Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
° COMMUNITY DEVELOPMENT Permit #: FPS2012 -00113
T [ G AA O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/09/2012
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Chase Bank Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: In -store remodel
Contractor: CROSSFIRE SPRINKLER CO Owner: FRED MEYER INC
17400 SE 82ND DR STORE #375
CLACKAMAS, OR 97015 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503 - 210 -5506 PHONE:
FAX: 503 - 210 -5538
FEES
Description Date Amount
Specifics: Permit Fee - COM 07/25/2012 $102.20
12% State Surcharge - Building 07/25/2012 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 07/25/2012 $40.88
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 07/25/2012 $4.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Misc Administration Fee 07/25/2012 $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 $164.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,434.00
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 otification _ -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or d' ect questions to O • ► : calling 503.232.1987 or 1.800.332.2344.
Is ued By: \ / A � Perm ittee Si / / /4 •
Call 503.639.4175 by 7:00 a.m. for the next available in • ction 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 p I t FOR OFFICE USE ONLY
City of Tigard P Received 1 3��
TO %� 1 /�O, iL K Date/B : ` Permit No.: v / w
q
13125 SW Hall Blvd., Tigard, OR 97223 JUL 2 5 2012 Plan Revt
0 . • -' r� a IM Other Permit:
Phone: 503.639.4171 Fax: 503.598.1 Date/B
T I G A R D Inspection Line: 503.639.4175 CITY CF TIGARD Date Read . g ® : Ju: See Page 2 for
Internet: www.tigard-or.gov Bl JILDIN DIV SIOA) Notified/Method: Supplemental Information
TYPE OF WORK [j I 1 � 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:
❑ 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: Chase Bank - 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: $2434
Existing building area: square feet
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:
CONTRACTOR BUILDING PERMIT FEES*
Business name: Crossfire Sprinkler Company (Please refer to fee schedule)
Permit fee:
Address: 17400 SE 82 Drive
State surcharge (12% of permit fee):
City/State/ZIP: Clackamas, OR 97015 FLS plan review (40% of permit fee):
Phone: (503) 210 -5506 Fax: (503) 210 -5538 (Due upon application)
CCB lic.: 174746 Total permit fees:
at
I Amount received: [l/(„ / , 31
Authorized sign... -. lr' _11,�—
This permit application expires if a permit is not obtained
Print name: tmothy A Bishop Date: 7/20/12 within 180 days after it has been accepted as complete.
• Fee methodology set by Tri-County Building Industry
Service Board.
L\ Building \Permits \FPS- PermitApp.doc 10/01/09 440- 4613T(l1 /02 /COM/WEB)
1
•
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done: °
1. New 2.) M odification to sprinkler : rinkler heads only:
❑ ) P Y
❑ Addition ❑ 1 -10 heads: No plan review required. JuL 2 5 2012
® Alteration ® 11+ heads: Plan review required.
Repair �;GN,��
❑ p Number of sprinkler heads: 14 �,� C1 P i�l�
It)
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 Light Hazard
Density .10
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 2434
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.
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