Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
_ - COMMUNITY DEVELOPMENT Permit #: FPS2012 00091
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/14/2012
T [ G.4RD 9 Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 155
Project: Pacific Parkway Center Avanti Market Place Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: (1) sprinkler head into new ceiling
Contractor: DELTA FIRE INC Owner: PACIFIC REALTY ASSOCIATES
14795 SW 72ND AVE ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 620 -4020 PHONE:
FAX: 503 - 620 -1058
FEES
Description Date Amount
Specifics: Permit Fee - COM 06/14/2012 $51.09
12% State Surcharge - Building 06/14/2012 $6.13
Type of Use: COM Plan Review - Fire Life Safety - COM 06/14/2012 $20.44
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
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 $77.66
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
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 By: e 1 - Permittee Signature: r ( �/1 3 6417
am
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. r
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.
JUN/12/2012/TUE 12:52 PM FAX No, P. 001
fC
Fire Protection System FOR 01:1:1CFTSE oNL
City of Tigard
I
RECEIVED .Raiiveir ._, 1
DaWB l ( . /2*" 1 .;, 771" ,1,1 ,..:EPS.xot a 0009 /
13125 Sillr Hall Blvd., Tigard, OR 97223 JUN 1 2 2012 Plan Review
' 2 . Phone: 503.639.417i ADC 503.598.196n Dilati: . . . ... .. .9thcr !q5 8(.1,9c:2044 - 60 107
• FIG Inspection Lida: 501639.4175 Dale Ready/By: ' • ' a s, tie_ ' I — it flosPapi 2 hr .
ARI)
Internet mvw.tigard-orgov CITY OF TIGARD Notified/Med* I 1J Supgilowenal kilernkados
:1 1 1 k 1 • L
. ...:',.' 4 , ; ., ::__": • . , • ; . 11 *.0 . iito i. ,..'.:* ;;, .f .1.. . i.: 4i t.. 4 ig r.... 1 , 7 :.,. , : : i : 0040:Atu anott we.YAI•vv•-.1 , 7-,,A r ---,,.
0 New construction . CI Demolition Penuit fees* are based on the value of tha work perforined_
Indicate the value (matted tO the nearest dollar) of all
t•:: , ddition/alternioulreplacement ° 0 Oe;r:
nt, materials, labor, overhead, and the profit for the
_ equipment,
, .;; 3 i . ..; ; ' ‘ .. r ...'t. i ',.;,- •*_ . .. , ..„::: . .,7:74* - 0* 0" ..... : : . :":.::.:..:: ".:::. : work indicated on this application: .
:
ID l- and 2-family dwelling
F Commereialimdustrial Valuation $
• Ninnba • . •
0 Accessory building ci'kuieftlail .
Of bedrimms:
0 Master builder it Oi6r. Number of bathrooms:
,.
. k. :: - .•!...';',. :: Total number of fkiers: ' •
lob site address . a (0 .'..
• a s.A_, ii4tpw dwelling area : square f
i
City/Stater/12: i llEITIM . 11111511Li ..., 1111.11111111111.: . • Garage/carport area: . .-square feet
s no. , 1 b , . jeet risme: fitt,c• a , . a . - .1.,.- i CoVered porch area square feet
Cross street/directions to job site: - . Avnityl• 2 c . Deck square feet
Piker structure area: square feet
. : - It'v
Subdivision: I Lot no.: Pinnit fai*olarp, based on the value of thdyrtsrli pmformed,
•
indicate 'the value (rotnded to die neareet dollar) of all
Tax map/parcel no.:
equipment, materials, labor overhead, and the profit for the
, .. .. '• •:: .:Dpsoprrisrf„ -:,. -• -:.; , -. .. . : ..- . ; , • work indicated on this applietuim
111051.= M MIM ' A
• 1 ' Valuation: l'1 7 - 60 -----
$
e . Existing building area square feet
• New building area square feet
, . . . • - • . , , . . . , ,
0 PROPERTY 0 .. . ...; • : 3:F .11;441, 4 . -. • • . ..-----:•;: Niniber of stodes:
Name: . • Type of construction:
—
Address:
. Occupancy groups: . .
•
City/State/ZEP:
Existing: •
Phone: ( ) Fax: ( )
New:
PPLICANT : . • :;'. .. • ' . a CONTACT P4.10.1 ::.:.•'.::'!' : , ,.:,... ...;..,i,-.:...,
,..,!...`',‘ ,....:' ' ''':.?; ' .:•!., 4 VIAIMOM: . ...•1 ' :: In 0::■ , '!:;
Main= Dame: L -. i s MIMMIIIIIII.1111.11111111.1111 . Ali eon•actors and subcontractors are required. be
Contact name: . g e:ic ic t v ..., licensed with the Oregon Oanstruction Contractors Board
under ORS 701 and may be required to be Ikensed in the
Address: • . • • i- 4 • jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/LP: :MT 171 c IrCallikeRUM
aPelY:
,,nri:, 1 40_0_,. • 4_6 1..L.,.: .
