Permit a CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
`°7 • COMMUNITY DEVELOPMENT Permit#: FPS2016-00048
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2016
Parcel: 2S102CB02300
Jurisdiction: Tigard
Site address: 13240 SW PACIFIC HWY
Project: Westside Surgery Center/Eye Health NW Subdivision: FREWING'S ORCHARD TRACTS Lot: 8
Project Description: Fire alarm-Change out fire alarm equipment,add horn&strobe build out.
Contractor: AMERICAN SECURITY ALARMS, INC. Owner: INLINE PROPERTIES LLC
5411 SE MCLOUGHLIN BLVD 13200 SW PACIFIC HWY
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503-231-0303 PHONE:
FAX: 503-230-1044
FEES
Description Date Amount
Specifics: Permit Fee-COM 04/12/2016 $263.60
12%State Surcharge-Building 04/12/2016 $31.63
Type of Use: COM Plan Review-Fire Life Safety-COM 04/12/2016 $105.44
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 04/12/2016 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 04/12/2016 $10.00
11x17)
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: Yes Alarm Type: Automatic
Pull Station Required: Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $412.67
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $17,885.00
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Ca 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 Applicatic E t 1
VEP
Fire Protection System l:uI UI 11( I. 1 til. ONI.1
Y MAR 2 3 2016
6 Received 9 /�
IV Permit No.: //Y�o�p/�D� g
City of Tigard Date/By: 7 ,
13125 SW Hall Blvd.,Tigard,OR 97211N y�y i; g'( � aI Plan Rew
g NJh y(Pi l /) Other Permit: II
Phone: 503.718.2439 Fax: 503.59V 0 Date/By:
1��
p p y p��P` r 1k! Date Ready loris. ® See Page 2 for
Inspection Line: 503.639.4175 U I t �G ,,, , j�` • Supplemental Information
T I G A R D C Notified/Method: � PP
Internet www tigard-or gov
F r. .- 131H to DA 1`At 1 AND 2-YAIVIIIN DWELLING
ion Permit fees*are based on the value of the work performed.
❑ Demolition
New construction 0 Indicate the value(rounded to the nearest dollar)of all
Cgt Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
x Y , Y 4 ag)""t: ' YF
work indicated on this application.
1af,' . x _ - u ,, aoY' w�5.. _ .. „ . __ ._,
Valuation: $
❑ 1-and 2-family dwelling Commercial/industrial
U Number of bedrooms:
❑Accessory building Multi-family
El Master builder 1:1 Other:
Number of bathrooms:
Total number of floors:
Job site address: 13 2.LI 0 SI.J 'Ac 1 FIC /"T w`f New dwelling area: square feet
City/State/ZIP: 'T(&74-r2-Z 04,-- q72.-73 Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name: (4/.t-S TSI OE St4/42 y- Covered porch area: square feet
Cross street/directions to job site: COMSe--/.ye- l A-c r7#/A1 Deck area: square feet
Other structure area: square feet
Iltst,OREDIZATAtkOMMERCIAIAiSE,CIIECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
(rounded to the nearest dollar)the value of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
7 fss e a ' a73 v _ x
work indicated on this application.
'k t , ,,. _
G%f�-N0eo/ , ,-,1642.4-e— .eC IP/,Cl r Valuation: $ /7
g 8.5.
. tSn�e
f gC
f L17Q
l-f�
Existingbuilding
area: square feet
New building area: square feet
q
•1,-..-=t.-,,,,,,,,,-
t•�' 1 ` o ii * ' , TEN• Number of stories:
w
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
„ � '4`(,,, ;‘,.,1;';:'.." ' a, ' i` .g'.. ' lN'1'A PERSON NO'1ICE
Business name: e/2/C//k) -At Ca// 71/,, (/)(- . All contractors and subcontractors are required to be
Contact name: X/Cf-/ //ft(-. ,e / licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 51/( ft- /`T CL L U6#/L IA) 344,0 jurisdiction in which work is being performed.If the
City/State/ZIP: ,it7LffA IP GX 9j°202- applicant is exempt from licensing,the following reasons
2apply:
Phone:(3 ) 23( 03'0 3 Fax::($63) Zai /Cti4
E-mail: f (C 14 A 5 At- MS . Co/l
is*,t,
', 1,a^L:,_ , ,. „ tar ' .0,t#,,F1r rRy .. . BUILDING PERMIT FEES*
Business name: ,)/t'IF R.1 Ci frt .S�CaK/r, /Aj ' (Please referlfeee'Echedu/e)
Address: 54 /( SE M 14i4&1-4 Lt A) 3(viii), Permit fee:
y State surcharge(12%of permit fee):
City/State/ZIP: �O�r('�AT1 v� 17 FLS plan review(40%of permit fee):
Phone:(52)3) .7. ( . 03031 Fax:(5t ) 2-223. I 0 4 4 (Due upon application)
CCB lic.: S � ��U %�� i? Total permit fees:
/" "`\�jjA J'�— Amount received:
Authorized signature: /�/v"
This permit application expires if a permit is not obtained
Print name: X/(u (tIu.e--"-� Date: 3 • 2.3 , Itwithin 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp.doc Rev 01/05/2012 440-46131(1 1/02/COM/WEB)
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
13240 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2016-00048
Jeff Grove
Nfpa 72 received
Violation Summary:
Inspector Contractor