Permit .: ,, CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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•'• • COMMUNITY DEVELOPMENT Permit #: FPS2012 -00007
Date Issued: 01/24/2012
it WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16195 SW 72ND AVE
Project: Option Care Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30
Project Description: Adding (2) and relocating (2) sprinkler heads.
Contractor: FIRESTOP CO Owner: PACIFIC REALTY ASSOCIATES LP
3203 NE 65TH ST. #2 ATTN: N PIVEN
VANCOUVER, WA 98663 15350 SE SEQUOIA PKWY #300
i PORTLAND, OR 97224
PHONE: 360- 718 -8604 PHONE:
FAX: 360- 718 -8603
FEES
•
Description Date Amount
Specifics: Permit Fee - COM 01/24/2012 $91.44
12% State Surcharge - Building 01/24/2012 $10.97
Type of Use: COM Plan Review - Fire Life Safety - COM 01/24/2012 $36.58
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
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 $138.99
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,000.00
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 .. may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: att0... 1 . 1 1111■ 'ermittee Signature:
'1
Cal 0 . • 75 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
Fire Protection System 0 FOR OFFICE USE ONLY
Received �^
City of Tigard .�`, �� '�� DateB : / �1 PermitNo.: _ I PO I�- �
n 13125 SW Hall Blvd., Tigard, OR -. ! A `l� Plan Review
$� Other Permit: t 7
Phone: 503.718.2439 Fax: 503.59 960 �,\ 1 � � Date/B : Oh P 4 Q r�
Inspection Line: 503.639.4175 , , P \\ ,GP S�O Date Ready/By: Juris ® See Page 2 for
TIGARD
Internet: www.tigard- or_gov O � A `� ` Notified/Method: Supplemental Information
TYPE OF WOI��,� REQUIRED DATA: 1- AND 2- FAMILYDWELLING
❑ New construction ❑ D Permit fees* are based on the value of the work performed.
Indicate the value (rotnded to the nearest dollar) of all
idition/alteration / replacement Other: equipment, materials, labor, overhead, and the profit for the
/ CATEGORY OF CONSTRUCTION work indicated on this application
Valuation: $ 11■72=.__ :.� . - - ='r
❑ 1- and 2- family dwelling mmercial /industrial , *tic - ' y :f '
❑ 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: I I Cl! o, )6i 1- 7' Z Ai �� j New dwelling area: square feet
City /State /ZIP: b Garage /carport area: square feet
Suite/bldg. /apt. no.: 39i) 1 Project name: Op f j) t,q 3 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 (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
ac? \ (
._
1C 1 r t✓ v tia- Valuation: $ z D v
Existing building area square feet
New building area: square feet
\ OWNER ❑ TENANT Number of stories:
Name: �,Q 1-- JC v 5 T Type of construction:
Address: �r Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
APPLICANT / ONTACT PERSON NOTICE
Business name: Fl 7 a � / L. � All contractors and subcontractors are required to be
Contact name: 1 ��� licensed with the Oregon Construction Contractors Board
t y A<, 0- Cif under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name:
)re e .57(:))-> C Permit fee:
Address: ` ✓ � ry L ''-j'" State surcharge (12% of permit fee):
City /State /ZIP: t r o
FLS plan review (40% ofpermit fee):
Phone: ( ) ` , — le I) 1! Fax: (- -, V / G4 - i e3 (Due upon application.)
CCB lic.: TT 7 J v Total permit fees' 3s-,, 74
Amount received:
Authorized signature: l �� l
This permit application expires if a perm t is not obtained
Print name: y Li A i 6.0 L., i.. Date: `---Z(.t_ l `Z — within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits \FPS- PermitApp.doc 02/01/2011 440- 4613T(1 I /02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) El New 2.) Modification to sprinkler heads only:
ddition 1 -10 heads: No plan review required.
Alteration 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 4
Additional description of work:
1✓ _ rz t 2_ ,e) (
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Wet ❑ Dry
Additional St andpipes ---
Information: Hazard Group
Density l Cj
Design Area
K. Factor 5, LP
Sprinkler Project Valuation: $ Lor _9,$)
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El 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.
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