Permit q CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
' COMMUNITY DEVELOPMENT Permit #: FPS2011 00048
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/12/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9591 SW WASHINGTON SQUARE RD B10
Project: Victoria's Secret Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Modification of approximately (150) sprinkler heads.
Contractor: HARVEY & PRICE CO Owner: PPR WASHINGTON SQUARE LLC
2015 NUGGET WAY 2235 FARADAY AVE STE #0
EUGENE, OR 97403 CARLSBAD, CA 92008
PHONE: 541 - 746 -1621 PHONE:
FAX: 541 - 746 -8729
FEES
Description Date Amount
Specifics: Permit Fee - COM 04/12/2011 $220.56
12% State Surcharge - Building 04/12/2011 $26.47
Type of Use: COM Plan Review - Fire Life Safety - COM 04/12/2011 $88.22
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg Sheet (over 04/12/2011 $2.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm Sheet (up to 04/12/2011 $15.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
Density: 0 Design Area: 0
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 $352.25
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $13,440.00
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, o 's suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility . ification Cente . T. - les are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules
or dir= t questions to OUN '.y cal ' g 503.232.1987 or 1.800.332.2344.
I r
Iss ed By: • �, Permittee Sig ature:
_ p t' l
Call 503.639.4175 by 7:00 a.m. for the next available insp • ion 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.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
D CEIVED Received t,
City o f Tigard DateB : Penult No.. t7 � g'
a 13125 SW Hall B lvd., Tigard, 972 { Plan Review F�s� // - �
• ` Phone: 503.718.2439 Fax: 503.598.1960 LU 1 Date/B : - .,- y. � Other Permit:
TIGARD
Ins Line: 503.639 Date Ready/By: Juris H See Page 2 for
Internet: www.tigard- or. goriTy OF TIGARD Notified/Method: 5 /A a ( Supplemental Information
TYPE OF WORK 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.
❑ 1- and 2- family dwelling Commercial /industrial Valuation: $
❑ Accessory building III Multi-family Number of bedrooms:
❑ Master builder 111 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: q 3 1 !, J, 5 e . 124> i� New dwelling area: square feet
City /State /ZIP: 11 /Q 2 / 4- (, 77-Z1 Garage /carport area: square feet
Suite/bldg. /apt. no.: B /0 Project name: V c roiiA 5g,' i? -r Covered porch area square feet
Cross street/directions to job site:(,,. pk 6 Es/Oa. w i -I To m Deck area: square feet
. IAA u_ Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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.
DL 7E eX /-5774 l-r Fa SfiWi/IJk Valuation: $ J 3t 0
J ^c,4 -i ems, //1)37:411- P S Existing building area square feet
AS
1 , 'd j, New building area: square feet
El PROPERTY OWNER TENANT Number of stories:
Name: L I o rfED - (24,4yv D3 Type of construction:
Address: --m 1 I m i rep P14146.tcoy Occupancy groups:
City /State /ZIP: ee?L()/H Ig r 5/ p H/ 0 4 3 2 3 o Existing:
Phone: ((: 14)415, _: Fax: ��� 7/ '�� F , 4i6; 1?4 New:
%APPLICANT CONTACT PERS N NOTICE
Business name: 4 d1 r /Le A ( All contractors and subcontractors are required to be
Contact name: j 5 T 11 %J 1 fat t-� ( �� licensed with the Oregon Construction Contractors Board
'� under ORS 701 and may be required to be Icensed in the
Address: jo jg ,(,/ -T iv / 4/ jurisdiction in which work is being performed. If the
� 97')EAvi. / q 77t-D3 .t j50I 5.5.--2.4,0 , applY ant is exempt from licensing, the following reasons
City /State /ZIP: / 7
Phone: ( S T 14 Gt [t 7j* I Fax:: (Q-1 ) 1 Gt 07 ZA
—
E -mail: .J WO fie1275 vey ivb P,P/cE, Crm -1
CONTRACTOR BUILDING PERMIT FEES*
Business name: !-// T poic (Please refer to fee Permit '' 7 Permit fee:
Address: Z- o /SA/)6(,CT' 1.4.A/ State surcharge (12% of permit fee):
City /State /ZIP: 8 1/ � /v�1 '' 7123 —
' 7 A `, ) / Z i FLS plan review (40% a
ofpermit fee):
Phone: (�jsf ) � 1 . Fax: ( I) � , 87 (Due e upon application.) Ac
CCB lie.: 0 o - 7 7 iclii 11 Total permit fees: It s ,A ' '
C
Authorized signature: Amount received: e55�. -5
This permit application expires if a permit is not obtained
Print name: J �. Date: within 180 days after it has been accepted as complete.
i S o7� 'f� �1 * Fee methodology set by Tri -County Building Industry
Service Board.
is \ Building \Permits\FPS- PermitApp.doc 02/01/11 440- 4613 T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
El Addition ❑ 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 ❑ 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.
C:\ Users \jroberts \AppData \Local \Temp \FPS - PermitApp.doc 02/01/11 2
HARVLY LETTER OF TRANSMITTAL
P.O. Box 1910 qP V�D 07- Apr -11
2015 Nugget Way R 1 2 ATTENTION
Eugene, Oregon C 2 Oii PLAN REVIEWER
UI LDINCD I In FIRE SPRINKLER PLANS FOR VICTORIA'S SECRET
TO: CITY OF TIGARD I ON AT WASHINGTON SQUARE MALL.
13125 SW HALL BLVD.
TIGARD, OR 97223
WE ARE SENDING YOU: ❑ Attached ❑ Under separate cover via the following items:
❑ Shop Drawings ❑ Prints 0 Plans ['Samples ❑ Spedfications
❑ Copy of Letter ❑ Change Order 0 PRODUCT SUBMITTALS
COPIES DATE NO. DESCRIPTION
2 07- Apr -11 PRODUCT SUBMITTAL
4 07- Apr -11 FIRE SPRINKLER PLAN
THESE ARE TRANSMITTED as checked below:
For approval ❑ Approved as submitted ❑ Resubmit copies for approval
El For your use ❑ Approved as noted ❑ Submit copies for distribution
❑ As requested ❑ Returned for corrections El Return 2 corrected prints
El For review and comment ❑
❑ FOR BIDS DUE: ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS:
INCLUDED WITH THIS LETTER OF TRANSMITTAL ARE 2 PRODUCT SUBMITTAL AND 5 SETS OF PLANS.
PLEASE RETURN TWO COPIES AT YOUR EARLIEST CONVENIENCE.
THANK YOU,
ELIJAH FINN
COPY TO FILE SIGNED:
If enclosures are not as noted, kindly notify us at once.
P.O. Box 1910 - 2015 Nugget Way Eugene, Oregon 97440 Ph 541 - 746 -1621 Fax 541- 746 -8729