Permit A CITY OF TIGARD
DEVELOPMENT SERVICES BUILDING PERMIT
�!+L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # BUP98 -0473
DATE ISSUED: 11/10/98
PARCEL: 2S1O2CB -02500
SITE ADDRESS...: 13090 SW PACIFIC HWY
SUBDIVIS]ON • FREWINGS ORCHARD TRACTS ZONING:C -G
BLOCK • LOT •007 JURISDICTION:TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION -
CLASS OF WORK.:FPS FIRST • 0 sf N: S: E: W:
TYPE OF USE...:COM SECOND...: 0 sf PROTECT OPENINGS?
TYPE OF CONST.:5N ..•• 0 sf N: S: E: W:
OCCUPANCY GRP.:A3 TOTAL . 0 sf ROOF CONST: FIRE RET ?:
OCCUPANCY LOAD: 0 BASEMENT.: 0 sf AREA SEP. RATED:
STOR.: 0 HT: 0 ft GARAGE...: 0 sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REDD SETBACKS REQUIRED
FLOOR LOAD • 0 psf LEFT: 0 ft RGHT: 0 ft FIR SPKL:Y SMOK DET..:
DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM: HNDICP ACC:
BEDRMS: 0 BATHS: 0 IMP SURFACE: 0 PRO CORR: PARKING: 0
VALUE. $ : 2000
Remarks : Installation of a hood sprinkler system
Owner: FEES
FOODMAKER, INC. type amount by date recpt
4500 KRUSE'WAY PRMT $ 32.50 GEO 11/10/98 98- 310698
SUITE 270 5PCT $ 1.63 GEO 11/10/98 98- 310698
LAKE OSWEGO OR 97035 FIRE $ 13.00 GEO 11/10/98 98- 310698
Phone #: 503- 636 -4785
Contract or:
HUSER SALES & SERVICE INC
1313 NW 17TH AVE
PORTLAND OR 97209
Phone #: 503- 227 -6688 $ 47.13 TOTAL
Reg #..: 116821
-- REQUIRED ACTIONS or INSPECTIONS--- -
This permit is issued subject to the regulations contained in the Sprinkler Rough -
Tigard Municipal Code, State of Ore. Specialty Codes and all other Sprinkler Final
applicable laws. 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 sore
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 -010 through OAR 952 - 00101987.
You many obtain a copy of these rules or direct questions to OUNC
by calling (503)246 -1987.
Permittee Signature: Issued B
,/-
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + +++ + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + ++
_ °•_ • - -
• ti
Fire Protection Permit Application Plan Check# —# C
CITY OF TIGARD Commercial or Residential Rec'd By
13125 SW HALL BLVD. Date Rec'd /D
TIGARD, OR 97223 Print or Type Date to P.E. 1 /
(503) 639 - 4171, x. 304 Incomplete or illegible applications will not be accepted Date to DST i/ 8
Permit #13aF9P — V7$ •
8 IA, P.7cp" D3 7.2.y �� Called /yam /..579,•P AV'
•
Job Narpe of Development/Project Type of System (Complete A or B as applicable)
Address Address A.) Sprinkler Wet ❑ Dry ❑
13.d 90 Sa) / . t4uV J 1 Na e Standpipes
t)d4D fpfnce R
Owner Mailing Address Hazard Group
&4 50 co wit u 3 O/ J Additional .
•
City/State Zip ?horg .- Information Density
LIT lc P. 6 1/4•()k ? 0 70,P
Name Design Area
J c k 111 114-x, � C
Occupant Mailing Address K. Factor
City/State Zip 1 I Phone A.1) Sprinkler Project Valuation $ dy CtO
',
Contractor Name B.) Fire Alarm
(Sprinkler or - +4106R . .it , � Q �4
Alarm Company) Mailing Address n Submittal Shall Include Battery Calculations YES ❑
._
Prior to permit 1 I IN �J 1 1
issuance, a City/State Zip Phone Individual Component YES ❑
copy y Cut Sheets
of all licenses 9 L. `4'Z 1 99 .B.1) Fire Alarm Project Valuation $
are required if tate Const. Cont. Boar Lic.# Exp. Date
expired
foo a in COT ( S Le w z,) ,
�i Project Valuation Subtotal (A & or B) $
database
Name Permit fee based on valuation
(see chart on back)
Architect Mailing Address 5% Surcharge $ 3
City/State Zip Phone FLS Plan Review 40% of Permit $
/3. el)
Describe work A.) New Addition 0 Alteration 0 Repair 0 TOTAL $
to be done: y 7 , /3
B.) Modification to sprinkler heads only: Plans required: Submit three sets of plans, including a vicinity map and
1. 1 -10 heads= No plans required the location of the nearest hydrant.
