Permit •
CITY TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00372
� :�i�4 DEVE RVIICES - 639 - 4171 DATE ISSUED: 8/12/2005
PARCEL: 1 S 134AA -01900
SITE ADDRESS: 10105 SW NIMBUS AVE ZONING: C -G
SUBDIVISION: 1 KOLL BUSINESS CENTER TIGARD LOT: 001 JURISDICTION: TIG
Project Description: Installation of hood suppression system.
REISSUE: � j FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: F FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 2,278.00
Owner: Contractor:
ROBINSON, WILLIAM R/CONSTANCE A LAING INVESTMENTS,INC.
ROBINSON, LYNN + BELL, KAY ET 3357 SE 21ST AVE
BY ELLIOTT ASSOC DBA: NATIONAL FIRE FIGHTER
PORTLAND, OR 97204 PORTLAND, OR 97202
Phone: Phone: 503 - 323 - 6646
Reg #:
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 8/4/2005 $72.10
[TAX] 8% State Surcha 8/4/2005 $5.77
[FLS] FLS Pln Rv 8/4/2005 $28.84
Total $106.71
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 than 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 these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: `22,512 Permittee Signature: ��
Call 503 - 639 -4175 by 7:00 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.
/o /kS S� O/m;cd .
Building Permit A licatio
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a °"'t'+? 1 ���'" Cit of Tigard V � Date received: 3p Permit no.'�,t�, j�����
_ _ � :` _ , Project/appl. no.: 1 Expire date:
CiryofTigard Address: 13125 SW Hall Blvd OR 97223
Phone: (503) 639 -4171 Vt w Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
®� T - i S O 1 &2 family: Simple Complex: ,/
Land use approval: r.�I`l _ .�.n11S
, .. "1 -, TYPE OF PFRM17 .. }
❑ 1 & 2 family dwelling or accessory commercial /industrial ❑ Multi- family Cl New construction CI Demolition
1:3 Addition/alteration/replacement Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
1 , , :'; 9 i ', ' , t JOB SITE INFORMATION-- TION- y xwH ' ': r
Job address: r (v\ rt at_ I] A( • . ,..„ Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: b I , 0 -
Description and location i work on premi /special conditions: c • [1> d\ ■L!!� In es
_ A t_hI)♦
1 OWNER A ' ° FOR SPECIAL INFORMATION, USE,CIILCKLIST
Name: . ; (Floodplain septrc'capacity' solar etc.) -
Mailing a. s ress: 1 & 2 family dwelling:
City: State: ZIP: Valuation of work $
Phone: Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
' - .APPLICANT - Garage /carport area (sq. ft.)
f f r . . - a • .. vered porch area (sq. ft.)
at Mailing address: `� —ti 1 L Deck area (sq. ft.)
Vi! ir�,T61'T ZIPS • - '111 Other structure area (sq. ft.)
Mr►; Commercial/industriallmulti- family:
Phone: . a ; . •�, �rtr.`�..s►
i CON7 Valuation of work $ ?9
Existing bldg. area (sq. ft.)
t I _ L/ _ New bldg. area (sq. ft.)
Address: - 5:.. �_ t V , , °�A
� � ��/ �� Number of stories
�WARIM 1 IIEM �IEZIra Type of construction
Phone:, � „ Rusemin E -mail:
Occupancy group(s): Existing:
CCB no.: r New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCJII l L(T /1)1 SIGNER _ _ licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
I N6INI l.li'
Name: Contact person: Fees due upon application $ & _,
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied 'th, whether specified herein o of. Credit card number: / /
Expires
Authorized signA e ` � /J Dat Name of cardholder as shown on credit card
Print name: -I 5 . 7 t £ Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6ro0icoM)
E_ P: Y 4 . �.l
Fire Protection Permit Check List
A.) ❑ New ❑ Addition ❑ Alteration ❑ Repair
B.) Modification to sprinkler heads only:
Describe work to 1. 1 -10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required.
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B or C as applicable):
A.) Sprinkler Wet ❑ Dry Li
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation $ a cY1" ,5
C.) Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A, B & C): $
Permit fee based on valuation (see chart): $
8% State Surcharge: $
FLS Plan Review 40% of Permit: $
TOTAL: $
Plan review requires a completed application and 3 sets of plans at submittal.
Plan review fees are required at submittal.
