Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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COMMUNITY DEVELOPMENT Permit #: FPS2013 00006
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/29/2013
Parcel: 25101 CB00500
Jurisdiction: Tigard
Site address: 12670 SW HALL BLVD, BLDG# 3
Project: Canteen Subdivision: 2007 -064 PARTITION PLAT Lot: B
Project Description: Provide fire sprinkler coverage @ new loading dock, offices, cash room, hallway 1/24/13 REPRINT Correct
address
Contractor: WYATT FIRE PROTECTION INC. Owner: TCTPI LLC
9095 SW BURNHAM 4260 GALEWOOD ST, STE A
TIGARD, OR 97223 LAKE OSWEGO, OR 97035
PHONE: 503 - 684 -2928 PHONE:
FAX: 503 - 684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - COM 01/29/2013 $134.48
12% State Surcharge - Building 01/29/2013 $16.14
Type of Use: COM Plan Review - Fire Life Safety - COM 01/10/2013 $53.79
Class of Work: ALT Type of Const: IIIB Info Process /Archiving - Lg $2.00 (over 01/29/2013 $2.00
Occupancy Grp: S -1 Height: ft 11x17)
Stories: 2 Info Process /Archiving - Sm $0.50 (up to 01/29/2013 $17.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard:
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 $223.91
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $5,070.00
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 Noti - - enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a op •f the rules
or dire •uestions to • NC • ailing 503.232.1987 or 1.800.332.2344. /
Issue By: , p Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for the next available inspection , ate.
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.
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i Building Permit Application
•
Fire Protection System RECEIVES FOR OFFICE USE ONLY
74 City of Tigard JAN 1 r jJ Rec eBya ( (() ( Permit NorPs
13125 SW Hall Blvd., Tigard, O 97223 O �013 �q h�. � 1. ' - Phone: 503.639.4171 Fax: 503.598.1960 1 Date/By: ew I 2e 1 Other Permit _
:
TIGA • Inspection Line: 503.639.4175 C /1L' Tirn B: �✓ r_un.1 8 See e 2
Internet: www.tigard- or.gov Vi' ilutp N Date otifie ! ��jl�j of A[(� Supplemental Pag Information for
BilILDmG DIVlslo �,�� Ready i s . -
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.
Valuation: $
❑ 1- and 2- family dwelling ommercial/industrial
❑ 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: / 2 6,70 ;MOW' J(i / F3, LY 0 • New dwelling area: square feet
City/State/ZIP: - 64-1Z.D I 04, 7223 Garage/carport area: square feet
Suite/bldg. /apt. no.: 3 ), Project name: 1 -rfJ 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: I 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.
y/a� p/Oz. 17124(.f 6g Cp l < g Valuation: $ 100 ,
tp `( / j / J � /�
+ �v�o p Existing building area: square feet
�r '�` //'-� / �v New building area: square feet
❑ PROPERTY OWNER I . ❑ TENANT Number of stories:
Name: Type of construction:
Address: • Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( • ) New: , 3 -79
APPLICANT . • ❑ CONTACT PERSON . , NOTICE
Business name: • Z j� �/(jr/6,9 C 1-494. 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: ( ) • I Fax:: ( )
E -mail:
CONTRACTOR
`� p� BUILDING PERMIT FEES*
Business name: r !/
I ,� Y j " 7) 2 12 0 7 7 ,( � (Please refer to fee schedule)
Address: 91 l 9 j ,v /2/4/hi77 ST Permit fee:
City/State/ZIP: 77 (32 722- 7z State surcharge (12% of permit fee):
! FLS plan review (40% of permit fee):
Phone: ($?3) b51 Fax: (5503) b 1 - 9057 (Due upon application.)
CCB lic.: k 7 77 Total permit fees:
/
Authorized signature: Amount received:
`
./r-e-- /� This permit application expires if a permit is not obtained
Print name:' (�`` Date:P/ .--/V .13 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits \FPS- PertnitApp.doc 03 /23/06 440.4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describ work t� he done
1.) fl New 2.) Modification to sprinkler heads only:
0 Addition 0 1-10 heads: No plan review required.
0 Alteration IgLi.1+ heads: Plan review required.
0 Repair
Number of sprinkler heads: )
Additional description of work:
Tyi5e of System (Complete A, B, C otD as applicabl)
A.) Commercial Sprinkler
C.'
D Wet El Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K Factor
Sprinkler Project Valuation: $
Hood Project Valuation:
C) FireAJarrn
• •••-• :
• f , '
Submittal shall Battery Calculations 0 Yes
include: Individual Component 10 Yes
Cut Sheets •
Fire Ala Project Valuation: $
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50 ,
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Fire Protecttoii Prmit Fes
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.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
http://www.ci.tigard.or.us/city_hallidepartments/cd/docs/FPS-PermitApp.doc 2