Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11111 I COMMUNITY DEVELOPMENT Permit#: FPS2014-00108
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/23/2014
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 800
Project: Microlnterconnects Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 37
Project Description: TI for new tenant.
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES LP
9095 SW BURNHAM ATTN: N PIVEN
TIGARD, OR 97223 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/18/2014 $102.20
12%State Surcharge-Building 06/18/2014 $12.26
Type of Use: COM Plan Review-Fire Life Safety-MF 06/18/2014 $40.88
Class of Work: ALT Type of Const: IIIB Info Process/Archiving-Lg$2.00(over 06/18/2014 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 06/18/2014 $7.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .1 Design Area: 1000
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $164.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,067.00
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 ification •• er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may •. -, a copy of the rules
or 'ect questions to OU' b •. 503.232.1987 or 1.800.332.2344.
ssued By: ,
4 / ` Permittee Signature: t
A
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 RECEIVE ' FOR OFFICE USE ONLY
City of Tigard ' Dec Bed Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 �+ I� I �� ICJ
g� Plan Review�� L>�r�� I/5� ,
I Phone: 503.718.2439 Fax: 503.598.1960 JUN 1 g 2014
I I G,A R 1 Inspection Line: 503.639.4175 �w, r Date Ready/ t ® See Page 2 for
Internet: www.tigard-or.gov 1� RD Notified/Method }3I/rf — 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:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 16655 SW 72"d AVE New dwelling area: square feet
City/State/ZIP:TIGARD.OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: ¢06 Project name:MICRO INTERCONNECTS 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*arc 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.
FIRE SPRINKLER ADD/RELOCATE FOR TI Valuation: $$2,067.00
Existing building area: square feet
New building area: 0 square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: LIGHT
Phone:( ) Fax:( ) New: LIGHT
® APPLICANT ® CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ashley Payne licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham Rd jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)684-2928 Fax: :(
E-mail:a.payne@a wya ttfire.co m
CONTRACTOR BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection (Please refer to fee schedule
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) ) (Due upon application.)
CCB lie.:64077 Total permit fees: (941. 3i1
Amount received:
Authorized signature: kt,
This permit application expires if a per t is not obtained
Print name:Ashley Payne Date:6/18/2014 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:'Building∎Pennits\FPS-PermitApp.doc Rev 01/05/2012 440-4613T(I1/02/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: 19
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Z Wet ❑ Dry
Additional Standpipes
Information: Hazard Group LIGHT
Density .1
Design Area 1000
K. Factor 5.6
Sprinkler Project Valuation: $ 2067
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: $
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: 2255 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:\Users\Ashley\Desktop\Permit Applications\Tigard App.doc Rev 01/05/2012 2
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
16655 SW 72ND AVE 800, TIGARD, OR, 97224
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2014-00108
Chip Barnett
Violation Summary:
Inspector Contractor