Permit g, CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111 a COMMUNITY DEVELOPMENT Permit #: FPS2012 -00148
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/27/2012
Parcel: 2S113AD01800
Jurisdiction: Tigard
Site address: 16756 SW 72ND AVE B14
Project: Pacific Realty Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS 5 -1.
Project Description: Installation of a pyrochem open face paint spray booth suppression system
Contractor: UNIVERSAL FIRE EQUIPMENT Owner: PACIFIC REALTY ASSOCIATES
18260 SW 100TH CT ATTN: N PIVEN
TUALATIN, OR 97062 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 691 -9000 PHONE: 503 - 624 -6300
FAX: 503 - 691 -9004
FEES
Description Date Amount
Specifics: Permit Fee - COM 09/27/2012 $112.96
12% State Surcharge - Building 09/27/2012 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 09/13/2012 $45.18
Class of Work: ALT Type of Const: IIIB Info Process /Archiving - Sm $0.50 (up to 09/27/2012 $7.50
Occupancy Grp: F -1 Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type:
Standpipe Required: No 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 Calcs Provided: Cut Sheets Required:
Total $179.20
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $3,450.00
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 - • • k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili• Notification Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or 'irect questions to OU - •y ca ing 503.232.1987 or 1.800.332.2344.
I sued By: I • /, Permittee Signature: Alli
Call 503.639.4175 by 7:00 a.m. for the next availa : = • pection date.
This permit card shall be kept in a conspicuous place on the j • • - e until comp ion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application ErEiliEn
Fire Protection System `f �'j FOR OFFICE USE ONLY
City of Tigard S E P fl 3 2012 Date/By: 9/13 //2- GPS a0la - D� /N8�
Pe rmit No.:
III
a 13125 SW Hall Blvd., Tigard,OR 97223 Plan Revie
0 �� I� / •• her Permit:
Ph one: 50 3.718.2439 Fax: 503.598 OF TIGARD DateB : � �� 611-2,-5-11
I 1 G �� R D Inspection Line: 503.639.4175 p� ; � Date Ready :y: /aria: ® See Page 2 for
Internet: www.tigard or.gov BUILDING VISION Notified/Method: T a-A/ Z 4 " lico Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
ew construction ❑ Demolition Permit fees' are based on the value of the work performed.
Indicate the value (rotnded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCT N work indicated on this application.
❑ 1- and 2- family dwelling mercial/industrial
Valuation: S
m
❑ 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: / 6 75 L c f „ 7, 72n i A..(k. I New dwelling area: square feet
City /State/ZIP: 7--, r.� i 0 c 2 c� 3 22 Garage /carport area: square feet
Suite/bldg. /apt. no.: is , 4 Project name:Pfrits lics_! l e4 1(s (ec it . 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: Lot no.: Permit fees' are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK L 'e work indicated on this application.
/? cs ,l ip p
4 __ ,n Sec- (O 4- „ G�L.- -'t Valuation: $ ( 7 / 5-0 C9(.2
��, FRG( P y 9` _5?cn 6 0 ^1/ AY c..__
Existing building area square feet
a �J `mil New building area: square feet
f .7. et„S'S. `e L-- ,3 3
❑ PROPERTY OWNER ! NANT Number of stories:
Name: P/ s4 L I y tea- < n Ca, ` G Type of construction:
Address: 1' 75 —d ( 5� ` ?Z _ 14 . 4 ., e __ � Occupancy groups:
City /State /ZIP: J r 7 ,q,,tesc b j_ 9 7 €-2 3 Existing:
Phone: 503) G 8' Y- 07 a S Fax: ( ) New:
133- 1'Pti ,,,
CANT vn t ACT PERSON
NOTICE
Business name:an i d (�M ,i.) Ave. f -- All contractors and subcontractors are required to be
Contact name: r� licensed with the Oregon Construction Contractors Board
- ` under ORS 701 and may be required to be licensed in the
Address: I R" 2 6. /Do * ,...,-.1- jurisdiction in which work is being performed. If the
City /State /ZIP: 7u 0944,4-„1/4)., 0 R' c) Z,s applicant is exempt from licensing, the following reasons
Z apply:
Phone: 3) 6� r - ? 0`9v Fax:: ( 5 - .., a 6 S / _ 4 , ki
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: 5.4- �- Go /.."- (Please refer to fee schedule)
Permit fee:
Address:
State surcharge (12% of permit fee):
City/State /ZIP:
FLS plan review (40% ofpermit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.: 8 b 7 2 3 Total permit fees:
Authorized signature: Amount received: C� S g
This permit application expires if a permit is not obtained
Print name: / `- f , Date: , ...- 3 -` within 180 days after it has been accepted as complete.
"L ' Fee methodology set by Tri -County Building Industry
Service Board.
1:\ Building \Permits\FPSPermitApp.dac 02/01/2011 4404613T(11 /02JCOM/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: I $
C.) Fire Alarm ,
Submittal shall Battery Calculations . • t El 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.
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