Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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~'• COMMUNITY DEVELOPMENT Permit #: FPS2009 -00067
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/12/2009
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 380
Subdivision: Lot: 0
Project: Maxim Healthcare ,
Project Description: Relocate (1) horn strobe, add (2) strobes.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Permit Fee - COM 08/05/2009 $62.50
CALIFORNIA ST 49TH FL Plan Review - Fire Life Safety - COM 08/05/2009 $25.00
PHONE. 12% State Surcharge - Building 08/05/2009 $7.50
Contractor:
SAFE TECH
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360 - 699 -2130
FAX: 360- 719 -1527
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
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 $95.00
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 1035
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 wprk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No • ation Center. Th. e rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir questions to OU c . i a • • 503.246.6699 or 1.800.332.2344. ej/lAcc____
`
I ued By:
y: 0 i Permittee Signet, re:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Q l 1
Fire Protection System RECEIVE 1 FOR OFFICE USE ONLY
City of Tigard
Received
/ M M
"
' 13125 SW Hall Blvd., Tigard,, OR 97223 A I !f; 0 5 2009 Date/B Date /B vie — � i��
Plan
114 2 . . , '•
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Phone: 503.639.4171 Fax: 503.598.1960 Date /By. . L I Other Permit: �� _ � r
'TIGARD tv Inspection Line: 503.639.4175 CITY OF TIGAR r Date Ready G H See Page 2 for
Internet: www.tigard-or.gov
BUILDING DIVISI • ' otified/Me 1 1. I 1 INEI Supplemental Information
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
® 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 ® Commercial /industrial Valuation: $
El 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: 10300 SW Greenburg Rd New dwelling area: square feet
City /State /ZIP: Tigard OR Garage /carport area: square feet
Suite /bldg. /apt. no.: 380 Project name: Maxim Healthcare Covered porch area: square feet
Cross street/directions to job site: Lincoln 1 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.
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.
Relocate 1 horn strobe, add 2 new strobe
Valuation: $$1,035.00
Existing building area: 4482 square feet
New building area: 0 square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing: B
Phone: ( ) Fax: ( )
New: B
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Safe Technology Group Inc. All contractors and subcontractors are required to be
Contact name: Jason Sweet licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6400 NE Hwy 99 Suite G375 jurisdiction in which work is being performed. If the
applicant is from licensing, the following reasons
City /State /ZIP: Vancouver WA 98665 PP exempt p g' g
apply:
Phone: (360) 699 - 2130 Fax: : (360) 719 - 1527
E - mail:
CONTRACTOR BUILDING,PERMIT FEES*
Business name: Safe Technology Group Inc
(Please refer to fee schedule)
Permit fee:
Address: 6400 NE Hwy 99 Suite G375
State surcharge (12% of permit fee):
City /State /ZIP: Vancouver WA 98665
FLS plan review (40% of permit fee): n O Q
Phone: (360) 699 - 2130 Fax: (360) 719 - 1527 (Dire upon application.) 5
CCB lie.: 173731 Total permit fees:
Authorized signature: / Amount received: Cfl 5 .6 a
This permit application expires if a permit is not obtained
Print name: Jason Sweet Date: 7 -23 -09 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 03/23/06 440- 4613T(1 I/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 El 1 -10 heads: No plan review required.
(E Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ 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 El Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1035.00
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50
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.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
\ \Safeserver \d$ \SAFE \ Forms \Use these forms \Permit Apps \Tigard \Tigard Fire Permi2.doc