Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2011 -00136
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2011
Parcel: 2S 112 DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 320
Project: Professional Eye Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Adding (8) sprinkler heads to existing system.
Contractor: FIRESTOP CO Owner: PACIFIC REALTY ASSOCIATES
3203 NE 65TH ST. #2 ATTN: N PIVEN
VANCOUVER, WA 98663 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 360- 718 -8604 PHONE: 503 - 624 -6300
FAX: 360 - 718 -8603
FEES
Description Date Amount
Specifics: Permit Fee - COM 11/16/2011 $59.16
12% State Surcharge - Building 11/16/2011 $7.10
Type of Use: COM Info Process /Archiving - Lg Sheet (over 11/16/2011 $2.00
Class of Work: ALT Type of Const: 11x17)
Occupancy Grp: Height: ft Info Process /Archiving - Sm Sheet (up to 11/16/2011 $3.00
Stories: 11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: 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 $71.26
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $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. ou ay obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.
Issued By: Permittee Signature:
Call 50 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.
Building Permit Application 1
Fire Protection System ‘ FOR OFF , US v
P �
City of Tigard l� O )\\ Received
DateB & ♦_ Permit No.: • /�-- i
Phone: 503.718.2439 Fax: 503.59 1960 y
13125 SW Hall Blvd., Tigard, OR 9;7 23.j r l- Plan Review
b q \ Other Permit: �l,Gl"--CI la.
L ��
T t G A a b Inspection Line: 5W.639.4175 �� 4 , \ . �C` Date/By: /�1 Date Ready/By: Juris: Yee Page 2 for
Internet: www.t or.gov 6 d.A1 Notified/Method: Supplemental Information
TYPE OF WOR{ \\ *, \) REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction 0 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 0 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: 1 J 3 `J V � Z
L n t ) p 1 y '5 z (- New dwelling area: square feet
City /State /ZIP: ✓ LA A,� 1 `J J ` 1 Garage /carport area: square feet
Suite/bldg. /apt. no.: t ` T],p� Project name: J i ' t _ ,,� 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 (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
I ff6 Valuation: $ t ?
1 /‘) `C f&_ D ( v 1 . ,� v l� Existing building area square feet
f � , 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:
APPLICANT CONTACT PERSON • • -
NOTICE
Business n ) 7 �i z Fi / All contractors and subcontractors q
bcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: � a l
i `f , C- under ORS 701 and may be required to be licensed in the
:5b-\;-:;-:) f1J
Address: ` ). i b l r_ ff 4_, -- t jurisdiction in which work is being p erformed. If the
City/State /ZIP: ) - n l:'. L , [� applicant is exempt from licensing, the following reasons
apply:
4 . ' 6 . --1 Fax:: (Z. . ) 7f ' �Q)
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
,y i c r? f 2 T � .� { (Please refer to fee schedule )47 • •
Business name:
! Permit fee:
Address: 3.2 .>' ?> ra' 1 S
- , State surcharge (12% of permit fee): 7• la
City/State /ZIP: � . " J•�. );- ") l 9
�� ) '� ,' �' ' FLS plan review (40% of it fee):
Phone: (Z %r i < — r' � ( Fax: V () 5/4/ -� (De ppication.)
CCB lie.: f r z C- , Total permit fees: f 5 V�'�4 j , }-(,
Authorized signature: /
/ /„.-- /„.-- Amount received: 47 1,
This permit application expires if a permit is not obtained
Print name: 17 7 lit- 1--k=-7- Date: jJ _ , �o i- � within 180 days after it has been accepted as complete.
t * Fee methodology set by Tri -County Building Industry
Service Board.
1:\ Building \ Permits \FPS- PermitApp.doc 02/01/2011 440- 4613TO 1 /02JCOM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
"Describe wotkt#511) done. ':...;, .
1.) I] New 2.) Modification to sprinkler heads only:
Addition 1 -10 heads: No plan review required.
❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: D
Additional description of work: : 6_� > L<I) '3 ? / JK4- 6? 3
e t
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e.Kof stem2 Com leteYABC sor .D;asapplicable),
r,':t<.4�. ^ *xre- <:. _ 4:SUZ. o�.' _ _ r;t ^ V"63� . �'ti%,.� °,� -:f' = r:.3�R -:. .yA :«w5 ^�+ •:w..i:kvs � :::f>.,Nt,':we;:6w". .�tfi.:,.' :-
t•3s to st'�"i`..`W`4 oS�. ''i } 9 { s .N.:'O. ,'
r ,
- ' • tA i?., y < .. . ::. ,' _._;,
A.) CommercialeSprinkle r .= ' r^` q X
... � ,.. ,��fi'+�: � �.�s.,. Y.r,.A�'t �d. �sk"d = %. 4 �:..�., , r,. :4tii•. x'ma,.
- Wet ❑ Dry
Additional - Standpipes
Information: Hazard Group ) __ % Lc I�` •
Density I j j7
Design Area
K. Factor (,1 •
Sprinkler Project Valuation: $ '
•
�" =':i;x •.T-; 3 v y ... ,- ,:F , �'7 „rr'�:�;- T:l:s9rm?i•`° w: }:T
, .
B) T etaIT'� HgodtFireA�Su ression'.$ `stem': a ” • Hood Project Valuation: $
• �•a, ...�, - - -: . - # -- �T�'E -i - ` <c+.0 --.t. - 'f- _ _ < .:�;i .: - :z .._w:snen•,: .°t"fii'iv�. i'r�.,�'Y.��
G) FirelAlafm
Submittal shall Battery Calculations ❑ Yes •
include: Individual Component ❑ Yes
Cut Sheets •
Fire Alarm Project Valuation: $
_s ., t
s,. Vii.- - � �•, = i��'kt �'� w; - .., - -. .,,_.....«...
D ` °" lte "§ derit a'ltS` iriklerAS,tandAAiorie S, stem)- - • ' - '
Square Footage: Permit Fee: �W'> w �: >, " - •
0 to 2,000 $198.75 }�: ii�� b:: e: =Av
2,001 to 3,600 $ 246.45
3,601 to 7,200 $310.05 - .k, -_ . 'r ^•.,::., < .'; '.` >e:
7,201 and greater $404.39 -
Sprinkler Project Square Footage: sq. ft.
ire` ,rotectionA�Permt _ees' •
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.
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