Permit (51) CITY OF TIGARD; a: .71 FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2018-00035
13125 SW Hall Blvd.,Ti Date Issued: 04/26/2018
T[[ ,' Jd.L and OR 97223 503.718.2439 9
Parcel: 2S101AB03100
Jurisdiction:
Site address: 12115 SW 70TH AVE 102
Project: TVF&R-Occupational Health Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: Fire Sprinklers:adding(41)fire sprinkler heads for TI.
Contractor: SPRINKIT FIRE PROTECTION INC Owner: TIGARD TRIANGLE PARTNERS LLC
PO BOX 2227 18187 SIERA DR
OREGON CITY, OR 97045 LAKE OSWEGO, OR 97034
PHONE: 503-272-6650 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 04/26/2018 $209.80
12%State Surcharge-Building 04/26/2018 $25.18
Type of Use: COM Plan Review-Fire Life Safety-COM 04/26/2018 $83.92
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 04/26/2018 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 04/26/2018 $10.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0.1 Design Area: 1500
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 $330.90
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $12,500.00
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 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 •-9UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: j ! e'_..,'--- __. Permittee Signature:
.......----
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.
,', alilc ing Permit Application
Fire Protection System (: "i q lF ,=.
DateBy: /, /I �/O )a� )��
City of Tigard V ( Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223RD D A 9 ?nip
i 8 Plan Re:
g Plan Review ^�
Phone: 503.718.2439 Fax: 503.598 19 i tt Date/By: "0�.3 ` Other Permit6it,r)0`fys/
T w G A R D Inspection Line: 503.639.4175 t -•i Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov �¢ A +- b '"+ Notified/Method /41�4 r/er Supplemental Information
9 f 'l)t r; 7)rkRai gl IIR, L
TSFP OF WORK - I Qb1R D I3AT. A S1:0 FA III.X DW 1 X10•" ,,
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY 41F CtO S'I fttU T& ,_` work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
.IOB SITE`IN ORMAATTOI AND LOCA'1I# Total number of floors:
Job site address:12115 SW 70th Ave.Suite 102 New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:102 Project name:TVF&R Health Clinic Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
1t,I QQI it*1:ATA;COM I C1AL .iS C1E t KLI `
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
'OSScRI nON OR1 work indicated on this application.
Add sprinklers for tentant improvement Valuation: $$12,500.00
Existing building area: square feet
New building area: square feet
❑ I'.1tOPtRTV OWNER ❑ 't'1+;NAlst r Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( )
New:
APPLI ANT 0 CONT CT ERSt31 i
Business name:Same as below All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:
( ) Fax::( )
E-mail:
Ct;el�T ACT IR
Business name:Sprinklt Fire Protection Inc. � rrT° "f'�
Permit fee:
Address:PO Box 2227
State surcharge(12%of permit fee):
City/State/ZIP:Oregon City,OR 97045 FLS plan review(40%of permit fee):
Phone:(503)272-6650 I Fax:( ) (Due upon application submittal.)
CCB lie.:211320 Total permit fees:
Authorized signature:
Amount received:
T This permit application expires if a permit is not obtained
Print name: J'4/`t J tro tq(.y c...r-1 Date:4/19/18 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doe 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
1.) Type of Work: 2.) Addition/alteration only to sprinkler
rinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New systemNumber of sprinkler heads: 41 Number of alarm devices:
Addition or 1] 1-10 heads: Affidavit required and ❑ 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:
e of 5 sterrt�onq tete. , - C car as ap icable)x
A.} ov er r
Sprinkler Type ® Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ® No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $ 12,500
Hood Project Valuation: $
F
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
) .tt xdent finMer(Stand M n st n
Permit ermit
Square Footage:
qFee:
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.
Y l rotect n Permit F,
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 fcc): $
FLS Plan Review(40% of permit fee): $
TOTAL: $
C:\Users\Sch\Desktop\FPS_PermitApp.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12115 SW 70TH AVE 102, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00035
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor