Permit (141) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
. ' COMMUNITY DEVELOPMENT ! " Permit#: FPS2018-00073
13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439 ,,' '+ ,-C Date Issued: 07/11/2018
T(� t1Fd. g'
`u� `�� J Parcel: 1S135DA02400
Jurisdiction: Tigard
Site address: 11045 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Fire sprinkler:New fire sprinkler system for new building. 10/25/18:REPRINTED to correct address from 11035 to
11045.
Contractor: PARKER FIRE PROTECTION INC Owner: BROOKSIDE RCF LLC
30205 SE KELSO RD 5987 SE ROBHIL DR
BORING, OR 97009 MILWAUKIE, OR 97222
PHONE: 503-663-6278 PHONE:
FAX: 503-663-7297
FEES
Description Date Amount
Specifics: Info Process/Archiving-Sm$0.50(up to 07/11/2018 $31.50
11x17)
Type of Use: COM Permit Fee-MF 07/11/2018 $594.22
Class of Work: NEW Type of Const: VB 12%State Surcharge-Building 07/11/2018 $71.31
Occupancy Grp: A-2 Height: 15 ft Plan Review-Fire Life Safety-MF 07/11/2018 $237.69
Stories: 1 Info Process/Archiving-Lg$2.00(over 07/11/2018 $4.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: ORD1
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 $938.72
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $60,000.00
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: ` �} Permittee Signature:
�,�( C,,`C� rte'i._\CsKi1�
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.
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111111 COMMUNITY DEVELOPMENT Permit#: FPS2018-00073
- •, .1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/11/2018
Parcel: 1S135DA02400
Jurisdiction: Tigard
Site address: 11035 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Fire sprinkler:New fire sprinkler system for new building.
Contractor: PARKER FIRE PROTECTION INC Owner: BROOKSIDE RCF LLC
30205 SE KELSO RD 5987 SE ROBHIL DR
BORING, OR 97009 MILWAUKIE, OR 97222
PHONE: 503-663-6278 PHONE:
FAX: 503-663-7297
FEES
Description Date Amount
Specifics: Info Process/Archiving-Sm$0.50(up to 07/11/2018 $31.50
11x17)
Type of Use: MF Permit Fee-MF 07/11/2018 $594.22
Class of Work: NEW Type of Const: VB 12%State Surcharge-Building 07/11/2018 $71.31
Occupancy Grp: A-2 Height: 15 ft Plan Review-Fire Life Safety-MF 07/11/2018 $237.69
Stories: 1 Info Process/Archiving-Lg$2.00(over 07/11/2018 $4.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: ORD1
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 $938.72
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $60,000.00
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 OUNCcalling 503. 32.1987 or 1.800.332.2344.
Issued By: / 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.
Building Permit Applicata ` `' AVE
f .
Fire Protection System FOR OFFICE USE ONLY
City of Tigard ` ' ` rJ D�ceiBea i0 X' rU
i1 iM. xM �� `� ��� Permit
13125 SW Hall Blvd.,Tigard,OR 97223 _
Plan Review
Phone: 503.718.2439 Fax 503. 9 1 ' � � Date/B : �� ....
y; Other Permit. j ?
TI GARD Inspection Line: 503.639.4175 t �t . DIVISION
r , Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov i iLDIN( DIVISI 1 Notified/Method:7 /1 ` , yAIII Supplemental Information
60/ *Ant iie.+ "ef-50"/
TYPE-OF WORK f ' Pernfit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
X New construction j i Demolition equipment,materials,labor,overhead,and the profit for the
U Addition/alteration/replacement LI Other:
work indicated on this application.
CATEGORY OF CONSTRUCTION valuation: $ 60p00.00
U 1-and 2-family dwelling ( f Commercial/industrial Number of bedrooms:
[-]Accessory building n Multi-family Number of bathrooms:
U Master builder X Other: Memory Care Total number of floors:
:;JOB, SITE'INFORMATION AND LOCATION New dwelling area: square feet
Job site address: 11035 SW Hall Blvd Garage/carport area: square feet
City/State/ZIP: Tigard, OR Covered porch area: square feet
Suite/bldg./apt.no.: Project nameBrookside Memory Care Deck area: square feet
Cross street/directions to job site: Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Permit fees*are based on the value of the work performed.
Subdivision: Lot no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
Tax map/parcel no.: work indicated on this application.
DESCRIPTION OF WORK Valuation: $
New Fire Sprinkler System per NFPA 13 Existing building area: square feet
New building area: square feet
Number of stories:
[X PROPERTY OWNER 0 TENANT Type of construction:
Name: Benny Damian
Occupancy groups:
Address: 11035 SW Hall Blvd
Existing:
City/State/ZIP: Tigard, OR
New:
Phone:( ) Fax ( )
„f PTIC ._
AI'PLIGANT cONTAT PERSON All contractors and subcontractors are required to be
Business name: licensed with the Oregon Construction Contractors Board
Contact name: under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
Address: applicant is exempt from licensing,the following reasons
City/State/ZIP: apply:
Phone:( ) Fax ( )
E-mail: `PaJ v^T./QJclZ Q G+►rlM 1 Cei"1 V:/ztnwycir•-•M%at^ `"1r` BUILDING PERMIT FEES*
CONTRACTOR (Please refer to fee schedule)
Business name: Parker Fire Protection Permit fee:
Address: 30205 SE Kelso Rd State surcharge(12%of permit fee):
City/State/ZIP:Boring, OR 97009 FLS plan review(40%of permit fee):
(Due upon application submittal.)
Phone:(503)358-1034 ry Fax:( ) Total permit fees:
CCB lic.: 124300 / t" /� Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Joseph Durbin Date:6/25/2018 * Fee methodology set by Tri-County Building Industry
Service Board.
REQUIRED DATA:I-AND 2-FAMILY DWELLING
1:\Building\Permits\PPS-PermicApp_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 2.) Addition/alteration only to 3.) Addition/alteration only to alarm
Work: sprinkler heads: devices:
IX New Number of sprinkler heads: Number of alarm devices:
system
l_..! 1-10 heads: Affidavit I_.._I 1-5 devices: Affidavit
I I Addition required and required and
or (3) copies of sketch showing (3) copies of sketch showing
area area
Alteration of work within building of work within building
to structure structure
existing
system IX 11+ heads: Plan review 6+ devices: Plan review
required and required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
a plical le):
A.) Commercial Sprinkler i'
Sprinkler Type I. l Dry
Additional Standpipes
Information: Sprinkler Supply Line Yes
Hazard Group . /
Density ei
Design Area /700
K. Factor S,
Sprinkler Project Valuation: $ 6'a ctid
B.) 'Type I - Hood Fire Suppression'System
Hood Project Valuation: $
.) Fire Alam.
Submittal shall Battery Calculations [ I Yes
include: Individual Component II Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand. one System)
Square Footage: Permit Fee:
0 to 2,000 $198.75 '4
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): $
2
V
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: $
3
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11045 SW HALL BLVD, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00073
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor