Permit (3) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
' COMMUNITY DEVELOPMENT Permit#: FPS2023-00082
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/11/2023
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15989 SW 72ND AVE
Project: Momo Sushi Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Fire sprinkler.Adding(22)new sprinkler heads to existing system.
Contractor: PEAK FIRE PROTECTION LLC Owner: PACIFIC REALTY ASSOCIATES
2095 NE ALOCLEK DRIVE STE 1108 ATTN: N PIVEN
HILLSBORO, OR 97124 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 541-640-7325 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/11/2023 $156.00
12%State Surcharge-Building 07/11/2023 $18.72
Type of Use: COM Plan Review-Fire Life Safety-COM 07/11/2023 $62.40
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 07/11/2023 $2.00
Occupancy Grp: B Height: 25 ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 07/11/2023 $12.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: ORD2
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 $251.62
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $7,200.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules/
Issued By: r Permittee Signature: / G
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
4 . b
Building Permit Application
Fire Pl otection System RECEIVED FOR OFFICE USE ONLY
CI of aflLo Receivad 1G to 1 Ap t$�,023 00082
b p� • ���� Dater Bq: Pcnnil No
-a 13125 SW Hall Blvd Tigard,OR 97223 JUIV
Plan Review
'o _ is Phone: 5(1.3,7t8.2439 Fax: 503.598.1960 Dalz/g7
O Other Permit:
I Inspection line: 503.639.4175 Date Ready/By: laris, —_-
TIGARD CITY OF rIY See Page Internet www-ti and-or. ov GAR NntificNMerhnA`1
g g l il! n)°!� P D - �3 Supplemental hd oar Jum
►M4< r
L
TYPE OF WORK R .., . ` ,..1 2= �LY D EI,LI:SC
❑New construction ❑Demolition Permit fees*are based on the value of the work'scrim tried
Indicate the value(rounded to the nearest dollar)of all
t ddiuon.alleration,teplaceincni ❑Other: equipment,materials,labor,overhead,and the profit for the
CAILGORY OF CONSTRUCT O:Y ij work indicated on this application.
Valuation: $
❑ I-and 2-family dwell ine Commercial/industrial _
ElAccessory building El Multi-familyNumber of bedrooms:
I -
El Master builder El(thee. Number of bathrooms:
JOB SI PF INFORMAT AND LOCA'I ION. Total number of floors: i
Joh sire address 15c:;i F. 1 --1-010 Avt New dwelling area: squarefcci
City/Slate/ZIP: Toy}{v�a r„Y�A , 0g, (21i ,1, Garage/carport area: square feel
_Suite/bldg./apt.no.: � Project name: to Mi Jj� Covered porch area: square feet
Cross street/directions to job site: Deck area: square Feet
Other structure area: square feet
1, -_ - r 1 L. i t- YiMgMERCIA1 ('SF.CIIF('M is t
ill divi.ion. Lot no.: Permit fees*are based on the value of the work per Corm,•1
l i, tiro t rtcd no.: Indicate the value(rounded to the nearest dollar)of all
1 P equipment,materials,labor,overhead,and the profit for ry
Valuation: pp$
D1SCRIP 11ON OF WORK ' work indicated on this application.
dal d- rocahe hew fP('ihkt, hey 2.-40
Existing building area: square feet
I , I
New building area: square feet
1l;1 )o�� :11 ' 1 *15A l I147te f121 Number of stories: I
Name: ICU WA() J(lvl tItec t Type of construction: -it
Address: v�•,`�..' /1r rotditik _. Occupancy groups:
City/State/ZIP: pi Existing:
Phone. 11:3 )9 (.tipau Fax:( ) New:
V APPLICANT CON I A( I' I'FRSOIY NOTICE
Business name: peak f( pi,,,' �t _. All contractors and subcouu ,skit s lii ..I uncd to he
Contact name: VJ� licensed with the Oregon Construction Cuntructnrs Bond
- --kitx
under ORS 701 and may be required to be licensed in lhi•
Address: to , ,t4 .c 1.e tr. iC 1I Qt _ jurisdiction in which work is being performed If the
('it 'Statc/ZIP: (ti 11ItbW OE. DI 1 ti4.1 applicant is exempt from licensing,the fullowim;reason:
[. +1 Fax::,�( )
apply.
Phone:(541) t/-lI •1'St ' yx� 1,
., CON'fRACfOR. l BL'TLDT)G PERMIT FEES* '.
till n¢ss nano: pea .. •F r.< OIw.�ceL�{r, I.. (Plane r•J rt lr.rin Gfel
r Permit fee
hiss.j 01 N6 A IOC44.k Dv . be mil'
'�
i m Slate ZIP: Rills�b 1 p� On�� State surchazge(l2"/oof permit fee)
y FLS plan review(40%of permit fee): I
Phone:(C�,II) Vipt 1r12.� Fax:( ) (Due upon application submittal.)
c t II tic-. A��0 (� Total permit fees:
/-1 Amount received:
Authorized signature: ZY)
This permit application expires if a permit is not obtained
Print name: e'h u �,x,' Date: (et is it.; within 180 days after it has been accepted as complete.
�v1 4 * Fee methodology set by Tri-County Building Industry
/ Service Board.
I:'Builds Permiis'6PSPermliApp_o3I 016.doc 440-4613T(I I/02/COMIWEB)
• 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: I
❑ New system Number of sprinkler heads: Z2 Number of alarm devices:
�f 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.
\dditional description of work:
1
Type of System (Complete A, B, C or D as applicable):
N.) Commercial Sprinkler
Sprinkler Type V et ❑ Dip
Additional Standpipes (U
Information: Sprinkler Supply Line d Yes ❑ No
Hazard Group D4119Vlrvx_��//yt_ Z.
Density t. i
Design Area
K. Factor CJ Ae
Sprinkler Project Valuation: $ ')Qipj
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: S
C.) Fire Alarm
Submittal shall I Battery Calculations
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
1.1 Residential Sprinkler (Stand Alone System)
ao acte: Permit Fcc
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater S404.39
Sprinkler Project Square Footage: I sq. 0.
Fjtg tection Permit Fees
Project valuation subtotal (see :1, 13 &C c : $
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\Peanits\FPS_PermitApp_O311)16.doc 2