for the next available inspe ion 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 OFFICE, USE ONL
q
li ' City of Tigard p_ ® Received
aIGB : t �1 Permit No ": me 'Si t W_ i"�
v 13125 SW Ball Blvd., Tigard, OR 9722 ` ,‘\ V an Review -1,11 ''�
II J
Phone; 503.639.4171 Pax: 503.595.1460 v \$N DateB • �� g j Other Permit:
�G v r j "`I
I;t (iA It D Inspection Line: 501639A175 O� � Date Rea . - Sec Page t for
Internet: www.tigard- or.gov ♦'`G Ready NNotified/method: /, J � ®
Supplemental Information
C �l ::: 4 6- L- /.. .._.
TYPE OF . ' REQU D DA I AND.2- FAMILY DWELLING .
0 New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
g- Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
C ATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- and 2- family dwelling Commercial /industrial Valuation: S
El Accessory building ❑ Multi - family Number of bedrooms:
LI Master builder ❑ Other: Number of bathrooms:
JOB ;S11 'E INFORMATION AND 1 OCATION Total number of floors:
Job site address: I 0',( 5 j 6 j - b vAz J New dwelling area: square feet
City /State /ZIP: istAtJi OR Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: w€ 7(9',, v L, {� p Covered porch area: square feet
Cross street/directions to job site: `�' Deck area: square feet
Other structure area: square feet
REQUIRED DATA COMMERCIAL: USE:CIIECKLIST
Subdivision: l Lot no.: Pennit 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, a nd the profit for the
DESCRIPTION OF W ORK work indicated on this application.
1a — v
Pi
�� • . q ��,, Valuation: S a6a.5.`�
Existing building area: b 0 K square feet
New building area: 02000 square feet
❑ "PROPERTY OWNER ] TF.YANT. Number of stories:
Name: OW L. . .,to- Type of construction:
•
Address: 1 0 . 0 . 0 S (. 6 .Q.P s 1� ° ) Occupancy groups:
City /State /ZIP: I IC)✓�.(X (5?. Existing: \L,
Phone: ( ) Fax: ( ) New:
APPLICANT :CONTACT PERSON '
. �.,.,.. N TICF.�:
Business name: A pp S , . , All contractors and subcontractors are required to be
Contact name: 4 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: JOl y 5 S ' ( a�� Ak)-(.. jurisdiction in which work is being performed. If the
City /State /Zip: 4. '1 r C applicant is exempt from licensing, the following reasons
Q,� apply:
Q
Phone:( ) 11= tAgiq Fax::( ) 6901 -II$t,
E -mail: ,ll @ Afe SSS • COrm
CONTRACTOR . -=
> . BUILDING F
' - .(P/edseiejer tofeeschedule . .
Business name: , A .
Permit fee:
Address:
City /State /ZIP: State surcharge (12% of pennit fee):
FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon applicalfon)
CCB lie.: # — Total permit fees:
Authorized signature: ryy` : g ,) Amount received:
at) This permit application expires If a permit is not obtained
Print name: ` .,• may Date: - —15-41 within 180 days after it has been accepted as complete.
-- a Pee methodology set by Tri County Building Industry
Service Board.
1: tBuildingI Permit stFPS •PermitApp.doc 03/23/06 440- 4613T(1) /02/COM/PEa)
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.
Er 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: j.. a_
Additional description of work: g t n
9
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
VrWet 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 ❑ 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.
L \Building \Permits \PPS- PennitApp.doc 02/01/2011 2