Permit IN ' : a CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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= COMMUNITY DEVELOPMENT Permit q: FPS2012 -00157
TIGARD 13125 SW Hall Blvd.. Tigard OR 97223 503.718.2439 Date Issued: 10/16/2012
Parcel: 1S133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE ,
Project: Westgate Baptist Church Subdivision: HAWK'S BEARD TOWNHOMES Lot: 62
Project Description: Fire alarm for 2nd story TI /Elevator
Contractor: ADVANCED SECURITY & FIRE Owner: WESTGATE BAPTIST CHURCH .: •
2218 NE SUNRISE LN 12930 SW SCHOLLS FERRY RD
HILLSBORO, OR 97124 TIGARD, OR 97223 .
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PHONE: 503 - 519 -4550 PHONE: 503 - 524 -3500
FAX: 503 - 643 -0848
FEES
Description Date Amount
Specifics: Permit Fee.- COM 10/16/2012 $102.20
12% State Surcharge - Building 10/16/2012 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 10/09/2012 $40.88
Class of Work: ALT Type of Const: IIIB Info Process /Archiving - Lg $2.00 (over 10/16/2012 $2.00
Occupancy Grp: E Height: ft 11x17)
Stories: 2 Info Process /Archiving - Sm $0.50 (up to 10/16/2012 $9.00
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: Yes Alarm Type: Automatic
Pull Station Required: Yes Smoke Detectors Req: Yes
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Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $166.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,000.00
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 • rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Ce er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -00 0. You may obtain a copy of the rules
or rect questions to OU - •y A . . ng 503.232.1987 or 1.800.332.2344.
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j t ,/,---)/2"ste Iss ed By: , MI 4 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.
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Buildin2 Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY
City of Tigard Received : /D g , / Permit No.: , S A`a- 57
13125 SW Hall Blvd., Tigard,OR 97 3 Plan Review l
C Phone: 503.718.2439 Fax: 503.598) 60 " `O ' L Da Re y l a f ' (.9 (G_ Other Permit:
T I G t\ k D O ... Inspection Line: 503.639.4175 ���((( ^,, Date Ready/By: Juris: 65 See Page 2 for
Internet: www.tigard- or.gov MY I ' c� O w ' atified/Method: /Q/ /572 - i _ i' , Supplemental Information
B O F
U IN L► • 1J 1, to/ r
TYPE W REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (romded 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 XCommercial/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:)e$ j4-1E, 5 _ , 5.7L 1 _ h zk �' ( h New dwelling area: square feet
City /State /ZIP: //, 73 /34 1-), t 7 e / ,d p q 7a a 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: )e 4 r t g f; 54- 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.
Tax map /parcel no.: Indicate the value (romded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
/� 1 DESCRIPTION OF WORK /9 ORK [ work indicated on this application.
/� , / / i 1 D h 7 7 - I1 r e /4 1 P In 5. 1.5 /-e Imo) . Valuation: $ 3 e44 , 41
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:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be 'tensed in the
Address: 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: /9d1//9 n c ed Seca r 1 /_ l r C Permit fee:
Address: c; %9 ) D N£ Su r) p; S e k n
State surcharge (12% of permit fee):
City /State /ZIP: /if- // ' bard p g7/azr
(5 ) ,S 55� ( 5 3) FLS plan review (Due up p lir fee
Phone: k Fax: 0 4213 - D V- (Due upon applic
CCB lit.: /44, I /e / �/3 Total permit fees:
L LR Amount
received . g
Authorized signature:
P Th is permit application expires if a permit is not obtained
Print name: J2, yl`c ()')p ' A y ; k Date: /�/9 l `� within 180 days after it has been accepted as complete.
/ * Fee methodology set by Tri- County Building Industry
Service Board.
1:\ Building \Permits\FPS- PermitApp.doc Rev 01/05/2012 440- 4613T(11 /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist r.
Page 2 - Supplemental Information -
Describe work to be done:
1.) ❑ New 2.)'° Modification to sprinkler head's: only: a .t
❑ Addition ❑ 110 heads: No plan review requied.;; -
❑ 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 $
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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
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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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