Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2022-00106
T[GA II T) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/20/2022
Parcel: 1 S 136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 3
Project Description: Fire sprinkler permit:Demolition and(4)new pendent sprinkler heads. Affidavit submitted.
Contractor: DELTA FIRE INC Owner: COSTCO WHOLESALE CORPORATION
14795 SW 72ND AVE PROPERTY TAX DEPT 111
PORTLAND,OR 97224 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 503-620-4020 PHONE:
FAX: 503-620-1058
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/20/2022 $123.72
12%State Surcharge-Building 07/20/2022 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 07/20/2022 $49.49
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 07/20/2022 $2.00
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: 0 Design Area: 0
K Factor:
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $190.06
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $4,411.00
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
r
Issued By: n 10j/ Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available i pection 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.
1111 City of Tigard Permit No.: „$2 j/-2-- 001 oce
. 13125 SW Hall Blvd.,Tigard,OR 97223
_ Phone: 503.718.2439 Fax: 503.598.1960 Date Received: /fj�
Inspection Line: 503.639.4175
TIGARD Internet: www.tigard-or.gov By: /}t„ 01:- T
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS RECEIVED
1 (1 to 10 SPRINKLER HEADS WITHOUT PLANS) JUL 1 9 2022
CITY OF TIGARD
BUILDING DIVISION
Project Name: Costco Tigard 111 Hearing Center Remodel Occupancy:
Job Address: 7850 SW Dartmouth St Type of Construction:
Suite:
Contractor: Delta Fire Inc Phone: 503-620-4020
Number of Proposed or Altered Heads: 4
Type: Wet Hazard: LIGHT Density:
1 Delta Fire Inc Oregon Construction Contractors Board No. 64174
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.
7
Signature: Date:
07/18/2022
Print Name: Lisa Fong
l:\Building\Fonns\FireSprinklerAffidavit_071514.docx Page 1 of 1
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard Received
g V '-'� Date/By: `7 lip-fr 4' Permit No.: q,p.� ?9..-obtao
Phone:
SW Hall Blvd.,Tigard,OR HH77[[ Plan Review t� ' T7 V
Phone: 503.718.2439 Fax: 503.598.19 0 9 qq Date/By:ED
/1 Other Permit:
T l G A R U Inspection Line: 503.639.4175 J U L 1 2022 L Date Ready/By: • ` Juris: 165 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: - �� - 3V Supplemental Information
CITY O''FTIGARD OP IUT Lirr-,
TYPE 0S13 b�dl4`�G DIVISION
REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New 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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: $
111Accessory building ❑Multi-family Number of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:7850 SW Dartmouth St. New dwelling area: square feet
City/State/ZIP:Tigard OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Costco Hearing Center Remodel Covered porch area: square feet
Cross street/directions to job site: 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Sprinkler system demo as required, installation of new pendent sprinkler heads Valuation: $4411.00
�a(ai✓l f- k4o0v` Existing building area: square feet
/ New building area: square feet
❑ PROPERTY OWNER 0 TENANT Number of stories:1
Name:Costco Tigard 111 Type of construction:
Address:7850 SW Dartmouth St Occupancy groups:
City/State/ZIP:Tigard OR 97224 Existing:
Phone:( ) Fax:( ) New:
❑■ APPLICANT ❑■ CONTACT PERSON NOTICE
Business name: Delta Fire Inc All contractors and subcontractors are required to be
Contact name: Lisa Fong licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:14795 SW 72nd Ave jurisdiction in which work is being performed.If the
City/State/ZIP:Portland OR 97224 applicant is exempt from licensing,the following reasons
apply:
Phone:( )503-620-4020 x100 Fax::( )503-620-1058
E-mail:lisaf@deltafire.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name:Delta Fire, Inc. 1
Permit fee:
Address:14795 SW 72nd ave.
State surcharge(12%of permit fee):
City/State/ZIP:Portland, OR 97224
FLS plan review(40%of permit fee):
Phone:( )503-620-4020 x 100 Fax:( ) (Due upon application submittal)
CCB lic.:64174 Total permit fees: 7de
Authorized signature: /7 c', Amount received: r- •-
This permit application expires if a permit is not obtained
Print name:Lisa Fong Date:07/18/2022 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
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: 4 Number of alarm devices:
O 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:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑■ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $4411.00
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 Footape: 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): $4411.00
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