Permit (255) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
8 COMMUNITY DEVELOPMENT Permit#: FPS2017-00199
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 01/17/2018
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Parcel: 2S 113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 200
Project: Liberty Mutual Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Fire alarm permit: Extending fire alarm for TI.
Contractor: PRIME ELECTRICAL SERVICES LLC Owner: G&S FC LLC
3312 SE BELLA VISTA PL 16083 SW UPPER BOONES FERRY RD,
VANCOUVER, WA 98683 STE
TIGARD, OR 97224
PHONE: 503-318-5170 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/17/2018 $112.96
12%State Surcharge-Building 01/17/2018 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 01/17/2018 $45.18
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Sm$0.50(up to 01/17/2018 $5.00
Occupancy Grp: B Height: ft 11x17)
Stories: Hourly Building Rate 01/17/2018 $180.00
Hourly Building 12%State Surcharge 01/17/2018 $21.60
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:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $378.30
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,500.00
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 OU by calling 5 c.232.1987 or 1.800.332.2344.
Issued By: / ittee Signature: ��. dk
Call 503.639.4175 by 7:00 a.m.for the next available inspection d• �
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 SystemFOR OFFICE USE ONLY
City of Tigard r "� ' ~ Date/By:Received l I, , 1-7 t 7 t PermitNo.: rZleS .fy i j.�0*Ctlii
° 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie,
y A Other Permit: /� 1 C�
Phone: 503.718.2439 Fax: 503.598.1960 r r o �3 (15 III
Date/By: C •` l!'' ���'/ (� �'u i
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FIG AR D Inspection Line: 503.639.4175 ''" G t / Date Ready/By: Inrisgi See Page 2 for
Internet: www.tigard-or.gov f=- a t r Notified/Method: ilk, l ( art' Supplemental Information
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Permit fees*are based on the value of the work performed.
0 New construction ❑Demolition
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
/ ✓. work indicated on this application.
Valuation: $
El 1-and 2-family dwelling ®Commercial/industrial
Number of bedrooms:
❑Accessory building 0 Multi-family
ElMaster builder 0 Other: Number of bathrooms:
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Total number of floors:
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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.:STE 200 - I Project name:Liberty Mutual Insurance Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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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
,r,iii//�i r ,/%i rr'/rr rrr/' ,, / /r'r / ; ii, f g/%/%ir'`r rr work indicated on this application.
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Extend Fire Alarm circuits for new tenant improvement Valuation: $$3,500.00
Existing building area: 23712 square feet
New building area: square feet
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�� 5 l i/i°;i rr ;iisi r �i/ �� Number of stories: 3
Name:Liberty Mutual Insurance Type of construction: office space
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
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Business name:Prime Electrical Services All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:Oleg Primachenko
under ORS 701 and may be required to be licensed in the
Address:PO Box 872395 jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:Vancouver,WA 98687 apply:
Phone:(503)318-5170 I Fax::(360)869-9989
E-mail:oleg.piprimeelectricalco.com
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Business name:SAME AS ABOVE
Permit fee: 112.96
Address:PO Box 872395
State surcharge(12%of permit fee): 13.56
City/State/ZIP:Vancouver,WA 98687 FLS plan review(40%of permit fee):
Phone:(503)318-5170 Fax:(360)869-9989 (Due upon application submittal.) 45.18
CCB lie.:217825 Total permit fees: 171.70
Amount received:
Authorized signature: fyt This permit application expires if a permit is not obtained
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within 180 days after it has been accepted as complete.
Print name:Oleg Primachenko Date:12/26/17 *
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
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1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
0 New system Number of sprinkler heads: Number of alarm devices: 18
❑ Addition or 0 1-10 heads: Affidavit required and
Alteration ❑ 1-5 devices: Affidavit required and
(3) copies of sketch showing area (3) copies of sketch showing area
tos is g of work within building structure of work within building structure
Ys
❑ 11+ heads: Plan review required and ® 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
:fen;4'I'531Kg#0.4404*071414:30PIA$';WW: :;94A400/
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Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line
0 Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
($a>
Hood Project Valuation: $
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Submittal shall
Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: I $ 3,500.00
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■ Square Footage:
e:
/
0 to 2,000 Permit Fee: , /% /%%% %ii/j%% //j/ i/%//6%j/ ///io%
$198.75 / ��/ ,/i//
2,001 to 3,600
$246.45
/
3,601 to 7,200 , ,
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$310.05 / /i// /j/� , r //r
7,201 and greater $404.39
Sprinkler Project Square Footage: I sq. ft.
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Project valuation subtotal (see A,B& C above): $ 3500
Permit fee based on project valuation (see fee schedule): $ 112.96
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $ 13.56
FLS Plan Review(40% of permit fee): $ 45.18
TOTAL: $ 171.70
C:\Users\Home\Downloads\FPS_PermitApp.doc
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