Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111111 ° COMMUNITY DEVELOPMENT Permit#: FPS2013-00134
T LGAAD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2013
Parcel: 2S102DA00701
Jurisdiction: Tigard
Site address: 13405 SW HALL BLVD
Project: Tigard Christian Church Subdivision: BARNUM PARK Lot: 9
Project Description: Install(1)Type 1 hood
Contractor: UNIVERSAL FIRE EQUIPMENT Owner: TIGARD CHRISTIAN CHURCH
18260 SW 100TH CT 13405 SW HALL BLVD
TUALATIN, OR 97062 TIGARD,OR 97223
PHONE: 503-691-9000 PHONE:
FAX: 503-691-9004
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/02/2013 $102.20
12%State Surcharge-Building 10/02/2013 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 10/02/2013 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 10/02/2013 $8.00
Occupancy Grp: A-3 Height: ft 11x17)
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 $163.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,350.00
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 • • k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili Iotification Cente. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
o direct questions to OUNC b • g 03.232.1987 or 1.800.332.2344.
I.sued By: ' O,, Permlttee Signature: I '
Call 503.639.4175 by 7:00 a.m.for the next available in ection e.
This permit card shall be kept in a conspicuous place on the job s' until com etion 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 OFFICI USI?ONLY
Cl of Ti and Fp Received - !)/ /d o 3.....60/6
III City g i-P 2 6 2 013 DateB : Orf O�iJ
° 13125 SW Hail Blvd.,Tigard,OR 97223 Plan Review ,
Phone: 503.718.2439 Fax: 503.598. Date/By: ��► '' �j Other Permit:
'OF TIGA
Inspection Line: 503.639.4175 RD Date Ready/By: Juris: ® See Page 2 for
' '"'"t° BUILDING DIVISION
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New ction ❑Demolition 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,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCT work indicated on this application.
El 1-1-and 2-family dwelling omercial/industrial Valuation: $
❑Accessory building El Multi-family Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:/3 Li 0.5.-Sty 14.,i/`/ R) Jc , New dwelling area: square feet
City/State/ZIP: .17 c/ /1 n�( 6_2 op 223 Garage/carport area: square feet
Suite/bldg./apt.no.: �'7 Project name. 1, ,.. IOW _A , 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(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ 2 35 5
,���l�i�.� o�/4- �yro �lt>z-�-t k�300 �-✓�
c / Existing building area square feet
et
�s t .r -� , rY Wyse. t`�-v �, .
e-x y „ __.5---4- h0 0 d ( New building area: square feet
ROPERTY OWNER C] TENANT Number of stories:
Name:T;(5;� AC-d �]P 1-7-1t4-c ._ C ',.-1-12-Z r� Type of construction:
Address: ISCAD S' S'(�� � ,I kJc." Occupancy groups:
City/State/ZIP: 7,--,_,, ,� o/� 7 Zz 3 Existing:
Phone:633) b J - 7 Fax:( )
New:
3-ICVPT1tANT ,y-_u�t ACr
PERSON NOTICE
Business name: II,� 4)c r S �.� �� /2��, 4- All contractors and subcontractors are required to be
Contact name: �t(. ` � licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be lbensed in the
Address: /?Z‘� �, /0D 1_ G-` jurisdiction in which work is being performed.If the
City/State/ZIP:Ti �./.a a\� 4 7 0 c --2.
applicant is exempt from licensing,the following reasons
c/ G TG f'1 e apply:
Phone: 3) d !- /000 / I Fax: : 62' (- /00 kil
E-mail:
CONTRACTOR BUILDING PERMIT FEES"
(Please refer to fee schedulee
Business name: S;4--`rt -e `4-S 6 Q el''' ..,_
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%ofpermit fee):
Phone:( ) I Fax:( ) (Due upon application.)
CCB lic.: W`6.7Z $ Total permit fees:
Authorized signatur=. Amount received:
�,- This permit application expires if a permit is not obtained
Print name: �.��p-c. A 4 Date: -Z-73 * within 180 days after it has been accepted as complete.
j Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPSPermitApp.doc Rev 01/05/2012 440.4613T(1l/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: I $ 165O c eo
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.
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