Permit „ CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
``� = COMMUNITY DEVELOPMENT Permit#: FPS2021-00131
Date Issued: 11/22/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Wholesale Subdivision: PALMER ACRES Lot: 3
Project Description: Fire alarm permit-adding 4 notification devices.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 $91.44
12%State Surcharge-Building 11/15/2021 $10.97
Type of Use: COM Plan Review-Fire Life Safety-COM 11/15/2021 $36.58
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:
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: Yes Cut Sheets Required: Yes
Total $139.49
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,000.00
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
Issued By: Ho{A... Vaw De wege- Permittee Signature: Ow A.^.^I
!may`
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.
F y,
Building Permit Application RECEIVED�-y - 10 l•
Fire Protection System Fire RECEIVED q FOR�7 OFFICE USE ONLY 'n—r
Received
Date/By:
/Q ZS 2o2/ �� .FPS' .021�1 31
IllgCity of Tigard O C T 1 9 2021 eeB Permit No..
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 1T�n �[j
�' Phone: 503.718.2439 Fax: 503.598.196p, DateBy: Al'AOther Permita�t t�lGJ+�+��U T
Inspection Line: 503.639.4175 la'i Y 0(= 1 IGpR® Date Ready/By Juris RI See Page 2 for
"';�:" BUILDING DIVISION I4/ 7 T[C Internet: www.tigard-or.gov �Nootitied/Method: 1 Supplemental Information
-lffiILG46 /- 1
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. I
E:! Addition/alteration/replacement ❑Other: equipmen. aterials,labor,overhead,and the p it for the
CATEGORY OF CONSTRUCTION work indicat : on this application.
El I-and 2-family dwelling ®Commercial/industrial _Valuation: $
❑Accessory building El Multi-familyNumber 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 ar-. ` uare feet
City/State/ZIP: Tigard, OR 97223 Garage/carp• area: squ feet
Suite/bldg./apt.no.: Project name: COStCO Wholesale Covere. .,rch area: square f •
Cross street/directions 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.
indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: 1 S 13 6 CD O 2 2 O 0
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: $2, 000 . 00
hearing aid center. SoW includes but not Existing building area: 145,B24 square feet
lira. to struct. , elec. , plumb. and fire prot . New building area: NO CHANGE square feet
® PROPERTY OWNER 0 TENANT Number of stones: 1
Name: Costco Wholesale Type of construction: V-B Fully Sprink.
Address: 999 Lake Drive Occupancy groups:
City/State/ZIP: Issaquah, WA 98027 Existing: M (Mercantile)
Phone:(206) 9 6 2-6 6 51 Fax:( ) New: NO CHANGE
�. APPLICANT ❑ CONTACT PERSON NOTICE
Business name: MG2 All contractors and subcontractors are required to he
Contact name:Levi S Chmi t t 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:(206) 9 6 2-6 6 51 Fax::( )
E-mamlevi .schmitt@mg2 .com
CONTRACTOR BUILDING PERMIT FEES*
Business name: Larry Prescott - Interstate Const . (Please refer ro fee schedule)
Permit fee: $91 .4 4
Address: 2201 Inter Ave . , Suite A �_..
State surcharge(12%of permit fee): $10 . 9 7
City/State/ZIP: Puyallup, WA 98372
FLS plan review(40%of permit fee): $3 6 . 5 8
Phone:(2 5 3) 4 3 5-0 9 4 9 Fax:( ) (Due upon application submittal.)
CCB lic.: 158136 Total permit fees: $13 8 . 9 9
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: Mostaf a Ahane Date: ‘Q J' 1,f^4G,' within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Authorized Agent for Costco Wholesale Service Board.
IanuitdingWcrrnns\ITS-PermnApp 031016.doc 440-4613T(11IO2/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:
See FP Permit Application
❑ New system Number of sprinkler heads: Number of alarm devices: 4
x❑ Addition or ❑ 1-10 heads: Affidavit required and ❑x 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 See FP Permit Application
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K.Factor
Sprinkler Project Valuation: $
Ham Prolecf ralvatimr.--$
C.) Fire Alarm
Submittal shall Battery Calculations ❑x Yes
include: Individual Component ❑x Yes
Cut Sheets
Fire Alarm Project Valuation: $ 2, 0 0 0 . 0 0
D.) Residenn er(Stand Alone System)
Square Footage: �� Permit Fee: _
0 to 2,000
2,001 to 3,600
3,601 to 7,200 $310.05
7,201 and $404.39
Sprinkler Project Square Footage: .ft.
Fire Protection Permit Fees
Project valuation subtotal (see A,B&C above): $ 2, 000 . 00
Permit fee based on project valuation (see fee schedule): $ 91 .4 4
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $ 10. 97
FLS Plan Review (40%of permit fee): $ 3 6 .5 8
TOTAL: $ 138 . 99
I:\Building\Pem its\FPS_PcrmitApp_031016.doc 2
RECEIVED
City of Tigard OCT 1 9 2021 Permit No.: FPS2D2(',23 (3 '
I 13125 S50 Hall Blvd.,Tigard,OR 978229603 IN
Date Received: 1 0/Z /�c iI
Phone: 503.718.2439 Fax: 503.598.1 ,
f �j
Inspection Line: 503.639.4175 CIT G i IUARD
fl(..A' t? Internet: www.tigard-or.gov BUILDING DIVISION By: CAP/OF GW
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OPY
OR TENANT IMPROVEMENTS ( 13IC ) '
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Costco Wholesale Optical & HAC Remodel Occupancy: M (Mercantile)
Job Address: 7850 SW Dartmouth Street Suite:
Contractor: Interstate Construction Group Inc. Phone: (253) 435-0949 _
Valuation of work: $2,000.00
Type of System: (check one) ElRequired nNon-required
(check one) *Automatic nManual (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) 0 /To be Relocated (max 5) 0
Number of Proposed Manual Alarm Stations: To be Added(max 5) 0 /To be Relocated (max 5) 0
Number of Proposed Notification Appliances: To be Added (max 5) 4 /To be Relocated(max 5) 0
I Larry Prescott Oregon Construction Contractors Board No. 158136
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.
• Building fire protection system permit.
• Electrical permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Larry Prescott 10/18/21
Signature: �»�_°���=o,a,� 2 a Date:
Print Name: Larry Prescott
l:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1