Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 a COMMUNITY DEVELOPMENT Permit #: FPS201300036
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/20/2013
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 100
Project: Language Line Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Modification of (1) fire sprinkler head
Contractor: WESTERN STATES FIRE PROTECTION Owner: PACIFIC REALTY ASSOCIATES LP
13896 FIR ST STE B ATTN: N PIVEN
OREGON CITY, OR 97045 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 657 -5155 PHONE:
FAX: 503 - 657 -5182
FEES
Description Date Amount
Specifics: Permit Fee - COM 03/20/2013 $59.16
12% State Surcharge - Building 03/20/2013 $7.10
Type of Use: COM Plan Review - Fire Life Safety - COM 03/20/2013 $23.66
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stones:
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 $89.92
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $797.00
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 No ' enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire questions to O b calling 503.232.1987 or 1.800.332.2344.
Issu By: Permittee Signature: ) /1
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 Application �r
Fire Protection System N '. FOR of FICI USE ONLY •
R eceived ' AI Ci of Tigard Permit No .11 —
I II tY g Date /B : 410 a 13125 SW Hall Blvd., Tigard, OR 97223 MAR 20 2013 Plan Review
el Phone: 503.718.2439 Fax: 503.598.1960 Date /B : Other Permit 2 006 67
TIC A R D Inspection Line: 503.639 CITY Date Ready /By: kris: Fa See Page 2 for
• Internet: www.tigard- or.gov TIGARD Notified /Method: Supplemental Information
BUILDING DIVISION
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.
❑ 1- and 2- family dwelling ® Commercial /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: 15115 SW SEQUOIA PARKWAY New dwelling area: square feet
City /State /ZIP: PORTLAND, OR 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: 100 Project name: LANGUAGE LINE TRANSLATION 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.
ADD / RELOCATE PENDENT FIRE SPRINKLERS Valuation: $797
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: WESTERN STATES FIRE PROTECTION CO. All contractors and subcontractors are required to be
Contact name: DARRELL FLUIT licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 13896 FIR STREET, SUITE B jurisdiction in which work is being performed. If the
City /State /ZIP: OREGON CITY, OREGON 97045 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 657 -5155 Fax: : (503) 657-5182
E -mail: darrell.fluit @wsfp.us
CONTRACTOR BUILDING PERMIT FEES* •
(Please refer to fee schedule)
Business name: WESTERN STATES FIRE PROTECTION CO.
Permit fee:
Address: 13896 FIR STREET, SUITE B
State surcharge (12% of permit fee):
City /State /ZIP: OREGON CITY, OREGON 97045
FLS plan review (40% of permit fee):
Phone: (503) 657 -5155 . Fax: (503) 657 -5182 (Due upon application.)
CCB tic.: 104570 Total permit fees:
Authorized signature Amount received:
This permit application expires if a permit is not obtained
Print name: DARRELL FLUIT Date: 03 / 20 /13 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building \Permits \FPS - PermitApp.doc Rev 01 /05/2012 440-461 3T( II i02/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: 1
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 LIGHT
Density 0.10
Design Area N/A
K. Factor 5.6
Sprinkler Project Valuation: $ 797
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El 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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