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Permit CITY OF TIGARD. FIRE PROTECTION SYSTEM PERMIT • < COMMUNITY DEVELOPMENT Permit #: FPS2013 -00037 T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/20/2013 Parcel: 2S112DD01600 Jurisdiction: Tigard Site address: 15495 SW SEQUOIA PKWY 140 Project: A Common Thread Subdivision: PACIFItRPORATE CENTER Lot: 4 Project Description: Modification of (8) fire sprinkler heads Contractor: WESTERN STATES FIRE PROTECTION Owner: PACIFIC REALTY ASSOCIATES 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: 503 =624 -6300 FAX: 503 - 657 -5182 FEES Description Date Amount Specifics: Permit Fee - COM 03/20/2013 $67.23 12% State Surcharge - Building 03/20/2013 $8.07 Type of Use: COM Plan Review - Fire Life Safety - COM 03/20/2013 $26.89 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 $102.19 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $1,023.00 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 questio o OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ag ' Permittee Signature: b 7-64./ 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 • Fire Protection System RECEIVED . FOR OFFICE USE ONLY . Received City of Tigard Date /B : ApAgnMA. li Permit No.: r:;&,,g r J ? a 13125 SW Hall Blvd., Tigard, OR 97223 MAR 2 0 2013 Plan Review' Q _ � / � ®' Phone: 503.718.2439 Fax: 503.598.19oti Date /B : Other Permit: T PG A R D Inspection Line: 503:639 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov CITYOFTIGARD 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: $ El Accessory building 12 Multi-family Number of bedrooms: El Master builder El Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: • Job site address: 15495 SW SEQUOIA PKWY. New dwelling area: square feet City/State /ZIP: PORTLAND, OR 97224 ' ' _ Garage /carport area: square feet Suite/bldg. /apt. no.: 140 Project name: A COMMON THREAD, INC. 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: $$1,023.00 ' 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* Business name: WESTERN STATES FIRE PROTECTION CO. (Please refer to fee schedule) 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 lic.: 104570 Total permit fees: /� / z // e S Amount received: Authorized signature: k �.� / \ r 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. 1:\Building \ Permits \FPS - PermitApp.doc Rev 01/ 05/2012 440-4+5 13T(1 I /02 /COM/WEB) - City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Describe work to be done: 1.) El 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: 8 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: $ 1023 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. C: \My Data \Drawings \LS3299 - A Common Thread \City of Tigard permit application.d2c Rev 01/05/2012 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 15495 SW SEQUOIA PKWY 140, TIGARD, OR, 97224 Commercial - Fire Protection System 910 Sprinkler Rough-In 03/22/2013 00:00 FPS2013-00037 PASS Violation Summary: Inspector Contractor 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 15495 SW SEQUOIA PKWY 140, TIGARD, OR, 97224 Commercial - Fire Protection System 910 Sprinkler Rough-In 03/22/2013 00:00 FPS2013-00037 PASS Violation Summary: Inspector Contractor