Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I — g • COMMUNITY DEVELOPMENT Permit #: FPS2012 -00149
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/20/2012
Parcel: 2S 113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 300
Project: Therapeutic Associates Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Fire alarm
Contractor: LEAR ELECTRIC CO INC Owner: G&S FC LLC
5140 SE CIRCLE AVE 16083 SW UPPER BOONES FERRY RD,
PORTLAND, OR 97236 STE
TIGARD, OR 97224
PHONE: 503 - 849 -4723 PHONE:
FAX: 503 - 661 -6389
FEES
Description Date Amount
Specifics: Permit Fee - COM 09/20/2012 $112.96
12% State Surcharge - Building 09/20/2012 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 09/20/2012 $45.18
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 09/20/2012 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: 3 Info Process /Archiving - Sm $0.50 (up to 09/20/2012 $2.50
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: Yes Alarm Type: Automatic
Pull Station Required: Smoke Detectors Req: No
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $176.20
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,500.00
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 _
„ Su i ti tti Issued By: �./l Permittee Signature: V (�/� (,
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 RECEIVED FOR OFFICE USE ONLY
Received City of Tigard Date/By: �7 �� PermitNo. + � ��
Other Permit:
13125 SW Hall Blvd., Ti ard, OR 97223 Y
C g Pl an iv evt`ew .• / //��
Phone: 503.718.2439 Fax: 503.598.1 1 Recei
2012 Date : / /304i0 a4,1/
•
T I GARD Inspection Line: 503.639 Date Read 1 " : G ® See Pa e 2 for
Internet: www.tigard- or.gov CITY OFTIGARD • ified/Method: J % Sup Iemental Information
BUILDING DIVISION • ' - -ffmti� g
TYPE OF WORK 1f TA: I- t D 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.
El I- and 2- family dwelling ® Commercial /industrial Valuation: S
❑ 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: 16083 SW Upper Boones Ferry Rd. New dwelling area: square feet
City /State /ZIP: Tigard / OR / 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: 300 Project name: Therapeutic Association 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: I Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this applicatio _
r
c o si
Provide fire alarm ananciation devices for new tenant improvement Valuation: S / �
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories:
Name: Therapeutic Association Type of construction:
Address: 16083 SW Upper Boones Ferry Rd. Occupancy groups:
City /State /ZIP: Tigard / OR / 97224 Existing:
Phone: ( ) Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Lear Electric Inc. All contractors and subcontractors are required to be
Contact name: Oleg Primachenko licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6002 NE 112 Ave. jurisdiction in which work is being performed. If the
City /State /ZIP: Portland, OR 97220 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 849 -4723 Fax: : (503) 255-0676
E -mail: op @learelectric.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: Lear Electric Inc. (Please rejerro fee schedule)
Permit fee:
Address: 6002 NE 112th Ave.
City /State /ZIP: Portland, OR 97220 State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (503) 849 -4723 Fax: (503) 255 -0676 (Due upon application.)
CCB lie.: 52278 Total permit fees: 1/71 , .2O
� �/ Amount received:
Authorized si ature: o..._ /'' �
This permit application expires if a permit is not obtained
Print name: avid Mumford Date: 9/14/12 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I :Building\Permits \FPS- PermitApp.doc Rev 01 /05/2012 440 -4613T(I I /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: $
C.) Fire Alarm
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 3,500.00
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.
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