Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
:1 ' COMMUNITY DEVELOPMENT Permit#: FPS2021-00035
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/10/2021
T f c-A It t 9 Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: None Lot: None
Project Description: Fire alarm permit-removing(2)existing notification appliances and adding(4)new appliances.AFFIDAVIT
SUBMITTED.
Contractor: APPLIED TECHNICAL SYSTEMS INC Owner: FRED MEYER STORES INC
7015 SW MCEWAN RD STORE#375
LAKE OSWEGO, OR 97035 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503-684-9611 PHONE:
FAX: 503-598-0498
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/06/2021 $102.20
12%State Surcharge-Building 05/06/2021 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 05/06/2021 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 05/06/2021 $2.00
Occupancy Grp: M Height: ft 11x17)
Stories:
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $157.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,500.00
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 by calling 503.232.1987 or 1.800.332.2344.
Issued By: 1 f" J Wm.De w e Permittee Signature: O JApp 1M,^a L
tln
Call 603.639.4175 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 Applicatio1RECEIVEE
'B- 1
Fire Protection System APR 1 2021 FOR OFFICE USE ONLY
City of Tigard 'ITYReceived /
13125 SW Hall Blvd.,Tigard,oR 9722r O F TlGARD DalelBy:G'T/6� �ZI Permit N°.:�s�zl QD���
Phone: 503.718.2439 Fax: 503.598 Plan Review , r
bLDING DIVISION Date/By: OtherPermir/gl P2OZ/_i9 [/<y
G
TI G AR D Inspection Line: 503.639.4175 Date Ready/By: tom' ® See Page 2 for
Internet. www.tigard-or.gov Notified/Method: 7 r�^ 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 El Multi-familyNumber of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11565 SW Pacific Highway New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Fred Meyer Grocery Pick Up Expansion 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: 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
DESCRIPTION OF WORK work indicated on this application,
Fire alarm work for TI. Fire alarm system is existing. Valuation: 5 2,500.00
Demo 2 existing notification appliances and provide 4 new appliances Existing building area:Area of work squarefeet
New building area: No Change square feet
0 PROPERTY OWNER ® TENANT Number of stories: 1
Name: Fred Meyer-Karena Zevely Type of construction: V-B
Address: 3800 SE 22nd Ave.
Occupancy groups:
City/State/ZIP: Portland, OR 97219
Existing: M
Phone:(503 ) 797.3511 Fax:( )
New: M(No Change)
IN APPLICANT J CONTACT PERSON
NOTICE
Business name: Western Construction Services
All contractors and subcontractors are required to be
Contact name: Pam Deegan licensed with the Oregon Construction Contractors Board
Address: 2300 E. 3rd Loop,Ste. 110 under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
City/State/ZIP: Vancouver,WA 98661 applicant is exempt from licensing,the following reasons
apply:
Phone:(360 ) 953.8517 Fax::(360 ) 694.7818
E-mail: pam@westernconstruction.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: 113t3 Aped i Pihr1I CGISAPS S Inc- (Please refer to fee schedule
Address: —70 IS S W - raleP, 1 1r1, Permit fee:
C eW�T1 d State 12°surcharge
City/State/ZIP: LaKe OS 4€4 CFI 9-10AS ( /oofpernitfee):
Phone:( �({ 9 �s I Fax:( ) FLS plan review(40%of permit fee):
(Due upon application submittal)
CCB lic.: 8Q 15 I k Total permit fees:
Authorized signature: �"�'t'1'Ir Amount received:
v—� This permit application expires if a permit is not obtained
Print name: Pamela A. Deegan QQ Date: 03.24.21 within 180 days after it has been accepted as complete.
* Fee methodology set by'fri-County Building Industry
Service Board.
..n.R n+n u,,,,.n..n.mu.
•
City 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: Number of alarm devices: 4
In 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 buildi g structure of work within building structure
system
Fire Alarm work ❑ 11+heads: Plan review required and ❑ 6+ devices: Plan review required and
only (3) sets of plans. (3) sets of plans.
Additional description of work:
Demo 2 existing notification appliances and provide 4 new.
Type of System (Complete A,B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
B.) Type I Hood Fire Suppression System •
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
To be provided by the fire alarm Cut Sheets
contractor when awarded. Fire Alarm Project Valuation: $ 2,500.00
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): $
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: $
1:\Budding\Permits\FPS_PermitApp-031016.doc 2
RECEIVED
City of Tigard Permit No.: �l'S2C2, 00(,,35
v 13125 SW Hall Blvd.,Tigard,OR 97223 APR 1. 202�
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: v¢/pl 426',21
Inspection Line: 503.639.4175 v1 lIY OF TIGARD
T1GARD Internet: www.tigard-or.gov By: at /r'`�''r"r/
Is! Nw1' nIVISION.
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS) O1 VICE Copy
Project Name: Tigard Fred Meyer Occupancy: M
Job Address: 11565 SW Pacific Hwy,Tigard 97223 Suite:
Contractor: Applied Technical Systems Phone: 503-472-4003
Valuation of work: $$8735.00
Type of System: (check one) ['Required ENon-required
(check one) ['Automatic ['Manual *Both
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added(max 5) /To be Relocated(ate 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 3)
Number of Proposed Notification Appliances: To be Added(max 5)4 /To be Relocated(max 5)
I George Faulkner Oregon Construction Contractors Board No. 89511
certify the following is true and defines the scope of work for this project:
a) All work complies with the current state-adopted NFPA-72 and the authority having jurisdiction.
b) All notification appliances are located in accordance with the current state-adopted NFPA-72.
c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having
jurisdiction.
d) Exposed wiring will not be covered until inspected.
e) Final approval shall be subject to on-site tests and inspections.
f) Voltage drop is adequate to operate all appliances.
g) Battery supplies are capable of supporting the system modifications.
h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications.
In addition,I understand the following is required:
• Submit(3) copies of a sketch showing the area of work within the building's structure.
• Bu'Iding a protection system permit.
• El ctrica ermit.
• A c p o t i document with a copy of the sketch attached shall be available for all inspections.
Signature: Date: 4/1/2021
PrintName: George Faulkner
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