Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• COMMUNITY DEVELOPMENT Permit#: FPS2013-00131
Date Issued: 09/16/2013
T[G ARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9491 SW WASHINGTON SQUARE RD A04
Project: Zumiez Subdivision:VASHINGTON SQUARE ESTATES NO Lot: S
Project Description: Relocate(3)fire sprinkler heads
Contractor: WYATT FIRE PROTECTION INC Owner: PPR WASHINGTON SQUARE LLC
9095 SW BURNHAM PO BOX 847
TIGARD, OR 97223 CARLSBAD,CA 92018
PHONE: 503-684-2928 PHONE:
FAX. 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/16/2013 $53 78
12%State Surcharge-Building 09/16/2013 $6.45
Type of Use: COM Plan Review-Fire Life Safety-COM 09/16/2013 $21 51
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 $81 74
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $587.00
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 .' the Oregon
Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a opy o the -es
or dijetrquestions to . NC by -Iling 503 232 1987 or 1.800 332 2344.
41-
Issued By: , / 0 ' / Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available inspection ate.
This permit card shall be kept in a conspicuous place on the job site until co, pletion of the project.
Approved plans are required on the job site at the time of eac. inspection.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
e
City of Tigard �`�1� � d b Permit No: i an/3
13125 SW Hall Blvd,Tigard,OR 9714 EG A lPlaan Rev ewe/LL�/1 �i'•'1 ° Phone: X03 6394171 Fax X03 X98 1 6s Date/By: Other Permit:
TIGARD Inspection Line. 503 639 4175 6 2013 Date Ready/By: Juns E1 See Page 2 for
Internet: www tigard-or gov SUP 1 Nottfied/Method Supplemental Information
TYPE OF WORK CV `\j � � REQUIRED DATA;1-.AND 2-FANIILY DWELLING
❑New construction ❑P `,inr i Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
.&ddition/alteration/replacement ❑Other: equipment,matenals,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
•
❑ 1-and 2-family dwellingommerciaUindustrial
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: 94 91 c / Wif*-/ , (D , New dwelling area: square feet
L {
City/State/ZIP: a,4 i /ox_ 97 2-2-3 Garage/carport area: square feet
Suite/bldg./apt.no.: Pr ject name: iv 1 Se— 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 �/� 1�� work indicated on this application.
3 ri/1-tom op/I i X_�-C-/`-S )4kEAV 5 Valuation: $ 5gg. �O
(��- V2)_-- � 4�f:4—5 Existing building area: square feet
New building area: square feet
W PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: 1r% /_
Phone:( ) Fax:( ) New: R. ---77/14--
,APPLICANT ❑ CONTACT PERSON NOTICE
Business name: e. -- d7A.- 7 7�� 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 - BBJILDLNG PERMIT FEES* ' .' ,
Business name:1�1 y�1��/o Z�� 1e, v - (P/dose refer to fee • .
Address: 9fl9s 6z),./}",,-4-7-27 Q ,'�•
Permit fee:
City/State/ZIP: �`�:�� v 9 72_Z� State plan re iew(12%of permit fee):
/ — FLS plan review(40%of permit fee):
Phone:(503) b -19 Z-S Fax:( 7)3 --9657 (Due upon application.)
CCB lie.: 614-0 77 Total permit fees:
Authorized signature:
Amount received: $?/.71f
This permit application expires if a permit is not obtained
Print name:, 1 ff 4. 79 0•0 Date: -A, 13 * within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board.
I\Budding\Permns'FPS-PermitApp doe 03/23/06 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
'Describe work to be done i- ":-:
1.) ID New 2.) Modification to sprinkler heads only:
Addition g--1-10 heads: No plan review required.
20-Alteration n 11+ heads: Plan review required.
Repair
Number of sprinkler heads:
Additional description of work:
:1_1.110—`e
A) Cdinthercial Sprinkler T
Wet LDry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Project Valuation:
C ) Fire Alarm .
Submittal shall Battery Calculations El Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
Square Footage: Permit Fee: 7" -
=H.?,
0 to 2000 $187.50 -15
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
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 2 sets of plans at submittal. Plan review fees are required at submittal.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level"3" technicians.
http.//www.ci.ttgard.onus/city_hall/departrnents/cd/docs/FPS-PermitApp.doc 2