2. 11 += Plan review required y
I hereby acknowledge that I have read this application, that the information given is
-
Number of sprinkler heads: correct. that I am the owner or authorized agent of the owner, and that plans submitted
are in compliance with Oregon State laws.
Additional Description of Work:
S ature of Own gent Date
A.) In Existing Building 0 New Building p " 2
Building tact Person Name �} Phone
Data B.) Commercial b� Residential 0 ;�e4� �`if� a � � 19 �
(1 FOR OFFICE USE ONLY:
No. of stories: Plat # Map/TL #:
Sq. Ft:
as /o2C8 - a i
Notes
•
Occupancy Class Type of Construction
/
is \firesupr.doc
4t
CITY OF TIGARD
BUILDING PERMIT FEES
TOTAL
STATE BUILDING
VALUATION OF PERMIT F.L.S. TAX PERMIT
PROJECT FEES (40 %) (5 %) FEES
1 -1500 25.00 10.00 1.25 36.25
1,501-1600 26.50 10.60 1.33 38.43
1,601 -1,700 28 :00 _ 11.20 1.40 40.60
1,701-1,800 29.50 11.80 1.48 42.78
1,801 -1,900 31.00 12.40 1.55 44.95
1,901-2,000 32.50 13.00 1.63 47.13
2,001-3,000 38.50 15.40 1.93 55.83
3,001 - 4,000 44.50 17.80 2.23 64.53
s 4,001 -5,000 50.50 20.20 2.53 73.23
5,001 -6,000 56.50 22.60 2.83 81.93
6,001 -7,000 62.50 25.00 3.13 90.63
7,001 -8,000 68.50 27.40 3.43 99.33
8,001 -9,000 74.50 29.80 3.73 108.03
9,001- 10,000 80.50 32.20. 4.03 116.73
10,001- 11,000 86.50 34.60 4.33 125.43
11,001-12,000 92.50 37.00 4.63 134.13
12,001- 13,000 98.50 39.40 4.93 142.83
13,001- 14,000 104.50 41.80 5.23 151.53
14, 001-15,000 110.50 44.20 5.53 160.23
15,001- 16,000 116.50 46.60 5.83 168.93
16,001- 17,000 122.50 49.00 6.13 177.63
17,001- 18,000 128.50 51.40 6.43 186.33
18,001- 19,000 134.50 53.80 6.73 195.73
19,001-20,000 140.50 56.20 7.03 203.73
20,001- 21,000 146.50 58.60 7.33 212.43
21,001-22,000 152.50 61.00 7.63 221.13
22,001-23,000 158.50 63.40 7.93 229.83
23,001- 24,000 164.50 65.80 8.23 238.53
24,001-25,000 170.50 68.20 8.53 247.23
25,001- 26,000 175.00 70.00 8.75 253.75
26,001- 27,000 179.50 71.80 8.98 260.28
27,001 - 28,000 184.00 73.60 9.20 266.80
28,001-29,000 188.50 75.40 9.43 273.33
29,001-30,000 193.00 77.20 9.65 279.85
30,001-31,000 197.50 79.00 9.88 286.38
31,001-32,000 202.00 80.80 10.10 292.90
32,001- 33,000 206.50 82.60 10.33 299.43
33,001- 34,000 211.00 84.40 10.55 305.95
34,001-35,000 215.50 86.20 10.78 312.48
•
35,001-36,000 220.00 88.00 11.00 319.00
36,001- 37,000 224.50 89.80 11.23 325.53
37,001-38,000 229.00 91.60 11.45 332.05
' firesupr.doc
c i ,,. o m' J. U 2• • t 1.h '- 1 MI, w. -.. ........ _._.. . . .
,2x-98 02 :28 PM F I REMASTER C � 9D - a611/73253 +383 +3807 P. 03
DISTRIBUTOR CERTIFICATION
INSTALLATION NAME: Jack in t11e Box # 7127 RESTAURANT FIRE SUPPRESSION SYSTEM
_
ADDRESS: 13090•SW&lific Hyvy.
