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Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT : COMMUNITY DEVELOPMENT Permit #: FPS2010 -00057 Date Issued: 05/21/2010 tiT I GAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S136 DC04500 Jurisdiction: Tigard Site address: 7501 SW DARTMOUTH ST 100 Subdivision: Lot: 0 Project: Winco Project Description: Relocating (2) sprinkler heads. Owner: FEES WINCO FOOD, LLC Description Date Amount ATTN: SUSAN BUSCHE, PO BOX 5756 BOISE, ID 83705 Permit Fee - COM 05/21/2010 $51.09 12% State Surcharge - Building 05/21/2010 $6.13 PHONE: Contractor: PHONE: FAX: Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Height: ft Stories: Commercial Sprinkler System: Sprinkler Required: Yes Sprinkler Type: Wet Standpipe Required: Hazard: Density: 0 Design Area: 0 K Factor: 0 Commercial Fire Alarm Svstem: Fire Alarm Required: Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $57.22 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: 300 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 o e rules or direct questions to OUNC by calling 503.246.6699 or 1.811 - - Issued By: Permittee Signature: Ca " 13.6175 by 7:00 a.m. for an inspection that business . 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 r en )` r' 4s, al 0 1 1 2 , 0I ()iNI "ji ;1,' ' h t,Y 4 '. +, , p • a ' 1 t °N,..i i Fire Protection System �� t b l y� i is Y ,, FAI I +4a Ott r a l ,'S, k .2 r J. i 1i ,„t.� i,1;b i d, Received City of Tigard © DateB : , f r Permit No.: 3-, lig 0, 13125 SW Hall Blvd., Tigard, OR ' r`\ - Plan Review P hone: 503.639.4171 Fax: 503. 1 ' .0 %� Date/B : Other Permit. h C $ v ; Y - o .it) I I t ; A IL Il Inspection Line: 503.639.4175 w^ y V �^--iL Date Ready/By: ® See Page 2 tor Internet: www.tigard- or.gov Os O � �w`` S� Notified/Method: Supplemental Information Q TYPE OF WO , , `�yG REQUIRED DATA: 1- AND 2- FAMILY DWELLING ' ❑ New construction ❑ I gy RE Q olition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all X Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1- and 2- family dwelling Commercial /industrial Valuation: $ ❑ 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: �] 50 ( is- /A) Pa.i,�-1 .‹nt.._ /E New dwelling area: square feet City /State /ZIP: ! Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: /Ai Vt C.- - t 1---',7- f t 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. R AS< 0-0_1)—t-,U (. 49 - --ik.(4,--e0-/) Valuation: $ 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: ❑ 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 licensed 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 ' PERMIT FEES* Business name: � `�, y�� (Please refer t o fee schedule </ Permit fee: Address: �, l ‘ . / L ' (PG=' c Cr o / � � State surcharge (12 /o of permit fee): City /State /ZIP: 0i- e L ; 1', ,„ ' f U 706,� o FLS plan review (40 /o of permit fee): Phone: (:5-0.3 - 7/ 0 _ 6 (�, 6- Fax: ( ) (Due upon application.) CCB lic.: // (:f' c o Total permit fees: Amount received: Authorized signature: �, c 9 This permit application expires if a permit is not obtained Print name: l � Date: - . 2 / —(O within 180 days after it has been accepted as complete. * Fee methodology set by Tri- County Building Industry Service Board. I:\Building\Permits\FPS- rmitApp.doc 10/01/09 440- 4613T(1I/02 /COM/WEB) City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Desc work to be, done: 1.) ❑ New 2.) Modification to sprinkler heads only: ❑ Addition ❑ 1 -10 heads: No plan review required. ❑ Alteration ❑ 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: 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 El Yes include: Individual Component El Yes Cut Sheets Fire Alarm Project Valuation: $ D.) .Residential.Sprinlder (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. L\ Building \ Permits \FPS- PemntApp.doc 10/01/09 2