Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11
COMMUNITY DEVELOPMENT Permit#: FPS2022-00014
Date Issued: 2/15/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S 136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY X
Project: Jersey Mike's Subs Subdivision: None Lot: None
Project Description: Fire hood permit-Installation of hood fire suppression system.
Contractor: PYE BARKER FIRE& SAFETY LLC Owner: PACIFIC CROSSROADS PROPERTIES INC
18260 SW 100TH CT BY WYSE INVESTMENT SERVICES CO
TUALATIN, OR 97062 810 SE BELMONT ST#100
PORTLAND, OR 97214
PHONE: 503-691-9000 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/14/2022 $112.96
12%State Surcharge-Building 02/14/2022 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 02/14/2022 $45.18
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 02/14/2022 $17.50
Occupancy Grp: B Height: 25 ft 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 $189.20
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: Vit..--tat) W\JOJCv, Permittee Signature: m a po ( 1 (3,,3
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.
,�, W _
Building Permit Application
Fire Protection System RECEIVE FOR OFFICE USE ONLY
City of Tigard 3 fl22 Received Ai �� �� /�� •ermit No� qM�
P3125 SW Hall Blvd.,Tigard,OR 97223 ���� �l L L Date By: ;,
g
' I Gk ('I Phone: 503.718.2439 Fax: 503.598.1960F i i �) DatPlane/By:Review a 7 -oZ,Z Other Permit:
i i t.;`I,t) Inspection Line: 503.639.4175 p� 1fls. Date Ready/By: 1I Iur s: ® See Page 2 for
g gr11�JL�C}I:,v.�h /� �/� I
Internet: www.ti and or. ov otified Method Supplemental Information
ew 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
// � `'',,, � ,,,,, / work indicated on this application.
/ P ii� ,
0 1-and 2-family dwelling Commercial/industrial Valuation: $
(�
❑Accessory building /❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
� /7 � �� /i,.z/ Total number of floors:
Job site address:1'fOS S•+(J 'NUN.) \kw j New dwelling area: square feet
City/State/ZIP:TiCj Yd► i V� cri "J Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:3 )tI f VA1 t(' Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
'A',,',/%!//,oaO/:,,,--/ �/a,���i/r//a/y,<//a0 YY'%',:,,&- ; oo
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
;779,• //i,, {• �c /�oGi/Go'i %e j;////%7.,,,, O / work indicated on this application.
nk 10 i VT fire % WITSMil
is t„ g ,,,n ` Valuation: $ , ,i
Existing building area: square feet
New building area: square feet
soot l/a��� . %% //ii`
o „ .°r„ s. ���'% / / Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
',tea/ $ % r � A'•::'W e
Business y
?WAIN'��iv IA
't . � All contractors and subcontractors are required to be
Contact name:name: a bQi�C licensed with the Oregon Construction Contractors Board
�` A under ORS 701 and may be required to be licensed in the
Address:f•t/1. 4 `"�'1Ai t jurisdiction in which work is being performed.If the
City/State/ZIP: �� /� V applicant is exempt from licensing,the following reasons
Vl WA WA-WI 1 DV., COO k./,1, apply:
Phone:( j) Li2C1 1 --clop() I Fax::( )
E-mail: Va, t 'ire i ' •2 '
Business name: Wr #-<j � Permit fee:
Address: iy)RAtO Sw kbV�k h bk
State surcharge(12%of permit fee):
City/State/ZIP:"rt l� ' fA1, lio622."` A Y n1 1V YFLS plan review(40%of permit fee):
Phone:( )VI i- (k0 0 0 Fax:( ) (Due upon application submittal.)
CCB lie.: '1,, ‘ A- Total permit fees:
Authorized signature: Me low 6 Amount received:
1 This permit application expires if a permit is not obtained
Print name:?mil "t)0 Q I O..��J1( A Date: 1 1 i‘ 1 i within 180 days after it has been accepted as complete.
} * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2:Supplemental Information
q ffi 4 l' ¢ s
v
•
4,4 0/r� t..7 J//Oiaivoiaaiaa...n..,, �`
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:
� .. ... /,���/�'a//�/ va .oap , lope
1. .(� %,.�"' �!Oa/w5iia �� //p�r�%/ 4 a c„;
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
/ i a atadiicioa/a � xo;,�,. %i��////ii//// " d,Z "�ui�y;% Hood Project Valuation: $ 34 —
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: ] $
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 andgreater $404.39
Sprinkler Project Square Footage: sq. ft.
����,, . � ;,,`yam,
aiiai�ia%/i a�e. 3 ` "/////i.
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