"New" fire protection systems require that plans bear the original seal of an Oregon
licensed fire suppression engineer, or NICET level "3" technicians.
is \dsts \forms \FPSchecklist.doc 11/21/01
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August 10, 2005 c=!''i u
CIW OF TIGARD
OREGON
National Fire Fighter
3357 SE 21 Ave
Portland, OR 97223
RE: R -102 FIRE SUPPRESSION SYSTEM FOR TYPE ONE HOOD
Project Information
Building Permit: BUP2005 -00372 Construction Type:5 -B
Tenant Name: Burger King Occupancy Type: B
Address: 10105 SW Nimbus Occupant Load: NA
Area: NA Stories: 1
The plan review was performed under the State of Oregon Mechanical Specialty Code
(OMSC) 2002 edition; Oregon Structural Specialty Code (OSSC) 2004 edition; and the
Tualatin Valley Fire & Rescue 2003 edition. The submitted plans are approved subject to the
following conditions.
1. The automatic fire suppression system shall be of a type recognized for protection of
commercial cooking appliance and exhaust systems of the type and arrangement protected.
Pre- engineered automatic dry- and wet - chemical fire suppression system shall be tested in
accordance with UL 300. Automatic fire suppression systems, including pre- engineered
and engineered dry- and wet - chemical fire - suppression systems, shall be listed and labeled
for specific use as protection for commercial cooking operations and shall be installed in
accordance with Section 304.1. Automatic fire suppression systems of the following types
shall be installed in accordance with the referenced standard indicated:
1. Carbon - dioxide extinguishing system, NFPA 12.
2. Automatic sprinkler system, NFPA 13.
3. Foam -water sprinkler system or foam -water spray systems, NFPA 16.
4. Dry- chemical extinguishing systems, NFPA 17.
5. Wet - chemical extinguishing systems, NFPA 17A. OMSC 509.2
2. Equipment and appliances shall be installed as required by the terms of their approval, in
accordance with the conditions of the listing, the manufacturer's installation instructions
and this code. Manufacturer's installation instructions shall be available on the job site at
the time of inspection. OMSC 304.1
3. Each automatic fire suppression system shall have both automatic and manual actuation
means. A manual actuation device shall be located at or near a means of egress from the
cooking area, a minimum of 10 feet and a maximum of 20 feet from the kitchen exhaust
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
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system. The manual actuation device shall be located a minimum of 4 feet 6 inches and a
maximum of 5 feet above the floor. The manual actuation shall require a maximum force
of 40 pounds and a maximum movement of 14 inches to actuate the fire suppression
system.
Exception: Automatic sprinkler systems shall not be required to be equipped with manual
actuation means. 509.3 System actuation.
4. The actuation of the automatic fire suppression system shall automatically shut down the
fuel or electrical power supply to the cooking appliances. The fuel and electrical power
supply reset shall be manual. 509.4 System interconnection.
5. The automatic fire suppression system shall be acceptance- tested in accordance with the
Fire Code and installation standard listed in Section 509.3, and with the manufacturer's
instructions. 509.5 System test and inspection.
Approved Plans: 1 set of approved plans, bearing the City of Tigard approval stamp, shall
be maintained on the jobsite. The plans shall be available to the Building Division inspectors
throughout all phases of construction. 106.4.2 OSSC
Premises Identification: Approved numbers or addresses shall be provided for all new
buildings in such a position as to be plainly visible and legible from the street or road
fronting the property.
When submitting revised drawings or additional information, please attach a copy of the
enclosed City of Tigard, Letter of Transmittal. The letter of transmittal assists the City of
Tigard in tracking and processing the documents.
Respect
al Henzel,
Senior Plans Examiner
CITY OF TIGARD C _,14C?,a 6031 -
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639- 4171Ai '
Inspection Requests (24 Hrs.): (503) 639 -4175 .' °1 I I..
INSPECTION WORKSHEET FOR DATE: v/ `'l / / TIME: PAGE:
SITE ADDRESS: 1 b 1 6 1 tnn L7t4 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GIA/2., K�� k
DESCRIPTION: S
OWNER: 4) li 'V' L-rt ► W 7 \ ` L PHONE #:
CONTRACTOR: 1 lN� & v � S . ir . v _ ,¢ PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
(q,i)
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C orrections /Comments/ Instructions:
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• , SS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: �` Dat / '� / ° P hone #: (503) 718- 2q2_--(
08/14/2007 10:10 FAX 5032327198 CARBON DIOXIDE 21002
— Kitchen Exhaust Hood Fire Suppression System Service Report —
r.r� CCB# 143295
2 - Ss- tionri® FIGHTER
3357 SE 21st Ave. • Portland, OR 97202 • 503- 232 -6646 • 1- 800 - 999 -0913
CUSTOMER NAME OvR 16,04 5Z8 Z DATE _., /D7
ADDRESS /0 / >S sW ili /NOUS / i4i4RD 9722 TIME �3 M M
pp 3 - $RO1 L� El Dry Chemical
SYSTEM MFG.:_ i S LI L CYLINDER SIZE: - R E $Wet Chemical
MODEL R - .,i 02 CONTROL HEAD: System Appears to meet
UL -300 Standards
DETECTION
✓Manual pull stat:i on tested dependent of detection ❑ In -line ❑ End of line
Tested good (tenninal link cut)
fusible links replaced / X '/SC) .(..7 Ntl' , bA--r b X 01 (fiQa i Lf R.
