Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
s COMMUNITY DEVELOPMENT Permit #: FPS2012 00099
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2012
Parcel: 2S101 DCO5000
Jurisdiction: Tigard
Site address: 13410 SW 76TH AVE
Project: Albertina Kerr Centers Subdivision: PACIFIC RIDGE Lot: 2
Project Description: Install Fire Alarm to monitor sprinkler system
Contractor: LIMITED ENERGY NW Owner: ALBERTINA KERR CENTERS
P.M.B. 190 ATTN: JERALD A HOFFERT
3439 NE SANDY BLVD. 424 NE 22ND
PORTLAND, OR 97232 PORTLAND, OR 97232
PHONE: 503 - 810 -7331 PHONE: 503 - 239 -8101
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 07/16/2012 $91.44
12% State Surcharge - Building 07/16/2012 $10.97
Type of Use: SF Plan Review - Fire Life Safety - COM 07/16/2012 $36.58
Class of Work: FPS Type of Const: VB
Occupancy Grp: R -3 Height: ft
Stories: 1
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: Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $138.99
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,000.00
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 u y obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B : 041/kmar Permittee Signature:
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 Application
Fire Protection System roll of i 1C1: usl: ONl.l
City of Tigard - Permit No.: Fps a,o (Y • • i
V 13125 SW Hall Blvd., Tigard,OR 97223 JUN 2 6 2012 R eceived Dat e/B
C g Phone: 503.718.2439 Fax: 503.598.1960 DatDate/By: Plan Review ��� �I t • ( Other Permit: (a. m
TI ii Inspection Line: 503.639.4175 CITY OF TIGfi RDP, Date Ready/By: Juris: ® See Page 2 for
GAD
Internet: www.tigard- or.gov BUILDING 1 D! !v!JiV 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
❑ Addition /alteration/replacement (8 Other: F 12 r A LAN- /4 equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1- and 2-family dwelling
Valuation: $ 060 y g ❑ Commercial/industrial
Accessory building ❑ Multi- family Number of bedrooms: i gre- 1 /
❑ Master builder ❑ Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: /
.Job site address: 13 4 ( 0 .SLJ 76 7 - 7 Au New dwelling area: square feet
City/State /ZIP: 71 ,/ R n ,_ Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: AL D€ fl U A 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
n
DESCRIPTION OF WORK work indicated on this application.
( jjS'T A L L /2E /le. -�zs— C y s AA 17 e R -SeQ NJ k k r Valuation: $
51 57-E-14._ 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:
❑ 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 (tensed 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*
(Please refer schedule)
fee schedule)
Business name: L1�tT�,r -6 F o'AG 4 0 Zr?-f43 f 6 eedu
Address: �� 170 _3 cf3 y- k i- 5,4.u' o
gnv Fp ( l9 N A State surcharge (12% of pe fee):
City/State/ZIP: f CJ 2 ? Z FLS plan rev revs iew (40 40 /o of permit fee):
Phone: (3-43) 18 7 33 / Fax: (34 b) N5 — 3 7Z. 8 (Due upon application.)
1
CCB lic.: / 3/ .6 „ Total permit fees:
Authorized signature: t / Amount received: a V [y
�[ This permit application expires if a permit is not obtained
Print name: c.4�„A a y L ! ?V /! 2 6 , I Date: 2 L A tin ZbI L * within 180 days after it has been accepted as complete.
Fee methodology set by Tri -County Building Industry
Service Board
IABuilding 'Permits\FPS- PermitApp.doc 02/01/2011 440.4613T(I1 /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: I $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ 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.
I: \Building \Permits \FPS - PermitApp.doc 02/01/2011 2