Permit INCITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2017 00062
Date Issued: 05/30/2017
T EGAD D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD
Project: G&S FC LLC Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: AES radio system change monitoring.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: G&S FC LLC
7324 SW DURHAM RD 16083 SW UPPER BOONES FERRY RD,
PORTLAND, OR 97224 STE
TIGARD, OR 97224
PHONE: 503-641-2222 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/30/2017 $67.23
12%State Surcharge-Building 05/30/2017 $8.07
Type of Use: COM Plan Review-Fire Life Safety-COM 05/30/2017 $26.89
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Sm$0.50(up to 05/30/2017 $10.00
Occupancy Grp: B Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type:
I 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 $112.19
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,020.00
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 Signa e: / �
‘,...."ira.....,6_
1503.639.4175 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 FOR OFFICE USE ONLY"
City of Tigard Received y�+
lig Date/B /(t� Permit No.: Fi ��cay 14
'1 13125 SW Hall Blvd.,Tigard,OR 97223
� Plan Revie, ►�
Phone: 503.718.2439 Fax: 503.598.196Q ��0
Date/By: �A gyp' C7 Other Permit:
II GAR D Inspection Line: 503.639.4175 r� Date Rea. Iuris: I See Page 2 for
Internet: www.tigard-or.gov A L� Notifie ethod: S 5 QVe. Supplemental Information
TYPE OF WORK 0 01:0�S`O*A`\" REQUIRED DATA:I-AND 2-FAMILY DWELLING
❑New construction ❑De ktiO V Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0° r: 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: $
ElAccessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 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,Oregon 97224 Garage/carport area: square feet
Suite/bldg./apt.no.:Bidg"B" Project name:lblen4erin€Iiwrge 6.f LLA: 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 work indicated on this application.
Change Monitoring To AES Radio System Valuation: $$1,020.00
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
0 APPLICANT 0 CONTACT PERSON
NOTICE
Business name:Performance Systems Integration LLC All contractors and subcontractors are required to be
Contact name:Dan Schelhaas licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:7324 SW Durham Rd jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:Portland,Oregon 97224
apply:
Phone:(503)jjc 641-2222 Fax::(5J03)641-1464
E-mail: F7v-. c Ps I n -J r4 ? f/ , c tin
CONTRACTOR BUILDING PERMIT FEES*
Business name:Performance Systems Integration LLC (Plerefer tafee schedule)
Address:7324 SW Durham Rd
Permit fee:
City/State/ZIP:Portland,Oregon 97224 State surcharge(12%of permit fee):
— FLS plan review(40%of permit fee):
Phone:(503)641-2222 Fax:(503)641-1464 (Due upon application submittal.)
CCB lic.:205924 Total permit fees:
Authorized sign711111"--- _ Amount received:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Dan Schelhaas Date:5/8/17
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices: 0
® Addition or El 1-10 heads: Affidavit required and El 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type of System (Complete A, B,C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type El Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
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 ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1020.00
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: $
C:\Users\Dans\Desktop\Permit Forms\346584 Fanno Creek Fire Alarm.doc 2