Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
II I COMMUNITY DEVELOPMENT Permit #: FPS2012 -00129
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/20/2012
Parcel: 1 S 134 BC00300
Jurisdiction: Tigard
Site address: 12282 SW SCHOLLS FERRY RD
Project: Boardwalk Burgers Subdivision: WINDSOR PLACE Lot: 32
Project Description: Modification of (19) fire sprinkler heads
Contractor: FIRE SYSTEMS WEST INC Owner: FW OR- GREENWAY TOWN CENTER LLC
600 SE MARITIME AVE #300 PO BOX 790830
VANCOUVER, WA 98661 SAN ANTONIO, TX 78279
PHONE: 360 - 693 -9906 PHONE:
FAX: 503 - 289 -2208
FEES
Description Date Amount
Specifics:, Permit Fee - COM 08/20/2012 $102.20
12% State Surcharge - Building 08/20/2012 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 08/06/2012 $40.88
Class of Work: ALT Type of Const: VB Info Process /Archiving - Lg $2.00 (over 08/20/2012 $2.00
Occupancy Grp: A -2 Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 08/20/2012 $6.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: 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 $163.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,500.00
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 direc : •es ion : OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ■ / 0 GO „ ,/ Permlttee Signature: '��, >
Call 503.639.4175 by 7:00 a.m. for the next available inspeI'•
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 RECEIVED
„ FOR OFFICE USE ONLY
See Page 2 for
Y Tigard AUG O6 ?312 Received
Plan Review ei a A o� o�e01, Clt of PemlitNo.: •
rril n DateB
13125 SW Hall Blvd., Tigard, OR 97223 77.
Phone: 503.718.2439 Fax: 503.598.1 F , Date/B : � � � n • tberPermit:
ITY(� TIGAItD
TIGARD Inspection Line: 503.639.4175 Date Read : 1 1� J ura: El
Internet: www.tigard-or.gov BUILDING DIVISION Notifi etltod: r � / Supplemental Information
TYPE OF WORK REQUIRED DA : 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.
❑ I- and 2- family dwelling Commercial /industrial Valuation: $
❑ 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: 11,22 Z St.J S'C LLS Fa p -T -(1 t� I New dwelling area: square feet
City /State /ZIP "1 4 ) `jam , Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 13041- 94)1'Nrl CA lc/ 6 K Covered porch area: square feet
Cross street/directions to job ste: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE 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.
Valuation: $ 2 cb 0
n (2-5)% ft(2-5)% �sz la:
OCA Pf¢L %.
SPiztk.i tSRI
( 1 9 ff f # 5 Existing building area: square feet
New building area: square feet
• `p PROPERTY OWNER ❑ TENANT Number of stories:
Name: A m pcki 1 t _t.v o• v 1^ Type of construction:
Address: 2.4 (p Iva-' 4 S'TH i c Occupancy groups:
City/State /ZIP120 fL I 6'- Existing:
Phone: (52>3 )3(3 1, * ¶72...! Fax: ( )
New:
A APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Ft 5tr5`I S)ZS £ „fL3' All contractors and subcontractors are required to be
Contact name: ...ii) S N/ sit; /0",-- (75-011,f licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: Coo o Sir /)1 MC I pia 4*----- 0 jurisdiction in which work is being performed. If the
City /State /ZIP: v��jJ /. („A9 g c �' applicant is exempt from licensing, the following reasons
apply:
Phone: (74,0) 4,97 ?70C, Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: (,) (Please refer 10 fee schedule)
Permit fee:
Address:
State surcharge (12% of permit fee): •
City /State /ZIP: o
FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.: el ( --7)-z... Total permit fees: �(
Authorized signature -1 /�..- Amount received: W
`/
This permit application expires if a permit is not obtained
•
Print name;_ipicovi 54j) Date: a G. ---- 1 Z, within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
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