✓Quartzoid links ::leaned _ C EX ER')
Conduit & pipit g properly secured
FIRE ALARM
- 1J0 Building fire alar.n in place
*A System tied into building fire alarm _
NOZZLES ,
s Duct & plenurn .overed w /correct nozzles
_/ _ positioned over all appliances w /correct nozzles
Covers /seals in !dace, clear of obstructions ,( 5 ) Caps /seals replaced this service
FUE; SHUT -OFF
V Gas valve world' g properly ❑ Mechanical $lenoid (0 Reset relay working properly) El Pneumatic
V.--Electrical shut -o if working properly
✓Reset breakers_. HOOD SIZE
t Re -lit pilot light,
COOKING APPLIANCES (Left to Right)
AGENT CYLINDER'!;
Jo /A Pressure gauge in operable range: Description Size Gas ec.
6 ✓ / Cartridge type: Cartridge weight /pressure verified I) )/6ie.S , 3 —1/47 ' //IX V 4 ❑
._ f ilm_ 1 41 2) �R �s 2 " �4rS / f x2./ 4, X El
..71
of last6 yr. 1 naintenance '
Date of last 12 yr, Hydrotest c - 3 ) ; • - C . - , ► 2 ) ( 2 ❑
Piping i& condu.i : securely bracketed 4) _ _ -
❑ ❑
_ & remote set/seals in place 5) ❑ ❑
j/ System operational and seals in place
APPLIANCES 6) ❑ ❑
✓ Proper separation in between fryers & flame 7) ❑ ❑
✓ Proper clearance from flame to filters 8) ❑ ❑
✓ Exhaust fan operating _ 9) ❑ ❑
J‹ filters in plac
t No class "A" mat trials under hood 10) ❑ ❑
CONDITIONS OF hI DOD Very Clean ❑ ❑ IBI ❑ Extremely Greasy C5/,,-0
PORTABLEEXTIN(UISHERS B ROILER float) sus sTtc[- yREAse 61_013S
( E R 5 i ft) R C 4 O t l e B /MA
✓Hand portable e: ainguisher of proper mounted on walls Glass "K" ❑ Other
y'Reyuired service performed 0 7
The above system has heen tested & inspected in accordance with manufactures specifications & is found to comply with all
current fire codes except the following:
A.
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Sconce hnititrn ate ` Customer Signature
CITY OF TICAR® . . 6V(f7AOS 063'1
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 /i:a
Inspection Requests (24 Hrs.): (503) 639 -4175 ... `' I
INSPECTION WORKSHEET FOR DATE: W51 TIME: PAGE:
SITE ADDRESS: 1616 S C 7 \kJ ki , #y\ (01AS r - CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: —c 2_% ' �v.
DESCRIPTION: (L I OWNER: 6
M) \v " k ` 1 PHONE #: f
CONTRACTOR: !�4 l \ � Q,S 1 r PHONE #: 5 2 ° L a ( . '
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
-0 # . Inspection L z - T v, ( e 0
qci c P r `. t i Lt` Lt l.,,. 5 , `, e r e s‹ L.,,,` CtiC .
Corrections /Comments Instructions: //
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n PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
in FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Vr; (j Date: ‘ 3 / 6 ? Phone #: (503) 718-
CITY OF , . N
B1 DING DIVISION PERMIT #:
13125'SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ' ; i'
Inspection Requests (24 Hrs.): (503) 639 -4175 °�I ..
INSPECTION WORKSHEET FOR DATE: 10 13 I /6 ( TIME: PAGE:
SITE ADDRESS: I U I 0 6 N CM S CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: `� i
OWNER: I Q Y l N)36 ) r III lii VA, PHONE #:
CONTRACTOR: L A 6 / - 1,1 ` f Q m e 4 yc , ri.s1 L PHONE #: 3 j2 — ( (l.4' Ip
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message .
�'► I 0 3 Pev►nIL1 1� � k - 40 d �l� P P e,�5, oYl
9A ei .) 21 n It-1 (/'NS k t. ✓VL- -
Corrections omments /Instructions:
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cAyyl c>tae. ‘)'-( 5
�1 A : L lirui S eQ__(z. wv <I nctL ( .fix C‘e,c U.) AA/A
ID- wd e I 7a- `'k- s i e N 0 -f its +
vy.v\ A (/\(\ 4 Pz.c2 . ( His LVO fi, '5.
n PASS n PARTIAL APPROVAL U CANCEL n NO ACCESS
X FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: (i Date: ` M ` 6 `� Phone #: (503) 718- 2Lt2Lli