Permit II CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
3 COMMUNITY DEVELOPMENT Permit #: FPS2012 -00074
TI G A _R..O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/31/2012
Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Project: Axiom Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Install fire alarm devices
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Description Date Amount
Specifics: Permit Fee - COM 05/31/2012 $86.06
12% State Surcharge - Building 05/31/2012 $10.33
Type of Use: COM Plan Review - Fire Life Safety - COM 05/31/2012 $34.42
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 05/31/2012 $8.00
Occupancy Grp: B Height: ft 11x17)
Stories: 12 Misc Administration Fee 05/31/2012 $5.00
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: Yes Alarm Type: Automatic
Pull Station Required: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $143.81
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,800.00
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 Notificatioo„Le ter. 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 que ons to O . by C. 'n • 3.232.1987 or 1.800.332.2344.
Issued By � i Permittee Signatures /
•
Call 503.639.4175 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 Applicat C i\ /ED
Fire Protection System g 9 ' 1T- ` FOR OFFICE USE ONLY
MAY 1 1 2012 Received / Q ` D y_
City of Tigard Date/By: ( ( G � '
Permit No.: 's 0 27 co
° 13125 SW Hall Blvd., Tigard, OR 7 n 1� Plan Revie ,
r
Phone: 503.718.2439 Fax: 503. 5
196 1F TIG A� D ate /B : A �J l r/ , t • ther Permit: Aj 0 020 (a„PE/ Z • TIGARD Inspection Line: 503.639.4175 BU'p Ui ^ D,d+,d NN Date Ready/:y: to` 'p ® See Page 2for
Internet: www.tigard- or.gov ' ` 0 hod/6/3/// , ' 0 11 �`Q Supplemental Information
.:. / -.-., Y
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. h
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $ t
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10260 SW Greenburg Rd Tigard, OR (Lincoln Twr) New dwelling area: square feet
City /State /ZIP: 97223 Garage /carport area: square feet `
Suite/bldg. /apt. no.: Ste 710 Project name: Axiom Expansion T.I. Covered porch area: square feet
street/directions to job site: Deck area: square feet (`
o
Other structure area: square feet IN
REQUIRED DATA: COMMERCIAL - USE CHECKLIST V
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed. ill
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. g
Install fire alarm devices per plans Valuation: $1,800.00
Existing building area: square feet is
New building area: square feet )J
® PROPERTY OWNER ❑ TENANT Number of stories: °Q
Name: Shorenstein Realty Services Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New: '
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
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: ( ) I Fax::( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: Capitol Electric Company, Inc. (Please rejerro fee schedule,
Permit fee: 86.06
Address: 11401 NE Marx Street
City/State /ZIP: Portland, OR 97220 State surcharge (12% of permit fee): 10.33
FLS plan review (40% of permit fee): 34.42
Phone: (530) 255 -9488 I Fax: (503) 255 - 1966 (Due upon application.)
/tCB lic.: 48748 '6, Total permit fees: 130.81
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: Dan Wilson Date: 5/9/2012 within 180 days after it has been accepted as complete.
• Fee methodology set by Tri- County Building Industry
Service Board.
I: \ Building \Pcrmits\FPS- PcrmitApp.doc Rev 01 /05/2012 440- 4613T(t t /02/COM /WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
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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 ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1,800.00
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): $ 1,800.00
Permit fee based on project valuation (see fee schedule): $ 86.06
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $ 10.33
FLS Plan Review (40% of permit fee): ' $ 34.42
TOTAL: $ 130.81
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
U: \FA Jobs \zz120516 -45 Axiom Exp @ LT -710, JMC\ 1 FPS- PermitApp.doc Rev 01/02/2012
CITY OF TIGARD
RECORDS RETENTION FEES WORKSHEET
BUILDING PERMITS
Fees for scanning building department submittals.
Size # of Pages Cost per Page Total
8 1/2" x 11" X $0.50 $0.00
8 1/2" x 14" X $0.50 $0.00
11" x 17" X $0.50 .$0.00
18" x 24" X $2.00 $0.00
24" x 36" X $2.00 $0.00
30" x 42" 4 X $2.00 $8.00
Other formats X $2.00 $0.00
TOTAL RECORDS RETENTION FEE I $8.00 I
11 1111 CITY OF TIGARD FEE AND PAYMENT HISTORY
f . 13 125 SW Hall Blvd., Tigard OR 97223
503.639.4171
T[GARD
FPS2012 -00074 - 10260 SW GREENBURG RD 710, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Permit Fee - COM 230 - 0000 -43104 $86.06 $86.06 $86.06
12% State Surcharge - Building 100- 0000 -24001 $10.33 $10.33 $10.33
Plan Review - Fire Life Safety - COM 230 - 0000 -43108 $34.42 $34.42 $34.42
Info Process /Archiving - Lg $2.00 (over 230 - 0000 -43135 $8.00 $8.00 $8.00
11x17)
Totals for Fees $138.81 $138.81 $0.00 $138.81
Receipt # Payment Method Check # Pavor: Receipt Date Receipt Amount
Total Payments: $0.00
Balance Due: $138.81
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