FPS2023-00051 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IN COMMUNITY DEVELOPMENT Permit#: FPS2023-00051
T I C;A R.i7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/1/2023
Parcel: 1S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 3
Project Description: Fire alarm.Adding(3)fire alarm devices to locker room remodel and mezzanine addition.
Contractor: GB MANCHESTER INC Owner: COSTCO WHOLESALE CORPORATION
6000 NE 88TH ST PROPERTY TAX DEPT 111
VANCOUVER,WA 98665 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 360-816-0484 PHONE:
FAX: 360-816-0482
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/01/2023 $220.56
12%State Surcharge-Building 05/01/2023 $26.47
Type of Use: COM Plan Review-Fire Life Safety-COM 05/01/2023 $88.22
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 05/01/2023 $2.00
Occupancy Grp: Height: ft 11x17)
Stories:
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: Yes Cut Sheets Required: Yes
Total $337.25
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $13,991.00
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 Cente hose rules are s in OAR 952-001-0010 through OAR 952-001-0090. You may obtain py of the rules
Issued By: A -d Permittee Signature: •
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.
Buitdii i Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard ECEIE,;, Received Date/B : / _ ` CV
1111 » 13125 SW Hall Blvd.,Tigard,OR 97 A Plan Review / I i L
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : i'IG��� "4. .
Inspection Line: 503.639.4175 27/ 2023 Date Ready/By: kris: M See Page 2 for
1 1 t�A it APR Internet: www.tigard-or.gov Notified/Method: Supplemental Information
OF TIGARD
TYPE OF �� • DING 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.
El1-and 2-family dwelling
PA Commercial/industrial Valuation: $
ElAccessory building El Multi-familyNumber of bedrooms:
❑Master builder ❑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.: N/A Project name: COSTCO LOCKER RM/MEZZ ADDITION 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.
ADD FIRE ALARM DEVICES TO LOCKER RM REMODEL AND MEZZ ADDITION Valuation: $ 13,991.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
151 APPLICANT uj CONTACT PERSON NOTICE
Business name: GB MANCHESTER I N C All contractors and subcontractors are required to be
Contact name: NATHAN BUTZ licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6000 NE 88TH ST. SUITE B103 jurisdiction in which work is being performed.If the
City/State/ZIP: VANCOUVER WA. 98665 applicant is exempt from licensing,the following reasons
apply:
Phone:(360 ) 816-0484 Fax::(360 ) 816-0482
E-mail: NATHAN.B@GBMANCHESTER.COM
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: GB MANCHESTER INC
Permit fee:
Address: 6000 NE 88TH ST. SUITE 8103
State surcharge(12%of permit fee):
City/State/ZIP: VANCOUVER WA, 98665 FLS plan review(40%of permit fee):
Phone:(360 )816-0484 Fax:( 360) 816-0482 (Due upon application submittal.)
CCB lic.: 202097 Total permit fees:
Amount received:
Authorized signature: Nathan Butz M« ==
This permit application expires if a permit is not obtained
Print name: NATHAN BUTZ Date: 04/25i2023 * within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\PermitsiFPS-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:
El New system Number of sprinkler heads: Number of alarm devices: �'
ElAddition 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
❑ 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 El Wet El Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K.Factor
Sprinkler Project Valuation: $
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: $ 13,991 00
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_PertnitApp_031016.doc 2
City of Tigard 11 Permit No.: F-Pc (ii3-005713125 SW Ha11 B1vd.,Tigard,OR 9 2L� ��
= Phone: 503.718.2439 Fax: 503.598.1960 Date Received: j
Inspection Line: 503.639.4175 Ai 2 7 2023
T IC,A R D Internet: www.tigard-or.gov By:
CITY OF TIGARD
FIRE ALARM ViLk-§TE ktARIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: COSTCO LOCKER RM/ MEZZ ADDITION Occupancy: A
Job Address: 7850 SW DARTMOUTH ST, TIGARD, OR 97223 Suite: N/A
Contractor: GB MANCHESTER INC Phone: 360-772-2244
Valuation of work: $13,991.00
Type of System: (check one) ❑■Required ❑Non-required
(check one) ❑Automatic [Manual ['Both
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added( 5) 0 /To be Relocated(.5) 0
Number of Proposed Manual Alarm Stations: To be Added(max 5) 0 /To be Relocated(max 5) 0
Number of Proposed Notification Appliances: To be Added( 5) 3 /To be Relocated(max 5) 0
I, NATHAN BUTZ Oregon Construction Contractors Board No. 202097
certify the following is true and defines the scope of work for this project:
a) All work complies with the current state-adopted NFPA-72 and the authority having jurisdiction.
b) All notification appliances are located in accordance with the current state-adopted NFPA-72.
c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having
jurisdiction.
d) Exposed wiring will not be covered until inspected.
e) Final approval shall be subject to on-site tests and inspections.
f) Voltage drop is adequate to operate all appliances.
g) Battery supplies are capable of supporting the system modifications.
h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications.
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.
• Electrical permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
ON �S,E-�som.0-GB MridieaM Yic,W.CO^Wmy,
Signature: Nathan Butz Dula 20,,.Buts
w2,M,,,�,00 Date: 4/25/2023
Print Name: NATHAN BUTZ
I:\Building\Forms\FireAlarmAfidavit 071514.docx Page 1 of 1