Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00123
"TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/10/2012
T
Parcel: 1 S135ACO2500
Jurisdiction: Tigard
Site address: 9304 SW MANDAMUS CT
Project: Longstaff Apartments Subdivision: ASHBROOK FARM Lot: 25
Project Description: Building 5 fire alarm
• Contractor: WESTERN STATES FIRE PROTECTION Owner: J.T. SMITH CO
13896 FIR ST STE B 5285 MEADOWS RD SUITE 171
OREGON CITY, OR 97045 LAKE OSWEGO, OR 97035
PHONE: 503 - 657 -5155 PHONE: 503 - 975 -7639
FAX: 503 - 657 -5182
FEES
Description Date Amount
Specifics: Permit Fee - MF . 09/10/2012 $134.48
12 %State Surcharge - Building 09/10/2012 $16.14
Type of Use: MF Plan' Review- Fire Life Safety- MF 07/31/2012 $53.79
Class of Work: FPS Type Of Const: VB • Info, Process /Archiving - Lg $2.00 (over 09/10/2012 $6.00
Occupancy Grp: R -2 Height: ft 11x17)
Stories: 2 Info Process /Archiving - Sm $0.50 (up to 09/10/2012 $14.00
11x17) •
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: No Alarm Type: Automatic
Pull Station Required: No Smoke Detectors Req: Yes
Battery Calcs Provided: No Cut Sheets Required: Yes
Total • $224.41
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation:
Residential Square Footage: 0
Fire Alarm Valuation: $6,000.00
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. You may obtain a copy of the rules
or direct ques ' • • . • OUNC by calling 503.232.1987 or 1.800.332.2344.
• Issued B . , /� / f `� Permittee Signature:
Call, 503.639.4175 by 7:00 a.m. for the next available inspec 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.
Building Permit Application r rt 7
Fire Protection System I f = ,a 5 .. q FOR OFFICE USE ONLY
City of Tigard JUL 3 1 20 12 Date/Bya //3/ /2_ e2 , Permit No osa9 /) _mi 3
° 13125 SW Hall Blvd., Tigard,OR 97223 Plan R e�w1� 1 (,� / r a .0 9
g Phone: 503.718.2439 Fax: 503.598.1960 f i ' ; Date/By: �j�� / / �1 O ther Permt lit/ �� — 4, 4 090 �
Inspection Line: 503.639.4175 l ,1 . r ; 7 .,.Sl.y Date Ready/By: kris: El See Page 2 for
TIGARD J i � 1 Internet: www.ti ardr. o ov r ,; , 1 ; ;. �>., Notified/Method: 77X. Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value ( rotded 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.
ID 1- and 2- family dwelling �mmercial/industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder CI Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ?30 y l 9 I .,,,,_, v „ 5 T 9g, , 992 , y'gJla, New dwelling area: square feet
City/State/ZIP: ; CD (1-- G 1722,5 9 3 , : 4 c �3 rd .... Garage /carport area: square feet
Suite/bldg. /apt. no.: ....5" Project name: 4 %��t: QS>k���
t Covered porch area square feet
Cross street/directions to job site: ( 1 c) /x'779 -7 3) Deck area: square feet
f / N S / 7 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.
c PttoTit m �i� \ gs -rt+.W>rTw ,� Valuation: ' $ ()00
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:
0/APPLICANT CONTACT PERSON NOTICE
NOTICE
Business name: �,S -,,J �-p� S cv ('D,� T \o-. Co W . All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
"' `( . '� O "'�''C1 t1 under ORS 701 and may be required to be leensed in the
Address: `? (o \ \ I .--1- c w .,- \ e •3 jurisdiction in which work is being performed. If the
City/State /ZIP: 0 ��(,� 1 e� p applicant is exempt from licensing, the following reasons
EL apply:
Phone: -j3) f _ S \SS Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: 5_, (\c �q
(Pleasere /ermjeeseheduleJ
Permit fee:
Address:
City/State /ZIP: State surcharge (12% of permit fee):
FLS plan review (40% of permit fee): ✓�� 79
Phone: (5 (cc - S U'SS l Fax: ( ) (Due upon application.)
CCB lic.: \01.-k'i p i Total permit fees:
Authorized signature: 4.3 Amount received:
1 This permit application expires if a permit is not obtained
' --I ? 1 I� 7___
wi 180 days after it has been accepted as complete.
Print nam
e' jw c�o v„T�A�� \hTt>, Date: —1 o \ +Fee methodology set by Tri -County Building Industry
Service Board.
I:\ Building ',Permits\FPS- PermitApp.doe Rev 01 /05/2012 440- 4613T(II /02/COWWEB)