Permit (11) IN CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2019-00132
Date Issued: 10/24/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134AA02100
Jurisdiction: Tigard
Site address: 10340 SW NIMBUS AVE ND
Project: A T&T Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: 3
Project Description: FACP Replacement and VESDA system installation.
Contractor: MCKINSTRY COMPANY LLC Owner: DIETRICH, NANCY BISHOP
16790 NE MASON STREET SUITE 100 ROBINSON, JERRY CHRISTOPHER TRUST
PORTLAND, OR 97230 ROBINSON, LYNN ET AL
9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/23/2019 $540.42
12%State Surcharge-Building 10/23/2019 $64.85
Type of Use: COM Plan Review-Fire Life Safety-COM 10/23/2019 $216.17
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 10/23/2019 $14.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 10/23/2019 $5.00
11x17)
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: No Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $840.44
1
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $50,000.00
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:
fr
•e •nature: f '( J ✓�'
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.
Buil ermit Application
Fire >rotection Systeme FOR OFFICE USE ONLY
City of Tigard VED Received / /1 l>7 7
114 - Date/By: L a l ` A Pe rt ..��/J� / /
'� 13125 SW Hall Blvd.,Tigard,OR 97223 Z Q 9 Plan Review f/ ►1/
Phone: 503.718.2439 Fax: 503.598.1960 U C T 17 Date/By: •2 Z ' Other Permit:
T I GARD Inspection Line: 503.639.4175 r Date Ready y: / kris: M See Page 2 for
Internet: www.tigard-or.gov CITY OF OGAHD Notified/Method: (& I�G7_ /A I Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
ElAccessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:10340 SW Nimbus Ave New dwelling area: square feet
City/State/ZIP:Tigard/OR/97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: A C ic! U N.$9J S 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
Subdivision:IKOLL Business Center Lot no.:3 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
DESCRIPTION OF WORK work indicated on this application.
FACP Replacement and VESDA system Installation Valuation: $$50,000.00
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:Dietrich,Nancy Bishop Type of construction:
Address:9701 SE McLoughlin Blvd Occupancy groups:
City/State/ZIP:Milwaukie OR 97222 Existing:
Phone:( ) Fax:( )
New:
® APPLICANT 0 CONTACT PERSON NOTICE
Business name:McKinstry All contractors and subcontractors are required to be
Contact name:Chris Sachse licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:16970 NE Mason St.Suite 100 jurisdiction in which work is being performed.If the
City/State/ZIP:Portland OR 97230 applicant is exempt from licensing,the following reasons
apply:
Phone:(323)3049323 Fax::( )
E-mail:chrissa@mckinstry.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:McKinstry
Permit fee:
Address:16970 NE Mason St.Suite 100
City/State/ZIP:Portland OR 97230 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(323)3049323 Fax:( ) (Due upon application submittal.)
CCB lic.:172811 Total permit fees:
Authorized signature: �� Gy�i! G Amount received:
This permit application expires if a permit is not obtained
Print name: aqt/91,`t. cm L'frDate: " /0/ 17 1)/(j within 180 days after it has been accepted as complete.
1 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pennits\FPS-PermitApp_031016.doc 440-4613T(I1/02/COM/WEB)
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CPy of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) Type of Work 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 0 Number of alarm devices:
® Addition or ❑ 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 FACP was upgraded to a servic able model and a new VESDA system was installed
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet El Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K.Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ® Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ 50000
D.) Residential Sprinkler (Stand Alone System)
Square Footage: 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.
Fire Protection Permit Fees
Project valuation subtotal(see A,B &C above): I $ 50000
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: $
\\mckinstry\portland\Projects\E-H\Gilbane\116206 AT&T Tigard Vesda Installation\2001 Mech Const\072 Permits\ATT Tigard-FPS_PermitApp.doc