Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11111 2 , COMMUNITY DEVELOPMENT Permit #: FPS2013 00021
T LCARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/11/2013
Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 465
Project: Doral Healthcare Finance Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Fire alarm for TI
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 255 -9488 PHONE: 503 - 619 -3200
FAX: 503 - 257 -7121
FEES
Description Date Amount
Specifics: Permit Fee - COM 02/11/2013 $51.09
12% State Surcharge - Building 02/11/2013 $6.13
Type of Use: COM Plan Review - Fire Life Safety - COM 02/11/2013 $20.44
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 02/11/2013 $8.00
Occupancy Grp: B Height: ft 11x17)
Stories: 5 Info Process /Archiving - Sm $0.50 (up to 02/11/2013 $3.00
11x17)
Misc Administration Fee 02/11/2013 $5.00
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
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $93.66
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,200.00
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 O calling
� 503.2 or 1.800.332.2344. /� /\ , 1
Issued By: Permittee Signature: D id A PPL/ /+ 4 J Iv
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 ApplicatioCEIVED
Fire Protection System FoR OFFICE USE ONLY
FEB 4 2013
Receive
Cit of Tigard Permit No.: .
Y Date /B �. .� .�Psao /3 —ovo�
'' 13125 SW Hall Blvd., Tigard, OR YOFTIGARD Plan Revi� Other Permit. P �� D�� J ?
Mill ` Phone: 503.718.2439 Fax: 503 Date /B N ��
Inspection Line: 503.639.4175 ���IMG DIVISION Date R •/ Juris: ® See Page 2 for
TIGARD N otified/Method: Su
Internet: www.tigard- or.gov pplemental 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.
El 1- and 2- family dwelling ® Commercial /industrial Valuation: $
El Accessory building ❑ Multi- family Number of bedrooms:
1=I Master builder El Other:
Number of bathrooms:
- JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10300 SW Greenburg Rd Tigard, OR (1- Lincoln) New dwelling area: square feet
City /State /ZIP: 97223 Garage /carport area: • square feet
Suite/bldg. /apt. no.: Ste 460 Project name: DORAL HEALTH T.I. 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 (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Install fire alarm devices per plans Valuation: $1,200.00
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER El TENANT Number of stories:
Name: Shorenstein Realty Services 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 licensed 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*
Business name: Capitol Electric Company, Inc. (Please refer ro fee schedule)
Permit fee: 69.92
Address: 11401 NE Marx Street
State surcharge (12% of permit fee): 8.39
City /State /ZIP: Portland, OR 97220 0
FLS plan review (40% of permit fee):
Phone: (530) 255 - 9488 Fax: (503) 255 - 1966 (Due upon application.) 27.97
CCB lic.: 48748 Total permit fees: 122.28
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: Dan Wilson Date: 1/17/2013 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
1: \Building'Pemws \FPS- PemiitApp.doc Rev 01 /05/2012 440- 4613T( II /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: $ 1,200.00
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): $ 1,200.00
Permit fee based on project valuation (see fee schedule): $ 69.92
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $ 8.39
FLS Plan Review (40% of permit fee): $ 27.97
TOTAL: $ 122.28
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
U: \FA Jobs \zz130432 -45 Doral Healthcare @ 1Lincoln -465\ 1 FPS- PermitApp.doc Rev231 /05/2012
PERMIT FEE DOUBLES IF WORK HAS STARTED WITHOUT BENEFIT OF PERMIT
'i 0 CALCULATE TOTAL FEE
PERMIT FEE CALCULATION (REFER TO TABLE)
$ 1,200.00 ROUNDED VALUATION
$ 51.09 (BASE FEE FOR FIRST $ 500.00 OF VALUATION)
+ $18.83 ($ 2.69 PER $ 100.00
$69.92 BASE PERMIT FEE
+ $8.39 STATE SURCHARGE = 12% OF BASE PERMIT FEE
+ $27.97 PLAN REVIEW CHARGE = 40% OF BASE PERMIT FEE
+ $11.00 RECORDS RETENTION FEES
+ $5.00 MISC ADMIN FEE (MAILING)
$122.28 TOTAL DUE FOR THIS PERMIT
EXAMPLE
CITY OF TIGARD
RECORDS RETENTION FEES WORKSHEET
BUILDING PERMITS
Fees for scanning building department submittals.
Size # of Pages Cost per Page Total
8 1/2" x 11" 6 X $0.50 $3.00
8 1/2" x 14" X $0.50 $0.00
11" x 17" X $0.50 $0.00
18" x 24" X $2.00 $0.00
24" x 36" X $2.00 $0.00
30" x 42" 4 X $2.00 $8.00
Other formats X $2.00 $0.00
TOTAL RECORDS RETENTION FEE I $11.00 I
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10300 SW GREENBURG RD 465, TIGARD, OR,
97223
Commercial - Fire Protection System
998 Alarm Final
05/10/2013 00:00
FPS2013-00021
PASS - No C of O
Violation Summary:
Inspector Contractor