Permit �, CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I COMMUNITY DEVELOPMENT Permit#: FPS2021-00088
Date Issued: 8/10/2021
T[G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Myer Clicklist Subdivision: None Lot: None
Project Description: Add(8)sprinkler heads
Contractor: COSCO FIRE PROTECTION INC Owner: FRED MEYER STORES INC
2501 SE COLUMBIA WAY SUITE 100 STORE#375
VANCOUVER,WA 98661 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 360-816-8418 PHONE:
FAX: 360-883-6390
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/02/2021 $112.96
12%State Surcharge-Building 08/02/2021 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 08/02/2021 $45.18
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 08/02/2021 $2.00
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .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 $173.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,080.00
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
Issued By: Permittee Signature:
}fof.iy V Gun/De/Wew OwAppLizotta n
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 ,S•_7 2i/2
Fire Protection System RECEIVED FOR OFFICE USE ONLY
City of Tigard Received \Z-lo'Z� NtV F?SZoZ. c io
t�j Date/By: Permit No.: - g�
13125 SW Hall Blvd.,Tigard,OR 97223 JUL 2 1 Mitt Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Other Permit:
��TY OF TIGARD Date/By:
T i ci Al'1) Inspection Line: 503.639.4175 Date Ready/By: orris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: 11('.�-. Supplemental Information
TYPE OF WORK REQUIRED DATA:l-AND 2-FAMILY DWELLING
['New construction E 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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
E 1-and 2-family dwelling Commercial/industrial
1::]Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I,Sto6 S1/\1 C,1(cC, WAN New dwelling area: square feet
City/State/ZiP: 1 (lad 1 09- Gt 2-2-3 Garage/carport area: square feet
Suite/bldg./apt.no.: "� Project name:'1(. e\ye)( t(`\�\--EX'O. Covered porch area: square feet
Cross street/directions to job site: J v 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.
A-ad ami rel oc c ` ie`n`n`'\erS Gve,ko Valuation: $ ✓ , 0-0
r cc) le-' (i..)(ld UQ'$y j o__Vpr yes Existing building area: square feet
ej ck. 2d Vad5 'coke-- New building area: square feet
In PROPERTY OWNER ❑ TENANT Number of stories:
Name:Tred 1,teye r Type of construction:
Address: &aco 5 . j .-Y\G1 Aw Occupancy groups:
City/State/ZIP: ?O -Auld t 0 R_ on Z 1I Existing:
Phone:(503) Ill —3S\ I Fax:( ) New:
. . APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: 0.,0Lc.) '' -(ice ?s(-O Li-- 01'1 All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: Ra� e1 U�a,�
under ORS 701 and may be required to be licensed in the
Address: ' ,O\ S' Co soriYJccx. W o. J, t c kr ��� jurisdiction in which work is being performed.If the
City/State/Z1P: WW1 co U\t t JV OI��\ LD applicant is exempt from licensing,the following reasons
apply:
Phone:(3100) SS3- 01 k.D,1 Fax: :( N/A
E-mail: 9_,(. ( N S a NI @ CO S Q-E .C O
CONTRACTOR BUILDING PERMIT FEES*
Business name: D.�t._1,F i t J R-19. E (Please refer to fee schedule)
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lie.: f4'-j s o 00 Total permit fees:
Amount received:
Authorized signature.
J This permit application expires if a permit is not obtained
Print name: T zkor\ove( �x� U Date: 11 at I-��t 1 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building industry
Service Board.
1:\Building\Permits\FPS-PeimitApp_031016.doc 440-4613T(1 1/02/COM/WEB)
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:
Ea Addition or r,St 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:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type at Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group .(ofr k . u-a
Density ,1
Design Area ISCav
K. Factor L0
Sprinkler Project Valuation: $ yya:o ,
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: $
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: $
I:\Building\Permits\FPS_PermitApp_031016.doc 2
City of Tigard Permit No.: FQ S 2.OZI-0°0 8 4j
II 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: '-I Val 12
Inspection Line: 503.639.4175 r,
T 1(.i A RI) Internet: www.tigard-or.gov By: C (�� t � G r a
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS RECEIVED
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) JUL 2 1 2O7'a
CITY OF TIGARD
BUILDING DIVISION
Project Name: Fred Meyer 385 Click List Expansion Occupancy: Business
Job Address: 11565 SW Pacific Hwy Type of Construction:
Suite:
Contractor: Cosco Fire Protection Phone: 3605539617
Number of Proposed or Altered Heads: 8
Type: Dry & Upright SR Hazard:Light Hazard Density: •1
Cosco Fire Protection Oregon Construction Contractors Board No. 67508
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits, beams,partitions, walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop (exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads (see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
In addition, I understand the following is required:
• Submit(3) copies of a sketch showing the area of work within the building's structure.
• Building fire protection system permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signatur' / \ Date: 7/21/2021
Print Name: Rachael Linson
I:\Building\Fonns\FireSprinklerAffidavit 071514.docx Page 1 of 1