Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11 4 2 COMMUNITY DEVELOPMENT Permit #: FPS2011 -00129
Date Issued: 10/21/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S113AA00300
Jurisdiction: Tigard
Site address: 16330 SW 72ND AVE B3
Project: A Cut Above Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: Adding (1) sprinkler head to existing system.
Contractor: FIRESTOP CO Owner: PACIFIC REALTY ASSOCIATES
3203 NE 65TH ST #2 ATTN N PIVEN
VANCOUVER, WA 98663 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE' 360- 718 -8604 PHONE
FAX 360- 718 -8603
FEES
Description Date Amount
Specifics: Permit Fee - COM 10/21/2011 $51.09
12% State Surcharge - Building 10/21/2011 $6.13
Type of Use: COM Info Process /Archiving - Sm Sheet (up to 10/21/2011 $3 00
Class of Work: ALT Type of Const: 11x17)
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type. Wet
Standpipe Required: No Hazard: LT
Density 10 Design Area: 1500
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 $60 22
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation. $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. • ay obtain a copy of the rules
or direct questions to OUNC by calling 503 232 1987 or :1'... . . •
Issued By: — Permittee Signature:
tm•
Call 503.639.4175 by 7:00 a.m. for the next available inspe• ion • ate.
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 0 42 FOR.OFFIC USE ONLY
Received R Permit No
City of Tigard �� ��\ Date /B to ,}
14 13125 SW Hall Blvd , Tigard, OR �� �' Plan Review i 1/ t S /! ('�) _ ,fi
Z Other Permit
Phone: 503 718.2439 Fax. 503 59 1960 P �t9 Date/By
TIGARD
Inspection Line: 503.6394175 O�+ 1G `� Date Ready /By uri ®
Internet www tigard- or.gov 6� -. 0�� Notified/Method Su ppleSeemental ge2 Info rmation or
C
TYPE OF WOti REQUIRED DATA: I- 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 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: % r ^ n 0 j LA) "/ � r� / rJ' �e s-- 6, „Z New dwelling area: square feet
City /State /ZIP.) Ct �� ID ( r) ,Z ' Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: LV ..( A 'c 0l� 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 (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
A -D / I) 3�Zt ./' i-c9Z- Valuation: $ 5 �. r� 00
I Y Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
C APPLICANT z1, X CONTACT PERSON NOTICE
Business name: '�I hZ j ( (" c vi /q w7 All contractors and subcontractors are required to be
Contact name: �t A_ej licensed with the Oregon Construction Contractors Board
�"—� under ORS 701 and may be required to be liensed in the
Address: 3 z_03 ell (� jurisdiction in which work is being performed. If the
City /State /ZIP: t(N--,) J J cam VIA i applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
� , � CONTRACTOR BUILDING PERMIT FEES*
Business name: ,}— L r p (.6 n1�7 (Please refer to P f
I � (( I _ Perr mit t fee:
Address: 3 lb 5 /J iY� /Drp�IIN S
City/State /ZIP: J j .,J �1 J Jd , �(2— State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (3(4)) -43% - 7s- (ti• D ll Fax: (3 9/ gr_ - (Q p (Due upon application.)
CCB lie.: 3-z_ I J g � Total permit fees: & 0 4—_
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: Z 6-,-.\ ! y e7 Lv.— Date: 1 i --"L i — i ` within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
1 \Building\Permns\FPS- PermitApp doe 02/01/2011 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.
2EL Alteration ❑ 11+ heads: Plan review required.
J Repair
Number of sprinkler heads:
Additional description of work: A \
� 7 C1 > S "Piz I r■S►L 2 101c4 7 oee -
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Wet ❑ Dry
Additional Standpipes IV b
Information: Hazard Group Ll Ci. 41
Density A-tt . /0
Design Area / r,Q
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Mann
Submittal shall Battery Calculations LI 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 \ Permits \FPS- PemvtApp doc 02/01/2011 2