Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
li g _ " COMMUNITY DEVELOPMENT Permit #: FPS2012 00180
T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/11/2012
Parcel: 2S113AB00500
Jurisdiction: TIGARD
Site address: 16083 SW UPPER BOONES FERRY RD 110
Project: United Advertising Publications Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Add (1) sprinkler head
Contractor: FIRESTOP CO Owner: G &S FC LLC
3203 NE 65TH ST #2 16083 SW UPPER BOONES FERRY RD,
VANCOUVER, WA 98663 STE
TIGARD, OR 97224
PHONE: 360 - 718 -8604 PHONE:
FAX: 360 - 718 -8603
FEES
Description Date Amount
Specifics: Permit Fee - COM 12/11/2012 $51.09
12% State Surcharge - Building 12/11/2012 $6.13
Type of Use: COM Plan Review - Fire Life Safety - COM 12/11/2012 $20.44
Class of Work: FPS Type of Const: IIIB
Occupancy Grp: B Height: ft
Stories: 3
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
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 Calcs Provided: Cut Sheets Required:
Total $77.66
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $500.00
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. Y ay obtain a copy of the rules
or direct questions to UNC by calling 503.232.1987 or 1.800.332.2344.
O
Issued By: / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspecti n 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 O\ I 1
Received
City of Tigard y t Date/By: Permit No.:
DEC 1 1 2012
13125 SW Hall Blvd., Tigard,OR 97223 �°'Z �� s'� PS.�p /� �Q /�
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
It l Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Jurir ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: 77&' 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.
CI 1- and 2- family dwelling Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ) CQ Gr 3 1 J V 1- 7t1 14 J v iV G•-> New dwelling area: square feet
City /State /ZIP: O P - rC . : 1-1 Z .7 --V1 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: 5 tTt✓ / /7) Covered porch area square feet
Cross street/directions to job site: u 1 N l -rte> / ,•-) � t .11 4 Deck area: square feet
v �`� �Y 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
DESCRIPTION OF WORK work indicated on this application.
( ►) p, , - 4 L� '1 - 2
Valuation: $ o = 3
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:
i rrAPPLICANT CONTACT PERSON NOTICE
Business name: -r,1--i L r��V 7 C l , / ) All contractors and subcontractors are required to be
t licensed with the Oregon Construction Contractors Board
Contact name:
1 rk n t A v - 1— under ORS 701 and may be required to be lensed in the
Address: 3 7 0 1\ 1 e -: ( J2 j -1'-i � l t Z Z jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
Cit ' I
y ti L .0 / J tJ`' 1 Z v ✓ • I is/ 6 ? app
Phone: (: ) l - e(t 6 Y Fax:: ( 0) I % - t/0 v
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: , (Please refer t o fee schedule)
>Z ` .�T h ? (j . _ Permit tee: ,5, /. 0 '
Address: �j7 t, I,_ J t. L 5--� L 1 3 o
City /State /ZIP: State surcharge (12 /o of permit fee): G /3
J (1 (.3 .0 J J 1Z / (/�/ . �� / �D FLS plan review (40 %ofpermit fee): / 1
Phone: (// 6) -:,-,1‹.1..... 7- b o t / Fax: (3- r f It . G Ci o 5 (Due upon application.) ,I U • 7 y
CCB lic.:1 2 57 Total permit fees:
Amount received: _77, (�, 6
Authorized signature: 1
This permit application expires if a permit is not obtained
Print name: ye l (U L t ! I Date: ! 1 7 within 180 days after it has been accepted as complete.
} t * Fee methodology set by Tri -County Building Industry
Service Board.
I \ Building \Permits\FPS- PermitApp.doc Rev 01/ 05/2012 440- 4613T(11 /02/COM/WEB)
a ^v
City of Tigard: Fire Protection Permit Checklist •
�� S
b y
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads onlyr
❑ 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 ❑ 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.\ Buildin \Perrruts \f PS- PernutApp.doc Rev 01 /05/2012 2