Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2019-00003
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/16/2019
T"f i. I<.1) g Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9567 SW WASHINGTON SQUARE RD BO3B
Project: Na Hoku Subdivision: None Lot: None
Project Description: Fire sprinkler. Adding and relocating(13)sprinkler heads for TI.
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR WASHINGTON SQUARE LLC
9095 SW BURNHAM PO BOX 847
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE: 503-684-2928 PHONE: 503-580-3845
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/16/2019 $112.96
12%State Surcharge-Building 01/16/2019 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 01/16/2019 $45.18
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 01/16/2019 $15.50
Occupancy Grp: B Height: ft 11x17)
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: ORD1
Density: .2 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 $187.20
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,930.00
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: 4 /Permittee Signature: 0,,
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 Application
Fire Protection SystemFEDORFOR OFFICE USE ONLY
CityRof Tigard t.'....' . Received q / /
13125 SW Hall Blvd.,Tigard,OR 97 r Date/By: / /l> !' ".,-di
P •' .1 `� naj
■ g , 2 2019 Plan Review �r� /�
Phone: 503.718.2439 Fax: 503 59 Date/By: -� — a /131/2V
.Y 1 &,?
1't C n 1:ll Inspection Line: 503.639.4175 ;.) Date Ready/By: / a i urn: See Page 2 for
Internet: www.tigard-or.govc �Fetified/Met / - ,41/ Supplemental Information
6Uii..Ol'�iG DlVi ON �ri !
TYPE,;011*WORK .., t ttpQi1 Ei bE A/1 ANT) 1"AMILY DWELLING `
0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CA:T GORY-,OP` O TRUCTIO
work indicated on this application.
❑ 1-and 2-family dwelling ID Commercial/industrial Valuation: $
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder ElOther: Number of bathrooms:
`.JOB SITE INFORMATION AM) LOCATION Total number of floors:
Job site address:9567 SW WASHINGTON SQUARE RD New dwelling area: square feet
City/State/ZIP:TIGRAD, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:BO3B Project name:Na Hoku Wash Sq 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 s
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
D SCR PT'IoN OF WORT work indicated on this application.
Add and relocate fire sprinkler heads for TI Valuation: $3930
Existing building area: square feet
New building area: 0 square feet
❑ EROPFI2TY OWNER ❑TENAJST Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
PPL- „ DtAC1ESOTI `;
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ronin Campbell licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard, OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:( )503.684.2928 Fax: :( )503.684.9657
E-mail:r.campbell@wyattfire.com
.. ii4 CONTRACTOR.,._ .. $i.II tttti lli FEES
...... t o r er&t s hedu a,
Business name:Wyatt Fire Protection Permit fee:
Address:9095 SW Burnham
State surcharge(12%of permit fee):
City/State/ZIP:Tigard,OR 97223 FLS plan review(40%of permit fee):
Phone:( )503.684.2928 Fax:( )503.684.9657 (Due upon application submittal.)
CCB lic.:64077 Total permit fees:
Authorized signature:
Amount received:
n, This permit application expires if a permit is not obtained
Print name:Ronin Campbell Date:1/2/19 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:ABuilding APermitsAFPS-PermitApp_031016.doc 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 heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 13 Number of alarm devices:
❑■ Addition or El 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:
Tyi*,of, ysteri Co i p1tte A.,B, or D 1e)
.) Comrimereia Sprier
Sprinkler Type Concealed QR ❑■ Wet El Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes El No
Hazard Group Ordinary group 2
Density .20
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $3,930
Type I 'Hood Eire Stip`` fires iion System r.
Hood Project Valuation: $
tre Aa
* ., � "4 .„.� `�-,.� .,�.,.., _``f.;`� .;,. am , ,.i g
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
l) Reside S y in : S nd Atdn teen s �
Square Footage: Permit Fee: IMM %y
0 to 2,000 $198.75 s
A y
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05 imvomftegmai�,MNSWOV 0 x
MIWWOMMOMMOVWx
7,201 and greater $404.39$404.39 'ii,lentIVIONIMEIBMOSIKOM
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: $
W:\Permits\Permit Application Forms(Updated July 2017)\Tigard Fire Permit App.doc2