Tigard, OR 97223
SYSTEM DESCRIPTION: 3.0 GALLQNS MODEL: R102
SERIAL NUMBER(S) .
NOZZLES USED:
QTY. P/N - MODEL QTY. P/N - MODEL QTY. P/N - MODEL
I IN 1 2W _2 2120 --
QTY OF DETECTORS: ONE LINK TEMPERATURE RATING 500
ENERGY SHUT OFF DEVICES: Gas Valve 1.25" Mechanical - Electric - Shunt Trip - Contactor
ACCESSORY EQUIPMENT PROVIDED :
PULL STATION DPDT MICRO SWITCH
COOKING VENTILATING EQUIPMENT INFORMATION:
DUCT 1 SIZE 15* 12" DUCT 2 SIZE DUCT 3 SIZE HOOD # I
DUCT I SIZE DUCT 2 SIZE DUCT 3 SIZE HOOD # 2
DUCT 1 SIZE DUCT 2 SIZE DUCT 3 SIZE HOOD 113
HOOD 1 SIZE 6'4" HOOD 2 SIZE HOOD 3 SIZE
COOKING APPLIANCES AND SIZE OF COOKING SURFACE. LIST APPLIANCES FROM LEFT TO RIGHT AND
. = INDICATE THOSE BEING PROTECTED.
1. GRIDDLE SIZE 72 *30" 4. SIZE
2 _ SIZE S. SIZE ,,__
3 SIZE 6. SIZE
TO BE COMPLETED BY INSTALLER:
CIRCLE ANSWER to the following statement. YES NO
The fire suppression system is installed in accordance with they marutfitcturc's instructions, NF•I'A standard 96 and 17
current issues and all applicable state and local codes. Exceptions to other provisions of WA 96 that were observed
are noted below:
Al.!. E'LECTRIC'AL WORK 01? WORK PROVIDED BY OTHERS TO COMPLETE ME INSTALLATION HAS BEEN
COMPLETED. ; •; : • :: • :
INSTALLERS NAME _ SIGNATURE _ - - • . .
DISTRIBUTOR: Tat . m rvi nt # lbl ADDRESS 505 Puya1Iup,Avenuk " • •■• •:• •
_ • PHONE: 1- 253 -3_$5-3804 Ta ama . WA 98421
DATE: •
TO BE COMPLETED BY CUSTOMER: _: `• •: �•�IV2). •
CIRCLE ANSWER to the following statement }_.'� S• : • •
I have received a copy o. f the automatic fire suppression systems' MFRS MANUAL.
I tt nderst p►ti l t is 1 ' • •
recommendation of the NI'TA standard 96 & 17 that the fire suppression system be jpec•ted and maintained every six
. . teisysteR4i7
• • • • • •
months to ensure E� ficiency and reliability anal that failure to do so may' result in faEli e of o p; r ate
•• •
properly. DATE:
L..._ �LL�MC_ B�TCTLt.
•
DISTRIBUTOR CERTIFICATION
. RESTAURANT FIRE SUPPRESSION SYSTEM
INSTALLATION NAME: lack in the Box # 7127
ADDRESS: 13090 -SW Pacific Hwy. _•
Tigard, OR 97223
SYSTEM DESCRIPTION: 4.5 Q9LLONS MODEL: R102
SERIAL NUMBER(S)
NOZZLES USED:
QTY. P/N - MODEL QTY. P/N - MODEL QTY. P/N - MODEL
2 IN 1 2W 4 _230
QTY OF DETECTORS: THREE LINK TEMPERATURE RATING
ENERGY SHUT OFF DEVICES: Gas Valve 125" Mechanical - Electric. - Shunt Trip - Contactor
ACCESSORY EQUIPMENT PROVIDED :
.P111LLE ATI O N P.LMLQR.Q .WIT.CH
•
COOKING VENTILATING EQUIPMENT INFORMATION:
DUCT I SIZE 15 *12" DUCT 2 SIZE DUCT 3 SIZE HOOD # 1
DUCT I SIZE DUCT 2 SIZE DUCT 3 SIZE HOOD # 2
DUCT I SIZE . _ DUCT 2 SIZE , _ DUCT 3 SIZE HOOD # 3
HOOD 1 SIZE - 8'7" HOOD 2 SIZE HOOD 3 SIZE
COOKING APPLIANCES AND SIZE OF COOKING SURFACE. LIST APPLIANCES FROM LEFT TO RIGHT AND
INDICATE THOSE BEING PROTECTED.
