Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2022-00022
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/17/2022
Parcel: 1 S136DB02502
Jurisdiction: Tigard
Site address: 11634 SW PACIFIC HWY
Project: Mike's Drive in Subdivision: None Lot: None
Project Description: Connect factory installed captive air tank suppression system.
Contractor: UNITED FIRE HEALTH &SAFETY EQUIPMENT COIN Owner: JORORET LLC
4611 NE MARTIN LUTHER KING JR BLVD 888 SW 5TH AVE STE 1600
PORTLAND, OR 97211 PORTLAND, OR 97204
PHONE: 503-249-0771 PHONE:
FAX: 503-249-0572
FEES
Description Date Amount
Specifics: Permit Fee-COM 0211612022 $69.92
12%State Surcharge-Building 02/16/2022 $8.39
Type of Use: COM Plan Review-Fire Life Safety-COM 02/16/2022 $27.97
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 02/16/2022 $12.50
Occupancy Grp: B Height: It 11x17)
Stories: 1
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 $118.78
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,200.00
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.yYYoouu may obtain a copy of the rrullesl
Issued By: q J"r vdl l� JIY� /V Permittee Signature: l A I �qqry� U 1 ,1
HJ 1
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 Building Permit ApplicatiolM `/CC
Fire Protection System I V CD
FOR OFFICE USE ONLY
FEB 7121 1
Date By: /�� _ FPS
^.t.��Myy�ry
City of Tigard AL2 Pe mit No.; `J VLA- 5"WE
13125 SW Hall Blvd.,Tigard,OR 972 3• _ Plan Rev
! g I1Y OF l IGAR� Plan Revew 1 ,
Phone: 503.718.2439 Fax: 503.598.1 I Date/By: 'P —� Ocher Permit:
Inspection Line: 503.639.4175 BUILDING DIVISION" I Date ReadyByi fur' ® See Page 2 for
Internet: wwwtlgard-orgov otified'Met Supplemental Information
/ _
TYPE`r i REQUIREDDATA:1-AND 2-FAMILY DWELLING
New construction F-1 Demolition I 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
"" work indicated on this application.
,.. .:: AI VGO tY, ,, lam!
Valuation: $
C] 1-and 2-family dwelling (x]Commercial/industrial
❑Accessory building ❑Multi-family I Number of bedrooms:
El Master builder
❑Other: I Number of bathrooms:
JOB SITE INFORMATION AND LOCAFION �V ' a `'� I Total number of floors:
Job site address 11634 SW Pacific Highway I New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223-8674 I Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name: Mikes Drive in I Covered porch area: square feet
Cross street/directions to job site:SW 741h Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST;
Subdivision: I Lot no.: I Permit fees*are based on the value of the work performed.
Tax map/parcel no.: I Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORKkIlf \tii „''ss11€'1 work indicated on this application
Connect factory installed Captive Aire Tank Fire Suppression System Valuation: $ 1206.00
Existing building area: square feet
New building area: square feet
_'❑ PROPERTY OWNER ( Number of stories:
Name. Mikes Drive in Type of construction:
Address: 1634 SW Pacific Highway I Occupancy groups:
City/State/ZIP. Tigard,OR 97223-6674 I Existing:
Phone:( )41, Fax:( )
New:
❑ CONTACT PERSON Ij a '
riXa. r NOTICE
Business name: United Fire
All contractors and wbcontractors are rcywred to be
Contact name: Ed Wallace I licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 4611 NE M.L.K.dr.Blvd. jurisdiction in which work is being performed.If the
City/State/ZIP: Portland,OR 97211 applicant is exempt from licensing,the following reasons
apply:
Phone:(971 ) 563-1592 Fax::( )
E-mail: ed@umtedfirepdxcom
_ + BUILDING PERMIT FEES"*
Business name United Fire t -1 (Please refer to fee schedule
Permit fee:
Address: 4811 NE M.L.K.Jr.Blvd.
I
0
of permit fee
City/ State surcharge12/o State/ZIP:Portland.OR 97211 I ( F ) I
FLS plan review(40%of permit fee):
Phone:( 971 ) 563-1592 Fax:( ) I (Due upon application submittal.)
CCB lic.: 65290 I Total permit fees:
Authorized signatu
Amount received:
This permit application expires if a permit is not obtained
IPrint name: E 44 4&le I Date:2-4-2022 I within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
Id9eddmg\Permds\FPS-PemntApp_031016.dm 440-4613T(11/02/COM/WEE)
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:
❑ 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:
T e of System (Complete A B C or D as applicable):
YP Y ( P
A.) Commercial Sprinkler 1
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B. Type I - Hood Fire Suppression System
YP PP
Hood Project Valuation: x$1200.00
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 l
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.
.ri
Fire Protection Permit Fees01M
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