Permit II CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I • ' COMMUNITY DEVELOPMENT Permit#: FPS2012 -00104
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/26/2012
Parcel: 2S101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY
Project: Triangle Point Subdivision: VARNS ACRES Lot: 9
Project Description: Fire sprinkler alteration for 3rd & 4th floor elevator lobby
Contractor: PATRIOT FIRE PROTECTION INC Owner: TRIANGLE POINTE LLC
4708 NE MINNEHAHA ST 901 NE GLISAN ST, #100
VANCOUVER, WA 98661 PORTLAND, OR 97232
PHONE: 360 - 699 -4403 PHONE: 503 - 297 -8791
FAX: 360 - 699 -4485
FEES
Description Date Amount
Specifics: Permit Fee - COM 07/26/2012 $112.96
12% State Surcharge - Building 07/26/2012 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 07/26/2012 $45.18
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 07/26/2012 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: 5 Info Process /Archiving - Sm $0.50 (up to 07/26/2012 $3.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
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 $176.70
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $4,000.00
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, o ' k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility tification Centel Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or di ct questions to OUNC. calla g 503.232.1987 or 1.800.332.2344
Iss ed By: Q Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspe ion 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.
•
Buildint Permit Annlication
Fire Protection System 1 11 R U 1. F 1( 1.1 C SE. O N L)
City of Tigard RECEIVED D ' Bv. _nallre / A0 /J -A) /Dy
Permit No
11 • 13125 SW Hall Blvd., Ttganl, OR 97223 11.2 Phone: 303.639.4171 Fax 503.3981960 J U L 012 •.:.: tirig ®la I "' Permit: ,/,, / , 0 , , - „, , a
1 I , „, I: I l Inspection line: 503.639.4175 Date Ready/By. Tom RI See Page 2 fbr
Internet www.tigard- or.gov CITYOFTIGARD Notified/Method S�Iemental l&Tre adn
BUILDING
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
)3rAddition/aheration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1 -and 2 -family dwelling aCommercial/indust rial Valuation: S
❑ Accessory building CI Multi - family Number of bedrooms:
❑ Master builder ❑ other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: IS'SS' Sy./ 6,61-let pt ff / New dwelling area: square feet
City /State/ZIP: **I L 1 0 a CO V7 Garage/carport area: square feet
Suite/bldgJapt. no.: I Project name: Te /a,,t,LE Pe, l NIZE.- area: Covered porch are square feet
Cross street/directions to job site: leo 4 4714 ,a
P., Deck area square feet
Other structure area: square feet
REQUIRED DATA: COM1 IERCLIL -(TSE CHECKLIST
Subdivision: I Lot no.: Permit fees* are based on the value of the work performed.
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.
(�. / °
A ❑ C OCs�'T� �t2 t t S TO 1 11J Valuation:
area: S �l Ob square feet
VvaLLS . IL I i Jos ce.0 ..... . Et, , s - rlae-- Existin
C, V G EA b Sysl Ef"-^ New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Type of construction:
Address: OccuPancY Pulps: Lt Cori-ri 1 z�
City /State/ZIP: Existing: l \ / •
Phone: ( ) Fax: ( ) New: \A r /
,APPLICANT 0 CONTACT PERSON NOTICE
Business name: rAle I -- ; 2G p�,o (, 1 tJ £ . All contractors and subcontractors are required to be
Contact name: E�-E- � �- t ►J S ( licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 4-706 1.3 E k 1 N/ V E I-4A14 l- S-". jurisdiction in which work is being performed. If the
City/State/ZIP: V i i 1/4 C ! (1)A- q / ( applicant is exempt from licensing, the following reasons
Phone: ( Z a -7 Coo o 1 I Fax:: ( 6 et ei -` *103
E -mail: 1 E FP e-t o� t.
tc l ea t _v a`'\
( CONTRACTOR BUILDING PERMIT FEES*
Business name: (i tr y �1 I1 - (Please refer to fee schedule)
Permit fee:
Address:
State surcharge (12% of permit fee):
City/State/ZIP: FLS plan review (4000 of permit fee):
Phone: ( ) I Fax ( ) (Due upon application.)
CCB lic.: "AA Z Z Total permit fees: f (l UL
Authorized signature: Amount received: `- ----
d
� This permit application expires if a permit Is not od
I Print name: 6 F r Co La__ t (VS I Data: .7 r 7 , ` I within 180 days after it has been accepted as complete.
• Fee methodology set by Tri-Coumy Building Industry
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
L) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
)4 *".: - Clteration 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
Tet ❑ DILT
Additional Standpipes
Information: Hazard Group Li(„r4'Y
Density , • l U
Design Area lST
K. Factor 5. 4
Sprinkler Project Valuation: $ 4, GU a "
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: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $29230
7,201 and greater $38130
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 2 sets of plans at submittal. Plan review fees are required at submittal.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
U: \32 -9000s \32.9690 Triangle Pointe \FPS- PemutApp.doc 2