IMESMMV 1 • ii . .
CONTRACTOR ' • ' " . ''' ' :" • - : •• i. : n• tinjmn p. . Fsektivr
• -''- " ' ''• ::•?.'!=0.W47.0 • - l . .
Business name: I ... to : e _a .
Permit fee; 51.0
Address: "011WhiliPlZr 4 ,
...
State surcharge (12% of pemit fee): (f • 13
City/StaterLfP: d l i nill i l
Fi-S plan revMw (40% of permit fee):
P 1 ....i; :AA - • 00 1:120Mkref • I. (Due upon application.) ao- 44-4,1
EZIEFF125,14 , li . . Total permit fees:
Authorized signature: F M lirni Amount received: 1 1 . ( 4
This permit application expires if a permit is not obtained
Print name: I -. l c • eAsv it C Date: , MM. within 180 dap after it has been accepted as complete.
• Fec methodology set by Tri-County St:0(611g Industry
Service Board.
tAsliiidin TPS-PthrlicApp.doc 03/11/D6 440-4613T(l I/02/COMAVEB)
JUN /12 /2012 /TUE 12:52 PM FAX No, P. 002
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47.1 ,' � i. ° 4 �'• , :i.: . . 1 FjferY Y t o - _ i 1 � • -.Checklist — �..._..._w. - , r or:";;.:, = :'.Q
•
,.P, a Information • -
ag .2: .Svppleenlal: �
•V�Y.hG. .. • ' r s oe eiiie ,:•.....,:.:. • _. : itt e1'.1,' -' -. ... .. ......:1.7.:,-..", _R14:'Y, . .1! , • • .., : a.•'
'�1. ......._� ._ ._......_.__....... . ... - 2.7 .- . attbn.to.sp erh�s Ooly ------- ...__.... _.. _..
...4.tr_
A4,Elition
1 -10 heads: No plan n repieive5luied .
'' Alteta$ion 0' 11+ heads: Plan-review requi dd.•
Number of sprinkler heads: 1.. r -
.T. .4...of.$ `tai I o . - .. 'Y _ OLD ' a . s 1i able , .. - , �.. i • . . • .... .
A.) Commerci .Sj rmk , ' '; ' •. ..... •:... •, : . :_ , • Additional , . Standpipes - , ' : - ,-
Information: Hazard .Gro 1 , , . . . ' `;! ..1 ,;
Density :: 'J: j, , ,.- ri �: , ; -s. •
• ; ,.s .1 ,
Design .A e&i .( - i.:-.. •••{4,Ir•, ,4(bt,.if?
K Factor
• Sprinlder Project Valuation: $ L( 19 , 00
. T . . _
Hood Project Valuation: . I $ .
• 11 � • . ,*k . r F - . i .:. f . :' . . .' t•S - '4 >. r' .. v. • i •Ir
C.) Fide. : �. °• ' � , .: ; • .. ,;: , � :2 : :7 + z .
' •
Submittal shall Battery Calculations 0 Yes : >
include: Individual Component • ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
•
D.) Residential Sprinkler S d Alo . e .. §0An
Square Footase: Permit Fee: -! s.r
$1 87.50 : 3,� _ '
0 to 2,000 ,}
; � . a :
;..�':. '
2,001. to 3,600 .... ,. -' , : .
;232.50 � � .,� .:' .` ";.
3;601 to 7,200 $292.50 r , :',' s' '
7,201 and greater $381.50 • ,
Sprinkler Project Square Footage: '', bq."ft.'
?ire °P.rot :: •.C
Project valuation subtotal (see A, B & C above): � $ ..:1(... : '.•.; c ...t r .
Permit fee based on project valuation (sec fee schedule): $ ,
Permit fee based on square footage see D above): A $ ... ;
• State Surcharge (12% of permit fee): $ , > . '. -. FLS. Plan Review (40% of permit fee $ ' '
TOTAL:, .. • - •. ..
,• f. -ti •'. Wes' .'• ,.1 • •.'.: •...,, •
Plan review requires a completed application and 2 sets of pl at sul • Plan review fees are required at subaiuttal.
i * ell ;, •
"New" fire protection systems require that plans bear the original`seal of an Oregon licensed fire su'pression
engineer, or NICET level "3" technicians. ... :, ' j•
r \Buil 8 \Pennies \FPS- PefadcApp.doe • 2