Permit s, CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2021-00130
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/22/2021
Parcel: 1 S 136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Wholesale Subdivision: PALMER ACRES
Lot: 3
Project Description: Fire sprinkler permit-reconnection 4 sprinkler heads.AFFIDAVIT SUBMITTED
Contractor: INTERSTATE CONSTRUCTION GROUP INC Owner: COSTCO WHOLESALE CORPORATION
437 29TH ST NE STE F PROPERTY TAX DEPT 111
PUYALLUP,WA 98372 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 253-435-0949 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/15/2021 $112.96
12°A)State Surcharge-Building 11/15/2021 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 11/15/2021 $45.18
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 11/15/2021 $0.50
Occupancy Grp: M Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type. Wet
Standpipe Required. Hazard: ORD2
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:
•
Tota I $172.20
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,450.00
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: Ho V De,Weg� Permittee Signature: ow A�
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.
tit
Building Permit Application E- (oh i. Z
Fire Protection System Fire S ti.CGEIVE . FoR oFFI(,,,USE ONLY
Cityof Tigard Received �f
Date/Nv: /O/` 202/ Permit No �s ��a /3v
13125 SW Hall Blvd.,Tigard,OR 97223 OCT 2,21 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 t _ Date/By: ��� Other Permit�P Q2/- (p
T I t \k I) Inspection Line: 503.639.4175 CITY O r !I UARL) Date Ready/By: 7, Fe See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISIO»ottfied/MethodiV/4S*u Supplemental Information
AV,sti - s
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Per fees*are based on the value of the work perfor•ed.
— Indicat he value(rounded to the nearest dollar)of. 1
®Addition/alteration/replacement D Other: cquipmen. aterials,labor,overhead,and the p it for the
CATEGORY OF CONSTRUCTION work indicate on this application.
❑ 1-and 2-family dwelling InCommercial/industrial Valuation: •
$
❑Accessory building ❑Multi-family Number of bedroom
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors•
Job site address:7850 SW Dartmouth St New dwelling arc . • uare feet
City/State/ZIP: Tigard, OR 97223 Garage/carp, area: squ. feet
Suite/bldg./apt.no.: Project name: Costco Wholesale Cover • torch area: square fc.
Cross streeUdirections to job site: D• area: square feet
SW Dartmouth St, Beaverton Tigard Hwy, 99W Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Tigard 97223 Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 1 S 13 6 CD O 2 2 O O 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.
Interior remodel of the optical sales and Valuation: $3, 450 . 00
hearing aid center. SoW includes but not Existing building area: 14 5,8 2 4 square feet
lira. to struct . , elec. , plumb. and fire prot . New building area: NO CHANGE square feet
M PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Costco Wholesale Type of construction: V-B Fully Sprink.
Address: 999 Lake Drive Occupancygroups:
city/State/ZIP: Issaquah, WA 98027 Existing: M (Mercantile)
Phone:(2 0 6) 9 6 2-6 6 51 Fax:( ) New: NO CHANGE
M. APPLICANT ❑ CONTACT PERSON NOTICE
Business name: MG2 All contractors and subcontractors are required to he
Contact name:Levi Schmitt licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the •
Address: 1101 2nd S t, Ste 100 jurisdiction in which work is being performed.If the
City/State/ZIP: Seattle, WA 98101 applicant is exempt from licensing,the following reasons
apply: _
Phone:(2 0 6) 9 6 2-6 6 51 Fax::( )
E-mail: levi .schmitt@mg2 .corn
CONTRACTOR BUILDING PERMIT FEES"
Business name: Larry Prescott - Interstate Const . (Please refer tofeeschedule,
Permit fee: 107 . 04
Address: 2201 Inter Ave. , Suite A
State surcharge(12%of permit fee): 12 . 84
City/State/ZIP: Puyallup, WA 98372
FLS plan review(40%of permit fee):
Phone:(2 5 3) 4 3 5-0 9 4 9 Fax:( ) (Due upon application submittal.) 42 .82
CCB lie.: 158136 Total permit fees: 162 . 70
Authorized signature: Amount received:
ln1 This permit application expires if a permit is not obtained
Mo s t a f a Aha h i / All within 180 days after it has been accepted as complete.
Print name: Date: �d (�`i�•� I
* Fee methodology set by Tri-County Building Industry
Authorized Agent. for Costco Wholesale Service Board.
tlnuilding\Pcrmits\PTS-PermiiApp_031016.doc 440-46I3T(1 1IO2ICOM/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:
See FA Permit Application
❑ New system Number of sprinkler heads: 4 Number of alarm devices:
0 Addition or 0 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
Elq
(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 x❑ Wet ❑ Dry
Additional Standpipes N/A
Information: Sprinkler Supply Line ❑x Yes ❑ No 1-in pipe and drops
Hazard Group Ordinary Group II
Density 0.2 0
Design Arca 1500
K.Factor 5.6
Sprinkler Project Valuation: $ 3,450 . 00
B.) type
Hoo rojec
C.) Fire Alarm See FA Permit Application
Submittal shall Battery Calculations [. Yes
include: Individual Component ❑�c Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residenn ' kler(Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000
,11
2,001 to 3,600 •
3,601 to 7,200 $310.05
7,201 and $404.39
Sprinkler Project Square Footage: ��q.f.
Fire Protection Permit Fees
Project valuation subtotal(see A,B&C above): $ 3,450. 00
Permit fee based on project valuation(see fee schedule): $ 107.04
Permit fee based on square footage(see D above): $ 12.84
State Surcharge(12%of permit fee): $ 4 2 .8 2
FLS Plan Review(40%of permit fee): $
TOTAL: $ 162 .70
I:\Building\Permits\FPS_PemvtApp_031016.doe 2
RECE F s t
City of Tigard Permit No.: � 2021-00 3
13125 SW Hall.2439 Tigard,OR 97223
111 8.19 OCT
T 1 9 / 5/2oZ4
s Phone: 503.718.2439 Fax: 503.598.1960 l• 9 2oL/ Date Received: Z ��.�J�
Internet: www.: 503-or.go 75 O' l O F-71 -1�'r"O
T 1 G A]t U Internet: www.tigard-or.gov CITY OF 1 I(;jH�-y'D By:
BUILDING DIVISION
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS FiC -+ ;r
(I to 10 SPRINKLER HEADS WITHOUT PLANS))
Project Name: Costco Wholesale Optical & HAC Remodel Occupancy: M (Mercantile)
Job Address: 7850 SW Dartmouth Street Type of Construction: V-B Fully Sprink.
Suite:
Contractor: Interstate Construction Group Inc. Phone: (253) 435-8949
Number of Proposed or Altered Heads: 4
Type: Wet Hazard: Ordinary Group II Density: 0.20 / 1500
1 Larry Prescott Oregon Construction Contractors Board No. 158136
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.
gn Larry Prescott �A,"aw` °� °°�� Date: 10/18/21
Signature:
. ® �,� ,���� sw�
Print Name: Larry Prescott
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