Permit 741 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
` COMMUNITY DEVELOPMENT Permit #: FPS2011 00148
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/15/2011
T�cx.r 9 Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 105
Project: Cognex Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: TI
Contractor: AFP SYSTEMS INC Owner: JDS LLC
19435 SW 129TH CRITERION CREEKVIEW LLC
TUALATIN, OR 97062 ATTN JAMES A MEYER
PO BOX 6525
BEAVERTON, OR 97007
PHONE: 503 - 692 -9284 PHONE:
FAX: 503 - 692 -1186
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/06/2011 $102.20
12% State Surcharge - Building 12/06/2011 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 12/06/2011 $40.88
Class of Work: ALT Type of Const: VB Info Process /Archiving - Sm $0.50 (up to 12/06/2011 $12.50
Occupancy Grp: B Height: ft 11x17)
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: 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 $167.84
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,825.00
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 may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B y : ' . . / 11 11111b Permittee Signature: 1
Call ! - ....4175 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
1CCAS) .
.....— :. .• . .‘
. ,•,,• ,
to •A •
Fire Protection System • : .... . :•FORFF
'OICE USE ONLY 1 • -
1,4*cPe. . . . . '
Il k ., City of Tigard • v 1 ■, D I NI Pennit Nu.: ---s 5- ' /1 lel All
; • • 13125 SW Hall Blvd., Tigard, OR ,c _ r .14C`,1,* Pian Re Other Pview di ri. n. jj ,N=g _ ermit. .
lem m
I .- Phone: 503.639.4171 Pax: 503.5 ' ...(V keZt-P g fribla i_
TioA it r) Inspection Line: 503.639.4175 C ' Aw
.(,'QPrAc; Date Ready/By:, Juris: See Page 2 for
Internet: www.tigard-or.gov Nolifie. ethod: /;•i' / • . -- Pti, Suppental Information
(? k ' \, \ r . . ,
.,:,.•:".::..:, ; : ; :,'..'. . ,'. ij,:: : : ' :_ : ',.:' TYPE.OF:.,WORRP: ,: ;-. -'„,.. ;'--,-,-.:...,:: ,:. ,- ,,- .-: RE i .. j,DATA;:1-Ai.
0 New construction 0 Demolition Permit fees* are based on the value of the work perfonned.
Indicate the value (rounded to the nearest dollar) of all
A Addition/alteration/replacement 0 Other: equipment, materials, labor, overhead, and the profit for the
r--_.: ,. :.-,--.:..; .:,-..,.,-_-.-, - - - ,, " -- -,, = - - ," ' '-‘-'- -• - - - ‘r,-:-
CATEGORY OF CONSTRUCTION ',:-.,= [. .- , v.ork indicated on this application.
:It :-: .-' :.':_,,:..--. .,,-:' .,:: -.- '..:.
Valuation: S
0 1- and 2-family dwelling %Commercial/industrial _ •
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
- ,---- ' - - , ,•... , :
JOB SITE INFORMATION -AND -LOCATION ,- ' ,..' ,.-. .-..--', i ; -',.:_,: .,---.-- : Total number of floors:
Job site address: I i31:95 <51.- "7 4 'NA... New dwelling area: square feet
City/State/ZIP: l ' t.• , 0 Q. ql zzA Garage/carport area: square feet
Suite/bldg./apt. no.: i 0,t-' Project name: C tvk A Covered porch area: square feet
Cross street/directions to job site: . Deck area: square feet
Other structure area: square feet
11EQUIRED'OAT8:•commgROALvsE.citEclaisT.:
Subdivision: I 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 V VVVVVVVVV VV
--- OF WORK -',.:',----'.,:-.:- -. ' -= ,. :,- .-.. -',- - .. - work indicated on this application.
Valuation: S 2.62 5
Existing building area: square feet
•
New building area: S 40 square feet
-, .':,,: • - - a PROPERTY Ov/NER. :1; ,;•' - -. ---,--.' -.- ,---=* ;(:]=TENAisiTi' '-., . '':''".'ll'" Number of stories:
Name: Type of construction: V
•
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( ) New: .
VAP pfkANt e :: . ' ,,. 01 , kAtl - Altits014 . ; : ;---: - ' :',: :., ---- --- [----- -, - '- - . ,' ,- :-- - - , -- , .. -2 - , -'•-: . : - :'--:',-,T.: NOTICE
Business name: Afp c .e71
‘ Y. C.- - All contractors and subcontractors are required to be
1
Contact ninne:
licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: lq 4 3 ..-- 6 \ t7291‘... Avq,... jurisdiction in which work is being performed. If the
Ci 7 .07-
applicant is exempt from licensing, the following reasons
City/State/ZIP: 0 e., 01 apply:
Phone: (S )b I I 2: L i V Pax: ' (S VI 2. - IR (f
E-mail:
• . '''• :;'''CliiiiRAC±4 ""`-'-'''''-`' ''''' . f : -:; ;:- '-: : , - --. --- - -:.-.7:".' '
.,. , :::: . _ - _:, , '7.,`.: - . ,, :(Please refer to fee schedule) - - . - ,• - : ... .. :,.
Business name: Ac? s ,-
—y...)k..rm'S \ Ae-. Permit fee:
Address: tct 43 c' 61,-J %2.9-11.. A.,....e_
State surcharge (12% of permit fee):
City/State/ZIP:Tj 6 .,\ c ZT iv 0 e q--) 2_
FLS plan review (40%of permit fee): .
. Phone: (SP3)'(2,-R 2, zi 14 Fax: (ct.,...) uct_ , wk 4- (Due upon application.)
CCB lie.: k 6 . . Total permit fees: .
6 , .
Authorized signature: d
Amount received: d 7. 0 (
• \ 5 9--
This permit application expires ifs permit is not obtained
Print name: \ a , . . . , 1 1 , 6 S ov:.4.- 5 Date: 12 i 1 I k within 180 days after It has been accepted as complete.
_ * Fee methodology set by Tri-County Building Industry
Service Board.
V.I3uilding■PermitaPS-PennitApp.doc 03/23/06 440-4613T(11/02/CONVWEB)
. .
• .
.. .
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 lg 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 31
Additional description of work:
Type of S stem: Com�'lete_ B, C or'D as applicable):
Yp Y � p > >
A, Commercial S
44 Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $ z 'Z c`
Bc }: Hood Fire.Sup.pres
Hood Project Valuation: I $ 9
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $
D) Residential Sprinkler (Stand Alone Sy :`: _'::.:::
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: 37 y 0 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.
7: \Building \Pemuts \FPS- Pcanitrlpp.doc 06/25/08 2