Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I COMMUNITY DEVELOPMENT Permit#: FPS2014 00099
-L[G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/18/2014
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 320
Project: Bridgeport Family Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Fire alarm for TI.
Contractor: LEAR ELECTRIC CO INC Owner: G&S FC LLC
6002 NE 112TH AVE 16083 SW UPPER BOONES FERRY RD,
PORTLAND, OR 97220 STE
TIGARD, OR 97224
PHONE: 503-255-0733 PHONE:
FAX: 503-255-0676
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/18/2014 $77.99
12%State Surcharge-Building 06/18/2014 $9.36
Type of Use: COM Plan Review-Fire Life Safety-COM 06/18/2014 $31.20
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 06/18/2014 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 06/18/2014 $5.00
11x17)
Commercial Sprinkler Svstem:
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: Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $125.55
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,450.00
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 - ' a i• -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or d. -ct questions to Ob C b - .n• 503.232.1987 or 1.800.332.2344.
I rued By: Permittee Signature: ir
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.
Baii,iing Permit Application
`Fire Protection System FOR OFFICE USE ONLY
R
City of Tigard Dateceived e/B : foirm Permit No •5
13125 SW Hall Blvd.,Tigard,OR 97223 • Plan Review i �
1 Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Mb/ u' ! _ ♦ '8
I'1 GA R D Inspection Line: B 03.63 .4175 Date Ready : / /� I��� See Page 2 for
Internet: www.ti ard-or. ov Notified/Method: (e C� Supplemental 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.
❑ 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: 16083 SW Upper Boones Ferry Rd. New dwelling area: square feet
City/State/ZIP:Tigard/OR/97224 Garage/carport area: square feet
Suite/bldg./apt.no.:320 Project name:Bridgeport Family Medicin 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Provide notification fire alarm devices for new tenant improvement Valuation: $ h
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER g TENANT Number of stories:
Name: Type of construction:
Address: 16083 SW Upper Boones Ferry Rd. Occupancy groups:
City/State/ZIP:Tigard/OR/97224 Existing:
Phone:( ) Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name:Lear Electric Inc. All contractors and subcontractors are required to be
Contact name:Oleg Primachenko licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:6002 NE 112th Ave. jurisdiction in which work is being performed.If the
City/State/ZIP:Portland,OR 97220 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)849-4723 Fax: :(503)255-0676
E-mail:op @learelectric.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Lear Electric Inc. (Please refer ra fee scledule�
Permit fee:
Address:6002 NE 112th Ave.
State surcharge(12%of permit fee):
City/State/ZIP:Portland,OR 97220 •
FLS plan review(40%of permit fee):
Phone:(503)849-4723 Fax:(503)255-0676 (Due upon application.) _
CCB lic.:52278 Total permit fees:
Authorized nature: Amount received:
g
This permit application expires if a permit is not obtained
Print name:David Mumford Date:6/3/14 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
l:\Building\Permits\FPS-PennitApp.doc Rev 01/05/2012 440-46131(11/02/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
❑ \V•ct ❑ 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 Z Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1,450.00
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): $
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.
\\SVR-LEAR01\RedirectedFolders\OP\Desktop\Fanno Creek Suite 305\Fire Alarm\11re Alarm\FPS-PermitApp Suite 320.doc Rev 01/05/2012
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16083 SW UPPER BOONES FERRY RD 320,
TIGARD, OR, 97224
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
July 17, 2014 at 7:18:08 AM
FPS2014-00099
Jeff Grove
Nfpa 72 received
Violation Summary:
Inspector Contractor