Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
Permit FPS2019-00158
s COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/26/2019
T[t;hRD Parcel: 2S115BA00100
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY N
Project: Planet Fitness Subdivision: None Lot: None
Project Description: Fire alarm. Installing fire alarm system consisting of(40)devices.
Contractor: M&E ELECTRIC Owner: TECOLOTE RESOURCES INC
15708 NE 81ST AVE KELLY'S LEGACY LLC, ET AL
VANCOUVER,WA 98662 BY HESSLIN HOLDINGS INC
23421 SOUTH POINTE DR STE 270
LAGUNA HILLS, CA 92653
PHONE: 360-573-0459
PHONE: 503-764-7595
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/26/2019 $209.80
12%State Surcharge-Building 12/26/2019 $25.18
Type of Use: COM Plan Review-Fire Life Safety-COM 12/26/2019 $83.92
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 12/26/2019 $2.00
Occupancy Grp: A-2 Height: ft 11x17)
Stories: 0 Info Process/Archiving-Sm$0.50(up to 12/26/2019 $27.50
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: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $348.40
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $12,500.00
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 b calling 503.232. •87 or 1.800.33 .2344.
Issued By: /
Permittee Signature: 97Actiek0
l� ✓'
Call 503.639.4175 by 7:00 a.m.for the next available ins ection 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 Peinit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY'
~ City of Tigard Received
"�
DEC 18 2019 Date/By: pi 1lG /, K ' �7/S
III 13125 SW Hall Blvd.,Tigard,OR 97223 V Plan Review/1 i,
Phone: OL Other Permit:
503.718.2439 Fax: 503." CITY OF TIGARD Date/By: / .1,�1
I.i ci A R it Inspection Line: 503.639.4175 BUILDING LD)NG D}VISION Date Ready/By: ,„ Juris: I See Page 2 for
Internet: www.tigard-or.gov Notified/Method:161‘-5/7 "' / Supplemental Information
,.,,.»' <`'i z � la11,i0.'.,};„' litEr
1 ,', 3 1 ' I I .,a; It % r f t�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
—ddition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
❑ 1-and 2-famil Valuation: $ ✓��
y dwellin �Qe�
g �ommercral/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
El Master builder El Other: Number of bathrooms:
1 ri ,if,a'P �N ,, 41 Total number of floors:
Job site address: %Q� cJe Q&(f°f' Er'� ''v" New dwelling area: square feet
City/State/ZIP: / , 4l� 49/L ! 749c3.444/
Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: gm Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
47-4g egi44e: - Other structure area: square feet
:m ' I I t, i
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
and dtheollprofit
of all
,
equipment,mat , aborad,,overhep ofit for the
ar ,� r l . s 1 work indicated on this application.
-lif tzi ��ic / Jaly Valuation: $
4/`,, 0�i �l Existing building area: square feet
j V New building area: square feet
' ` iIQ. Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
Business name: $ e`lee" lig/e.— All contractors and subcontractors are required to be
Contact name: b4Q is (1/ licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: /��� � °!OSA jurisdiction in which work is being performed.If the
City/State/ZIP:dj� vj7�,y,K p/ e_ a ���,� apply:ppicant is exempt from licensing,the following reasons
3") 7 ( �73 ( ( )
Phone: Fax:
E-mail:r' a rY'e, ttJ a -
1,
Business name: e" 'ff..[d fx/ iln4.'� :,,; , L '
/ Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.) _
CCB lie.: 44,..4:46,e j�n'j Q Total permit fees:
gle ' EVQ 0/12,531 , t 1 e"� Amount received:
Authorized signature: f
This permit application expires if a permit is not obtained
Print name: )ywa/� o f/e. . Date:/�-`7,/4„2-/7,-,41 /5? within 180 days after it has been accepted as complete.
V ' C * Fee methodology set by Tri-County Building Industry
Service Board.
440-4613T(I1/02/COM/WEB)
I:\Building\Permiis\FPS-PermitAppo3 t 016.doc
r
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:
Ill New system Number of sprinkler heads: 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:
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes El No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
34tjilirm
Hood Project Valuation: $
Submittal shall Battery Calculations G Yes
include: Individual Component a Yes
Cut Sheets
L Fire Alarm Project Valuation: $/ ,fele)
rtF
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a � °h t”. E E
�9
^�� •„4' E '414;4111115r;•,/.;,4%t,/01 . l l 1 d.. , Es' i
Square Footage: Permit Fees
q g � � � �
����s ° s"C�t� �3E� t
0 to 2,000 $198.75 `' ;€ �4064 tilt'
2,001 to 3,600
$246.45
3601 to 7200 $310.05 ,
7 201 and eater $404.39 E F °
Sprinkler Project Square Footage: sq. ft.
, , r of rt
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: $
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