Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00145
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12280 SW SCHOLLS FERRY RD
Project: Little Caesars Subdivision: WINDSOR PLACE Lot: 32
Project Description: Dropping down one sprinkler head inside walk -in cooler
Contractor: FIRE EXTINGUISHER SERVICE CTR Owner: FW OR- GREENWAY TOWN CENTER LLC
3460 SW 209TH AVE PO BOX 790830
BEAVERTON, OR 97005 SAN ANTONIO, TX 78279
PHONE: 503 - 643 -3309 PHONE:
FAX: 503 - 356 -1736
FEES
Description Date Amount
Specifics: Permit Fee - COM 08/30/2012 $51.09
12% State Surcharge - Building 08/30/2012 $6.13
Type of Use: COM Plan Review - Fire Life Safety - COM 08/30/2012 $20.44
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type:
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 Calm Provided: Cut Sheets Required:
Total $77.66
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $300.00
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: 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.
BuildingjPermit Application
Fire Protection System R EVE colt OFFICE USE ONLY
City of T i g a r d A U G 3 0 2012 Date/By: s'( 30//2.- Sr( Permit No.: p 0.0 l_ .. Bo/
° 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 CITY / � T � / e�p DateBy: Other Penni p join. oolS "
TIGARD
Inspection Line: 503.639.4175 i IGAR Date ReadyBy: Jude: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING OMS O i otified/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 (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.
❑ 1- and 2- family dwelling ommercial/industrial Valuation: $
Y
❑ 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: /010a sy✓ serf t -Ls ce- / Ree . New dwelling area: square feet
City /State /ZIP: - 77(. 1 777--,0 , .'‘C- - °J 7 2 23 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: (_/ -7°7 CfIL Covered porch area square feet
�
Cross street/directions to job site: l / Si ; � eh o / %S e Deck area: square feet
071' J Ife TO ,../t! Cam✓ 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 (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
,, "��7 DESCRIPTION OF WORK work indicated on this application.
fD° �cp,p )/' J Op)./Ai , U!`/ 0 cite- /rKie. rn w ,,v_sid>S Valuation: $ 300 —
W yekL-1C_ — /n) C-ri0 L-0.1 r Existing building area ? i LI square feet
New building area: t 2/ square fee
❑ PROPERTY OWNER I 1 / `I(J TENANT Number of stories: /)
Name: G� C f,,, ,' f— 72_
7 & 2_,6 01, Type of construction: (iDL 24- Qpc-/e-
8- J9
Address: /8 ) s 7u_LH .7-,„/ J,L /.. y y Occupancy groups: 2
City/State /ZIP: �rs 16.9 p4. - 1 0 v 6 Existing: 4 . '
Phone: ( 51 1 3 ) loUB -7v $S Fax: (Sb3) 6/(2-33'2_2
PI „,,/ New: ()
❑ APPLICANT (J CONTACT PERSON NOTICE
Business name: I-1 �7. All contractors and subcontractors are required to be
Contact name: �yyj� C - G9 /�l�j 4 v licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be lensed in the
Address: -jam e ,06 Q-6 U - 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 to fee schedule)
Business name: r-, 2E C�-)17 tel 61- /-E. /cSii27 rVC„, C-T 2 - Permit fee:
Address: 2 V& o S W „2_0 •
City/State /ZIP: Cs<,�vC/Z 7-0,../ 0 A 9 7 af,.� State surcharge (12 % of permit fee):
FLS plan review (40% ofpermit fee):
Phone: (5 Ill _ 01 12 j Fax: ( ) (Due upon application.)
i /CCB lic.: r q 3 Ky Total permit fees:
Authorized signature:
Amount received: 11
1 This permit application expires if a permit is not obtained
Print name: pwt G nil IN Gr. v4 Date: - 6/ /1'2,” Within 180 days after it has been accepted as complete.
• Fee methodology set by Tri -County Building Industry
Service Board.
1:\ Building \PermitsWPS- PermiWpp.doc Rev 01/05/2012 440 -4613T(II /02/COM/WEB)
t ♦ v
City of Tigard: Fire Protection Permit Checklis ' `
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler had only:
E l Addition J1_/ 1 -10 heads: No plan review required.
Alteration ❑ 11+ heads: Plan review required.
❑ Repair ry
Number of sprinkler heads: /
Additional description of work: ,,, _. viyi 041.7 kv 6 /4 _ i .i 4vG A (7j -
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
[a 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: $
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 Rev 01 /05/2012 2
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00145
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12280 SW SCHOLLS FERRY RD
Project: Little Caesars Subdivision: WINDSOR PLACE Lot: 32
Project Description: Dropping down one sprinkler head inside walk -in cooler
Contractor: FIRE EXTINGUISHER SERVICE CTR Owner: FW OR- GREENWAY TOWN CENTER LLC
3460 SW 209TH AVE PO BOX 790830
BEAVERTON, OR 97005 SAN ANTONIO, TX 78279
PHONE: 503 - 643 -3309 PHONE:
FAX: 503 - 356 -1736
FEES
Description Date Amount
Specifics: Permit Fee - COM 08/30/2012 $51.09
12% State Surcharge - Building 08/30/2012 $6.13
Type of Use: COM Plan Review - Fire Life Safety - COM 08/30/2012 $20.44
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type:
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 Calm Provided: Cut Sheets Required:
Total $77.66
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $300.00
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: 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.