Permit ,, CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• °1' 1. _ : COMMUNITY DEVELOPMENT Permit #: FPS2012 -00014
13 125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/01/2012
TIGARD P� g Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 300
Project: PacTrust Corporation Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Construct conference room.
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 02/01/2012 $67.23
12% State Surcharge - Building 02/01/2012 $8.07
Type of Use: COM Plan Review - Fire Life Safety - MF 02/01/2012 $26.89
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 $102.19
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,100.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
A
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State . • r. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire k is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t • I the rules adopted by the Oregon
Utility N ion C,-- -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0rss ��u may obtain a copy of the rules
or direct estions to OU . by in 503.232.1987 or 1.800.332.2344.
Issued y: i' , l' / Permittee Signature: k
Call 503.639.4175 by 7:00 a.m. for the next available inspection da e.
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 /j� FOR OFFICE USE ONLY
City of Tigard Date/By: ��/ � r Permit No.: /� � A
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /
' 9 : Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T l G A R D Inspection Line: 503.639.4175 Date Ready/By: lads: H See Page 2 for
Internet: www.tigard- or.gov Notified/Method: 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 (rotnded to the nearest dollar) of all
ddition/aiteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
dwelling Valuation: $
❑ 1- and 2-family g ❑Commercial /industrial
❑ 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 �j 3 S 0 5 (A_.) S `, New dwelling area: square feet
' lG` V � ,
City /State /ZIP: ' ( t ' G` --32'( 0 / �/ Garage /carport area: square feet
Suite/bldg. /apt. no.: 5.2?) Project name: P 4-e._ �� ! 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.
p � Valuation: $ / /d0
C
G \, -1--e. , t 4 'VLo A °( v—; ,. y Q ✓d {-C c-- 1 -,b) -)
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:
A PPLICANT ❑ CONTACT PERSON NOTICE
Business name: E,' ,- e +o f l� <t f (_ (. All contractors and subcontractors are required to be
Contact name: A l c.._(:_, (2 tom_ licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be ]tensed in the
Address: 'Z 2- U 3 /U C . t 5 ` I-1^ 5+ "" 1- jurisdiction in which work is being performed. If the
City /State /ZIP: U Cz_-„J O, -c) L,.L. (� f i 5 g (. Cv j applicant is exempt from licensing, the following reasons apply:
i PP Y:
Phone: ( — I — I ( - n 6, C) '1 Fax: : ( 3C --.1 (� ' 6 (e, O''
E- mail: /1 l Z c 0. i-- , v Z__ S - { - 0 C0 , C-0'
BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule)
Address: C -.� _ Permit fee:
State surcharge (12% of permit fee):
City /State /ZIP: FLS plan review (40 o fpermit fee):
Phone: ( ) 1 Fax: ( ) (Due u pon application.)
CCB lic.: (S 3 - 2_ Total permit fees: / q
Authorized signature: / Amount received:
This permit application expires if a permit is not obtained
Print name: A. ( c 1 t--.- Date: 2.- k - k'"Z within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
0- ■2ivv" ,0 i /t'' `' °.-- - 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.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ 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 ❑ 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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