Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
X a B ' COMMUNITY DEVELOPMENT Permit #: FPS2010 -00033
L T [ G RHO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/09/2010
. at > l Parcel: 2S104BB07900
Jurisdiction: Tigard
Site address: 14300 SW BARROWS RD
Subdivision: RUSSELL'S SCHOLLS FERRY SUB Lot: 2
Project: Albertsons
Project Description: Add /alter (10) heads or less for TI. Have reflected ceiling plan on site for inspection showing
extent and location of work.
Owner: FEES
NEW ALBERTSON'S INC Description Date Amount
ATTN: 70428 - CORPORATE TAX, PO BOX 20,
Permit Fee COM 04/09/2010 $69.92
250 PARKCENTER BLVD 12% State Surcharge - Building 04/09/2010 $8.39
PHONE:
Contractor:
COSCO FIRE PROTECTION INC.
11800 NE 95TH ST., STE 240
VANCOUVER, WA 98682
PHONE: 360 - 883 -6383
FAX: 360 - 883 -6390
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
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: Cut Sheets Required:
Total $78.31
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 2500
Residential Square Footage: 0
Fire Alarm Valuation: 0
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
I (
Issued By: .�1 .� 1 CL 1(\). l f �� IJ , {� y� n n ^ Permittee Signature: ap�
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Call a.m. for an inspection that business day.
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.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard RECEIVED Date/ByReceived
. Permit No :� 52O16 —Q0033
lig
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C : • Phone: 503.639.4171 Fax: 5O3.8.
V " Date /By: Other Permit
Inspection Line: 503.639.4175H � Q 10 Date Ready/By: kris: ® See Page 2 for
TIGARD Notified/Method: Supplemental Information
Internet: www.tigard-or.gov OF TIGARD Ile'''.
il>tISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rotnded 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.
dwelling Valuation: $
❑ 1- and2 -famil
2-family g ® Commercial /industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 14300 SW Barrows Rd. New dwelling area: square feet
City /State /ZIP: Tigard, OR, 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Albertsons - 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.
Tax map /parcel no.: Indicate the value (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Add (2) Heads to New Starbucks Kiosk. Valuation: S!
Relocate (6) Heads in Meat/Fish Area. Existing building area square feet
Add (1) Head in Sales Lobby. Lower (1) Head in Customer Service Booth. 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:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be lensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: Cosco Fire Protection (Please refer ro fee schedule)
Permit fee:
Address: 11800 NE 95 St., Suite 240
State surcharge (12% of permit fee):
City /State /ZIP: Vancouver, WA, 98682 (40% FLS plan review (40% ofpermit fee):
Phone: (360) 883 -6383 Fax: (360) 883 -6390 (Due upon application.)
1 CCB lic.: 67508 1 I (' Total permit fees:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: Kevin Friesen Date: 4/6/10 within 180 days after it has been accepted as complete. .
* Fee methodology set by Tri- County Building Industry
Service Board.
1:\Building\Permits \FPS - PermitApp.doc 10/01/09 440- 4613T(11 /02 /COM/WEB)
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City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition (ZI 1 -10 heads: No plan review required.
® Alteration ❑ 11+ heads: Plan review required.
El Repair
Number of sprinkler heads: / 0
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes
Information: 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: $
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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
http: //w w.tigard- or.gov /city_hall /departments /cd /dots /PPS- PermitApp.doc 10/01/(22)