Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
lig Permit#: FPS2022-00121
' COMMUNITY DEVELOPMENT Date Issued: 9/5/2023
T t G A.11.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15989 SW 72ND AVE
Project: Momo Sushi&Grill Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Hood suppression system.
Contractor: UNITED FIRE HEALTH &SAFETY EQUIPMENT CO IN Owner: PACIFIC REALTY ASSOCIATES
4611 NE MARTIN LUTHER KING JR BLVD ATTN: N PIVEN
PORTLAND, OR 97211 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-249-0771 PHONE:
FAX: 503-249-0572
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/20/2022 $59.16
12%State Surcharge-Building 09/20/2022 $7.10
Type of Use: COM Plan Review-Fire Life Safety-COM 09/20/2022 $23.66
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 09/20/2022 $6.00
Occupancy Grp: B Height: 25 ft 11x17)
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Dry
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 $95.92
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
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 J. started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow�,�- rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You m�� ' a copy of the rules
Issued By: Permutes Signature: '
Call . 39.4175 by 7:00 a.m.for the next available inspel"n 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.
•
Fire System Purchase Order #5575696-148 EcoN TANI?
Issued: 8/31/2022 7:36 PM
SCOPE OF WORK: Contract and coordinate system installation,hookup,and test with job site contact person listed below. Secure
necessary permits. Furnish all labor and loose parts necessary to complete system installation including required final demonstration
and inspection with fire official. Econ-Air will not be responsible for any costs incurred as a result of additional trips to the job site.
Review attached drawing(s)and parts lists for system details. Subcontractors must obtain a written change order from Econ-Air prior to
performing any additional work or for additional parts; Econ-Air will not pay more monies than the issued PO amount. Time is of the
essence. This contract may be withdrawn by Econ-Air if not accepted and returned within 24 hours.
JOB DETAILS: ii ` D
TO: United Fire FROM: Andrew Upperman JOB: MOMO SUSIL9IGAf4D62
Ed Wallace.owner 2702 NE 114th Ave 15989 Soutfi �, ?Avenue
4611 NE Martin Luther King Bou Suite 2 Tigard, • - :r Fir.
Portland.OR 97211 Vancouver,WA 98684-0000 Contact:
Phone: (503)249-0771 Phone: (360)360-2330 Phone: (971)930-7194
Fax: (503)249-0572 Fax: Email:jeremy@excelhvac.net
Email:ed@unitedfirepdx.com Email:
reg148@captiveaire.com
Fire System(s): FS#1 Tank FS 4.0.4.0 4.0 gallon - Fire Cabinet Right-[covering 1 hood)
Late Night Hook-up: No Prevailing Wages: No Field Cut Risers: No
Fire System Details(appliance drops or other):
Total Price for this Installation of Fire System(includes items listed below,excluding permit): $ 800.00
1. All loose parts not supplied with hood system. 4. All mileage to job site.
2. Gas valves as indicated above. 5. System installation costs/hook-up.
3. Trip test fee.if applicable. 6. All test and drawing fees.
Total Price for Permits(permit&receipt must be attached): $ TBD
PULL PERMITS ASAP AND SEND VERIFICATION OF PERMITS TO Econ-Air
Econ-Air must approve request for additional fees,parts, labor or any charges not stated on this purchase order prior to performing
work in order to receive payment. Payment will be delayed if the following is not submitted with invoices:
1. Installation certificate indicating installation is complete.
2. Test report signed by authority having jurisdiction.
3. Current Certificate of Insurance on file with Econ-Air as the certificate holder.
evidencing Workers Compensation and General Liability coverage.
4. Receipt for permits.
For Econ-Air Gft//L — Date 8/31/22
For Distributor " ___'� Date / //
A0_2_<
Acceptance of contract: The above terms and conditions are satisfactory and hereby accepted.
'Any modifications must be initialed by Econ-Air Representative:
(if applicable)
Econ-Air Accepts Amendment Date
Distributor Accepts Amendment Date