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Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT COMMUNITY DEVELOPMENT Permit #: FPS2011 -00103 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08!16/2011 Parcel: 2S110DCO2200 Jurisdiction: Tigard Site address: 15570 SW PACIFIC HWY Project: Safeway Subdivision: 1997 -016 PARTITION PLAT Lot: 2 Project Description: Modification of (6) fire sprinkler heads for pharmacy remodel. Contractor: DELTA FIRE INC Owner: TRC MM LLC 14795 SW 72ND AVE 5973 AVENIDA ENCINAS STE 300 PORTLAND, OR 97224 CARLSBAD, CA 92008 PHONE: 503 - 620 -4020 PHONE: FAX: 503 - 620 -1058 FEES Description Date Amount Specifics: Permit Fee - COM 08/16/2011 $112.96 12% State Surcharge - Building 08/16/2011 $13.56 Type of Use: COM Plan Review - Fire Life Safety - COM 08/16/2011 $45.18 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 $171.70 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $4,000.00 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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility N • a ion er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtai a copy of the rules or dire questions to OUNC by - g 03.232.1987 or 1.800.332.2344. Issue By: / 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. Building Permit Application Fire Protection System FOR OFFICE USE ONLY City of Ti Received h' Tigard Date /By • a //(Q // / Permit 130.: /G��/';�I OQ a / 03 • 13125 SW Hall Blvd., Tigard,OR 97223 Plan Revew - - Phone: 503.639.4171 Fax: 503.598.1960 Datei v: Other Permit: 4u,o?pl/ -06/ • TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for Internet: ww'w.tigard- or gov Notified/Method: Supplemental Information TYPE OF WORK : REQUIRED D&TA 1 AND 2 F IILY 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 Y � CATEGORY OF CONSTRUCTION work indicated on this application. ❑ I- and 2- family dwelling XCommerciallindustrial Valuation: S ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION , LOCATION - Total number of floors: Job site address: t GJ C� �,� 'Ycc' c New dwelling area: square feet City /State /ZIP: T f © � Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area square f �� P q e I Cross street/directions to job site: 24 n ` Deck area: square feet I 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 • n S ` work indicated on this application. 00 e eA0C � ( In _ .fit _k CPC - PinPe� Valuation: S ^I OW �'+� 1 C/��i ll/ j[XS 1k� �l) /1 I C OQ e ryy� e hr ' e � y V c e n ( Existing building area square feet WL�� 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: 11)e kr fire- in Ch All contractors and subcontractors are required to be Contact name: u �o * �+ r Y(� 1 �e, licensed with the Oregon Construction Contractors Board R co V under ORS 701 and may be required to be lensed in the Address: 11.4 �a Z 3(J 7a �� e, jurisdiction in which work is being performed. If the City/State /ZIP: t� ©t' -t_krx nc� o� 5 6' aq applicant is exempt from licensing, the following reasons / r 1 6 apply: - Phone: (5 i i 0 - `7, , 0 Fax: : ( `50 i . r E -mail: pia, .5@ • 1 W n tel _ `� - v � CONTRACTOR • BUILDI iG,PERM1T FEES* - Pledse a ,,. 'ich ) Business name: .� f n� " ( le�io�ee 'sche l 4 c r �+ ' f 'n /� Permit fee: Addre """�� <, c � ( �.1 !� ./`�C��e,e State surcharge (12% of permit fee): City /State /ZIP:'Qrl.(i,, il r,� . v � v v v �� FLS plan review d o ap a fee): Phone: (' a0 - rO� Fax: /Due e upon n appliclic CCB lic.: C y4 1744 Total permit fees: V/ + Authorized signature: ni Amount received: ,(,(/ This permit application expires if a permit is not obtained Print name: He /��` P« - �-„ � tV 1 Dat . 5/ \ within 180 days after it has been accepted as complete. V4 vas -� v ,l U `(yvt�w ` J J/( / ,1 U` * Fee methodology set by Tri- County Building industry Service Board. C\BuildingTermiu \FPS- PermitApp.doc 03!23/06 440- 4613T(1 i102 /CON/WEB) City of-Tigard: Fire Protection Permit Checklist Page 2 = Supplemental Information Describe work.to be done: 1.) ❑ New 2.) M6difcation to sprinkler heads only: ' ku .7-i] u uv1, � r 1 1 n 1_ J . : NT 1 • 1 1 -1 .. DV u nexus. �vo p ian review requireu. K'\iteration ❑ 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: Additional description of work: • - Type. of System (Complete. A, 1.3,..c or.i) as applicable): A.) Commercial Sprinkler ❑ Wet ❑ Dry • Additional Standpipes Information: Hazard Group Density Desig -n Area • r K. Factor Sprinkler Project Valuation: $ G, , 0 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 $187.50 2,001 to 3,600 I $232.50 • 3,601 to 7,200 $292.50 . 7,201 and greater $381.50 • . Sprinkler Project Square Footage: 1 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): I $ 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. "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or \ICET level "3" technicians. \Buildin Permits \ FPS- PemuLApp.doc 2