Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I COMMUNITY DEVELOPMENT Permit #: FPS2013 -00042
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2013
Parcel: 1S 135BA00102
Jurisdiction: TIGARD
Site address: 10100 SW WASHINGTON SQUARE RD A -1
Project: Red Robin Subdivision: OAKBURG Lot: 27
Project Description: Provide additional. nozzle and drop for (1) new gas rediant char broiler
Contractor: FIRE EXTINGUISHER SERVICE CTR Owner: PPR SQUARE TOO LLC
3460 SW 209TH AVE PO BOX 847
BEAVERTON, OR 97005 CARLSBAD, CA 92018
PHONE: 503 - 643 -3309 PHONE:
FAX: 503 - 356 -1736
FEES
Description Date Amount
Specifics: Permit Fee - COM 04/01/2013 $64.54
12% State Surcharge - Building 04/01/2013 $7.74
Type of Use: COM Plan Review - Fire Life Safety - COM 04/01/2013 $25.82
Class of Work: ALT Type of Const: IIB Info Process /Archiving - Sm $0.50 (up to 04/01/2013 $6.00
Occupancy Grp: A -2 Height: ft 11x17)
Stories: 1
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 $104.10
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,000.00
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 ork is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t• f. •w the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 r 1 • r 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: Permittee Signature: -
` Call 503.639.4175 by 7:00 a.m. for the next available inspef n d
This permit card shall be kept in a conspicuous place on the job site until comple • n of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application RECEIVED
Fire Protection System FOR OFFICE USE ONLY
Received
City of Tigard O 1 2013 Dat B : 11 Permit No.: ` PS�lI 1 3 '(/JT"
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review i
' II Phone: 503.718.2439 Fax: 503.598.1960 e/g � � �/ (0 I Other Permit:
CITYOFTI Dat
I I c; API) Inspection Line: 5013.639 BUILDING DIM /0 Date ReadyBy: turf ® See Page 2 for
Internet: www.tigard- or.gov IJ Notified/M od:(�/ Supplemental Information Cet
TYPE OF WORK '� ^' ` e 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
Cii‘dition/alterAion/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application
❑ 1- and 2- family dwelling VtCmmercial/industrial
' Valu on:
❑ Accessory building ❑ Multi - family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
/ () 1 0 0 JOB SITE INF I RMATION AND LOCATION Total number of floors:
Job site address: P ,, e ; ; C� ` ,, New dwelling area: square feet
City /State /ZIP: iG•. _ ?�,f r.. r � - 1 1 9? 1'127- Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area square feet
Cross street/directions to job site: Deck area: square feet
er structure area: square feet
EQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I Lot no.: rmit 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
yyII
DESCRIPTION OF AA WORK work indicated on this application.
�� G5�� Ire tJ 1 . t `tab t 4 tew f k I ✓� 0 z7- k i'h Valuation: $ 4:)66
4 r r t !u e Oki G'A S L r b,�116 Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
I
Name: 12,...., 6 j 0 Type of construction:
Address: ' ot) , n �, Occupancy groups:
City /State /ZIP: / r ■��r�•, J '�'" Exi stin :
p rtl 7 � � ' h` g Phone: (63) a 1J, 3 / Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: vl a „ ,f �.�� e C 1-‘4.- All contractors and subcontractors are required to be
Contact name: 1 ! ”' licensed with the Oregon Construction Contractors Board
y[ under ORS 701 and may be required to be 'tensed in the
Address: s _ a _ Q V '% . - jurisdiction in which work is being performed. If the
City/State /ZIP: / ti-e-( 1 ��f applicant is exempt from licensing, the following reasons
� � )' 4...> '7 apply:
Phone: (53) .3- 6 / J I Fax: : ( -� / ?, 3 �
E -mail: `��
CONTRACTOR //�� BUILDING PERMIT FEES*
Business name: '1...4e S Ape I - / f.' (Please refer to fee schedule)
Address: � 7 r 1 Permit fee:
City /State /ZIP: es..., State surcharge (12% of permit fee):
FLS plan review (40% ofpermit fee):
Phone: ( ) Fax: ( ) (Due upon application.) _
CCB lit.: 4 � 3 i Total permit fees:
Authorized signature: Amount received: ! JL� f
-
/ li. . _ This permit application expires if a permit is not obtained
Print name: ' _ Date: within 180 days after it has been accepted as complete.
,' '� * Fee methodology set by Tri -County Building Industry
Service Board.
1 : \ Building \Permiu\FPS- PermitApp.d°c Rev 01/05/2012 440- 4613T(11 /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
E l Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
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
Density
Dcsign Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
C.) Fire Alarm
Submittal shall Battery Calculations El Yes
include: Individual Component El 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 three (3) sets of plans at submittal.
Plan review fees are required at submittal.
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