Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2022-00099
TIC;,A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/18/2022
Parcel: 2S 115BA00100
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY M
Project: Trader Joe's Subdivision: None
Lot: None
Project Description: Fire sprinkler permit:Adding pendent sprinklers for a new Trader Joe's.
Contractor: VANPORT MECHANICAL&FIRE SPRINKLERS Owner: TECOLOTE RESOURCES INC
6101 NE 127TH AVE STE 200 KELLY'S LEGACY LLC ET AL
VANCOUVER,WA 98682 BY HESLIN HOLDINGS INC
23421 SOUTH POINTE DR STE 270
LAGUNA HILLS, CA 92653
PHONE: 360-892-8280 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/08/2022 $626.50
12%State Surcharge-Building 07/08/2022 $75.18
Type of Use: COM Plan Review-Fire Life Safety-COM 07/08/2022 $250.60
Class of Work: ALT Type of Const: VA Info Process/Archiving-Lg$2.00(over 07/08/2022 $2.00
Occupancy Grp: M Height: 25 ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 07/08/2022 $6.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: 0.1 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:
Total $960.28
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $66,000.00
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 o 'n py of the rules
//JJ
Issued By: /(/A��� „ Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspect' n date.
This permit card shall be kept in a conspicuous place on the job site unt' ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard D Received
g 1 E C E I V Date/By: 6 2,7 �+77 Permit No.: / / 5 7eq 19,. ary/
IN 4 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review WL/Y` (!w%
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 1.3 ...,2„,2 Other Permit: 0. 1g.—e`115A
T i( A F p Inspection Line: 503.639.4175 Da,Ready/By: Juris: See Page 2 for
Internet: www.tigard-or.gov 2UZZ otified/ thod: 12 Q Supplemental Information
TYPE OF WQ1�,>�c,I REQUIRED DATA:11-AND 2-FAMILY DWELLING
LDING DI\ftSION°
El New construction 0 Demolition Permit fees*are based on the value of the work performed.
- Indicate the value(rounded to the nearest dollar)of all
4ddition/alteration/replacement El Other: equipment,materials,labor,overhead,and the profit for the
�! CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling Commercial/industrial Valuation: $
❑Accessory building El Multi-familyNumber of bedrooms:
❑Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1,6)200 ytd rAc)i-,C_ \*w ( New dwelling area: square feet
City/State/ZIP: p 6,A.>Z,p , i OV 1'ZZ. - Garage/carport area: square feet
Suite/bldg./apt.no.: - Project name:�' Av - Jo ES! Covered porch area: square feet
Cross street/directionsto job site: Deck area: square feet
st w io 1
FI Y I Mt Am? 5 w 7L)iz•oskrvI fz-DA)" Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: /� l Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 'L,�j `S I�jTz�O O Z 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.
P't 917 P 34 QE -4 T 5P1z1 t1K 5 F 1ZDnn • -x.-ri. Valuation: $ (go 006
OYw 1 5. m F4e) N - - Existing building area:(1,-r�5 square feet
IN Pr t-1-5 AA'L7 G E7 L-✓1, 45 New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New
),APPLICANT CONTACT PERSON NOTICE
�� '��Business name: X. ! Al E�1+ . F i -- 1 I h(C, All contractors and subcontractors are required to be
Contact name: J/��E� Alicensed with the Oregon Construction Contractors Board
Address:ac under ORS 701 and may be required to be licensed in the
0 1 1.J E l'Z„"j 'ZL AvE #'Z„8b jurisdiction in which work is being performed.If the
City/State/ZIP: v pr N co V ve - WPk $Z applicant is exempt from licensing,the following reasons
I apply:
Phone:(3tp 0 —Z,5(..,—9 ii3 S Fax::( )
E-mail: .J AwjE,fL-@ YR J•!litter NI EG}4 - C O n.)
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: vpNpo�TEGH F 1 / /ucr Permit fee: i
Address: W J t l N E )'L'Y'3• Ay a $t Z,47)D
State surcharge(12%of permit fee):
City/State/ZIP: VAN CO 'E W \2)b 15 Z FLS plan review(40%of permit fee):
Phone:(?' O-77. b- C)83 6 Fax:( ) (Due upon application submittal.)
CCB lie.: 2_0 Z Total permit fees:
Authorized signature:
Amount received:
This permit application expires if a permit is not obtained
Print name: _ 1 t�� Date: 1 4 J ZZ within 180 days after it has been accepted as complete.
` * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-Permi*App_031016.doc 440-4613T(1 I/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: Number of alarm devices:
71 Addition or El 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
X 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 X. Wet 3SC Dry
Additional Standpipes N/A
Information: Sprinkler Supply Line 0 Yes No
Hazard Group DILL, f}AZ, 49»P, 'It
Density ,20
Design Area j 5'O
K. Factor C , (0K,
Sprinkler Project Valuation: $ (I)toi 000—B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler(Stand Alone System)
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 and greater $404.39
Sprinkler Project Square Footage: sq.ft.
Fire Protection Permit Fees
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