Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
'
COMMUNITY DEVELOPMENT Permit#: FPS2012 -00070
T (c, A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11 /2012
Parcel: 1S136DB00201
• Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Modification of approximately (272) fire sprinkler heads for remodel.
Contractor: CROSSFIRE SPRINKLER CO Owner: FRED MEYER INC
17400 SE 82ND DR 3800 SE 22ND AVE
CLACKAMAS, OR 97015 PORTLAND, OR 97202
PHONE: 503- 210 -5506 PHONE: 503 - 232 -8844
FAX: 503 - 210 -5538
FEES
Description Date Amount
Specifics: Permit Fee - COM 05/03/2012 $631.88
12% State Surcharge - Building 05/03/2012 $75.83
Type of Use: COM Plan Review - Fire Life Safety - COM 05/03/2012 $252.75
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 05/03/2012 $4.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 05/03/2012 $3.50
11x17)
Misc Administration Fee 06/11/2012 $5.00
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
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 $972.96
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $66,411.00
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800:332.2344. -�)
Issued By: O �v, Permittee Signature: DX! / 9 - l I D
1
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. �-r (� #}
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 Applicati �j�
Fire Protection System �ECEI h E® FOR order USE ONLY
111 City of Tigard MAY — 1 2012 Date/B en� /� PermitNo.: e„, rj5 /a -00070
13125 SW Hall Blvd., Tigard, OR 97 223 Plan Revie\
a Phone: 503.639.4171 Fax: 503.59 p : � / 110 Other Permit: t✓ l a0� — ��a y
trri OF TI GARD
T I G A R D Inspection Line: 503.639 Date Ready /B' : i AMIE WI See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVI Notified/Method: fp / LI 1,7 Supplemental Information
Fr T 0 Y
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 ❑ Multi- family Number of bedrooms:
0 Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11565 SW Pacific Hwy New dwelling area: square feet
City/State /ZIP: Tigard, OR Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: Fred Meyer 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.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Add/ Relocate Heads to maintain coverage around new walls & ceilings Valuation: $66411
Existing building area: square feet
I n - p I, - -72 New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Fred Meyer Type of construction:
Address: 3800 SE 22 Ave Occupancy groups:
City/State /ZIP: Portland, OR 97202 Existing:
Phone: (503)797 7624 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax::(
E -mail: v q eakii ( &4SSF1 Z -WILL$ o CoM
CONTRACTOR BUILDING PERMIT FEES*
Business name: Crossfire Sprinkler Company (Please refer to fee schedule)
Permit fee:
Address: 17400 SE 82 Drive
City/State /ZIP: Clackamas, OR 97015 State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (503) 210 -5506 Fax: (503) 210 -5538 (Due upon application.)
CCB lic.: 174746 � Total permit fees:
Amount received:
Authorized sign. re: - r _
This permit application expires if a permit is not obtained
Print name: Timot ll A Bishop Date: 5/1/12 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
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