Permit r 9r L
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CITY OF TIGARD a'5 . FIRE PROTECTION SYSTEM PERMIT
II I ' COMMUNITY DEVELOPMENT Permit #: FPS2013 -00010
T i GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/15/2013
Parcel: 1 S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 417
Project: Cypress Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Add and relocate 10 heads for new walls TI 2/5/13 REPRINTED to correct permit specific information
Contractor: PACIFIC FIRE SYSTEMS LLC Owner: LINCOLN CENTER LLC
6704 RIVERIA CT BY SHORENSTEIN PROPERTIES LLC
WEST LINN, OR 97068 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 710 -6646 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 01/15/2013 $75.30
12% State Surcharge - Building 01/15/2013 $9.04
Type of Use: COM Plan Review - Fire Life Safety - COM 01/15/2013 $30.12
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
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: Alarm Type: .
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $114.46
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,320.00
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. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1 o
503.232.1987 or 1.800.332.2344. �7
Issued By: /I ,G eJ���LC/r Permittee Signature: �9/ \
��++ 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.
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
= COMMUNITY DEVELOPMENT Permit #: FPS2013 -00010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/15/2013
Parcel: 1 S 135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 417
Project: Cypress Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Add and relocate 10 heads for new walls TI
Contractor: PACIFIC FIRE SYSTEMS LLC Owner: LINCOLN CENTER LLC
6704 RIVERIA CT BY SHORENSTEIN PROPERTIES LLC
WEST LINN, OR 97068 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 710 -6646 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 01/15/2013 $75.30
12% State Surcharge - Building 01/15/2013 $9.04
Type of Use: COM Plan Review - Fire Life Safety - COM 01/15/2013 $30.12
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $114.46
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
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. You may obtain a .: of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: jitiii4 f ,l , C ,- n Permittee Signature:
/
/ Call / 5003.6339 .4 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 oft = project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System RECEIVE 0 FOR oFFICL USE ONLY
City of Tigard Received
JAN 1 5 Date/BY. (/ / S /-.3 S-1.-- Permit No. /PSG I - OO(. D '
Iiii a 2013 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review po�1 r' COQ (
C . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: .
y: Other Perini
T I G n R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: !uri //''� Hi See Page 2 for
Internet: www.tigard - or.gov B UILDING DIVISIO Notified/Method: (D 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 (rotnded to the nearest dollar) of all
P r-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 0-commercial/industrial Valuation: $
El 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: /6,0./2 0 �w rLeruI J eLr2c, rG
/� New dwelling area: square feet
���d
City /State /ZIP: / V cc t2 j}J/f / Garage /carport area: square feet
Kii( Idg. /apt. no.: L f / 7 / Pr ` ojject name: e •,, 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 (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
/ DESCRIPTION OF WORK J / work indicated on this application.
,4ei � <4 g /D e - /Q I L/ -e4t.d 1 fO2 /(.) Valuation: $ �3,2 0
.
Existing building area square feet
New building area: square feet
El 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: ( ) Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
/�� (Please refer to fee schedule)
Business name:
/-atcl 'p- r c SyST
Permit fee:
Address: C70 Y 1414.) 1 "e4/44._
//l / p State surcharge (12 %ofpermit fee):
City/State/ZIP: 6/(/"eA�/ K / ®a_ X70 G s' FLS plan review (40% of permit fee):
Phone: (!03) 7/0 - 46 ` C Fax: ( ) (Due upon application)
CCB lic.: / f O It./ Total permit fees:
/
Authorized signature: Amount received:
,h This permit application expires if a permit is not obtained
Print name: �' Date: / — /� / 3
/ within 180 days after it has been accepted as complete.
�� „, * Fee methodology set by Tri- County Building Industry
/ Service Board.
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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 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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