Permit (232) y
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
w
COMMUNITY DEVELOPMENT Permit #: FPS2012 -00169
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/07/2012
Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY S
Project: Gentle Dental Subdivision: 2004 -015 PARTITION PLAT Lot: 1
Project Description: Modification of (36) fire sprinkler heads for TI
•
•
Contractor: CROSSFIRE SPRINKLER CO Owner: SN PROPERTIES PARTNERSHIP
17400 SE 82ND DR 1121 SW SALMON ST
CLACKAMAS, OR 97015 PORTLAND, OR 97205
PHONE: 503 - 210 -5506 PHONE:
FAX: 503 - 210 -5538
FEES
Description Date Amount
Specifics: Permit Fee - COM 10/31/2012 $123.72
12% State Surcharge - Building 10/31/2012 $14.85
Type of Use: COM Plan Review - Fire Life Safety - COM 10/31/2012 $49.49
Class of Work: ALT Type of Const: Info Process /Archiving - Sm $0.50 (up to 10/31/2012 $4.50,
Occupancy Grp: B Height: ft 11x17)
Stories: 1 Misc Administration Fee 10/31/2012 $10.50
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 0
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 $203.06
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $4,249.00
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 to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ��n , �.�- Permittee Signature: y � /I IV e44-17 �, I
•
AilLeit/ 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 Applicatio
Fire Protection System ECEIVED H)RR ul l l(l: I s1: ()Nis
Cl of Tigard ((�� T Received
' Permit No.: F/�
i • 13125 SW Hall Tigard, OR 972230 I 3 0 2012 Plan Review a 30 'y " r, A .-Oa /log
`` 4 `J I Other Pennii: 64/1
Phone: 503.639,4171 Fax: 503.598. I Il ARD 60 � Datd6 : ' ' ' �
III
T I i A 1( a Inspection Line: 503.639.4175 CITY O Date Ready :y: Juris: Bl See Page 2 far
Internet: www.tigard-or.gov WILG DIVISION Notified/Method: ( 7 / Z sr Supplemental laformatton
:^ — ...�+._ -• . -..... �ixG y � _ � -' V I I - TsS.t . ter - - +� — .. �f r .1 ` pY -•, ti t
❑ 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
't = - —`_ sr3 ... i l.z y z - 7: s;_e - s __ I r.: -:--:,,C___--- work indicated on this application.
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: S
❑ Accessory building ❑ Multi- family Number of bedrooms:
....
❑ Master builder ❑ Other: Number of bathrooms:
:i f .e, lo Ja!_:_ ::.e.,._ _.s :.' .e_A: 4'54 -4.-:". 9 ,,..• _ - Total number of Floors:
J ob site address: 16200 SW Pacific Hwy New dwelling area: square feet
City /State /ZIP: Tigard, OR Garage /carport area: square feet
Suite/bldg. /apt. no.: S Project name: Gentle Dental Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
Subdivision: I 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
_ V- - I . __ ;,• : ;fl y,,, -� � work indicated on this application.
Add! Relocate Heads to maintain coverage around new walls & ceilings Valuation: $54,249.00
Existing building area: square feet
yy
New building area: square feet DIN
- ,- .. ' �' .77-___=F. - _ — » _ � ' — _, Number of stories: IA •
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP:
Existing:
Phone: ( ) Fax: ( ) New:
m .�
- •r:,....- .- •s- e.».-- ,tea.^ -_.•- — .IC .
Business name: All contractors and subcontractors are required to be Z
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: ( ) I Fax: : ( )
E -mail:
•
Business name: Crossfire Sprinkler Company - ' � -
Address: 17400 SE 82 Drive Permit fee:
State surcharge (12% of permit fee):
City /State/ZIP: Clackamas, OR 97015 FLS plan review (40% of permit fee):
Phone: (503) 210 -5506 I Fax: (5' t 5538 (Due upon application.) i
CCB lic.: 174746 _ Total permit fees:
tam` Amount received:
Authorized signal e: /� �i!\�
t This permit application expires if a permit is not obtained
Print name: Timothy A Bishop [Date: 10 /30 /12 I within 180 days after it has been accepted as complete.
J ' Fee methodology set by Tri -County Building Industry
Service Board.
I ‘13wlding1Pamiu1FPS- PermilApp, doe 10/01/09 440.4613T(I I /02 /CORVWEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
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: M
Additional description of work:
- --.
3 77 � - -- —'=�
® Wet ❑ Dry
• Additional Standpipes
Information: Hazard Group Light Hazard
Density .10
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 4249
:rte• s _: ac::_ - r �., r s =�� -.
Hood Project Valuation: $
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
•
_ "'� . ` "°'_-- �_� �c�•______ � �—� -- - - - - •-ice - � - -
_ "� . uare Foo • :e: s- =—
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.
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 2 sets of plans at submittal. Plan review fees are required at submittal.
(:: \Documents and Settings \CAD \My Documents \ Permits \tigard permit.doc 10/01/0'12