1. FRYER SIZE 15* 14" . 4. FRYER SIZEI5L
2. EI SIZE 15 *14" _ 5. _ _ SIZE
3. _ FRYER SIZE 1 S* I4" 6. _ SIZE
TO BE COMPLETED BY INSTALLER;.
CIRCLE ANSWER to the following statement. YES NO
The fire suppression system is installed in accordance with the manufactures instructions, NTPA standard 96 and 17
current issues and all applicable state and local codes. Exceptions to other provisions of NNTA 96 that were observed
are noted he /ow:
ALL ELECTRICAL WORK OR WORK PROVIDED BY NITERS TO COMPLI :11: THE INS'IALI..ATION HAS BEEN
c OMPLETED .. : : :: •
INSTALLERS NAME SIGNATURE ' • " ••• •• ; :
DISTRIBUTOR: TacomalerviCenttr #161 ADDRESS S05 allup Aygnue• ••' '•' • :..:.
DATE: PHONE: 1 -253 -383 -3804 T m 98421
TO BE COMPLETED BY CUSTOMER: :•• : : ••• s • . ••
•• ... . . . • ..
• CIRCLF ANSWER to the following statement • 1(w: •
I have received a copy of the automatic fire suppression systems' OWNERS MANU4T,.1 understand that it is the
recommendation of the NITA standard 96 & 17 that the lire suppression system empecte¢ and rrurintnircl ewe v
months to ensure c /liciency and reliability and that failure to do so may result in ,ra:11 of t, e;ycllt d 6274;4
properly. DATE:
Page No. 1 CASE HISTORY FOR CASE NO.: BUP98 -0473
FOODMAKER, INC.
13090 SW PACIFIC HWY
12/28/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
-- -- - -- -- - - - --- - --
BUPC005 Application received / / / / 11/03/98 RECD JSD 11/04/98 DLH
BUPC008 Permit created / / / / 11/04/98 DONE DLH 11/04/98 DLH
BUPC012 Plans routed to Plans Examiner / / / / 11/04/98 SENT DLH 11/04/98 DLH
BUPCO24 Plans Approved by CPE / / / / 11/05/98 APPR RDP 11/05/98 RDP
BUPCO26 Approved Plans routed to DSTs / / / / 11/05/98 APPR RDP 11/05/98 RDP
BUPCO29 DST Post Review Completed / / / / 11/05/98 DONE DLH 11/05/98 DLH
BUPC090 (F) Ready to issue / / / / 11/05/98 PASS DLH 11/05/98 DLH
BUPC100 (F) Issue permit / / / / 11/10/98 PASS GEO 11/10/98 DST
BUPC783 Sprinkler Rough -In 11/05/98 / / 12/03/98 PASS RB 12/03/98 J *H
BUPC784 Sprinkler Final 11/05/98 / / 12/03/98 PASS RB 12/03/98 J *H
BUPC960 Case Finaled / / / / 12/03/98 PASS RB 12/03/98 J *H
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 - 4175 _ s�ness Line: 639-4171 ari. C ie -0 4
5//10 /c-- Date Requested ' AM 5.LL._0 BLD
Location /30q 0 Sa I t Ijaj Suite MEC
Contact Contact Person 7Z2Ak. Ph 7 -- 19 PLM
Contractor 1 A-� Ph 07'L 1 /2 SWR
V
BUILDING Tenant/Owner A IN P 8D K DDD ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain f SGN
Crawl Drain Inspection Notes: 00 DATE Cry (`� SIT
Slab
Post & Beam
Ext Sheath /Shear A. 1111k) ALA
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire all -
ire S nn l 5U ppg €r, pd,,
ire
Susp'd Ceiling
Roof
c
Fin .
SS' PART FAIL
ING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA /�
v Ex
Approach /Sidewalk Date
Inspector `�t `�/ c -- - -. 3(
Other 4
Final
PASS PART. FAIL DO NOT REMOVE this inspection record from the job site.