Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2013 -00049
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/24/2013
Parcel: 1 S133AD16200
Jurisdiction: Tigard
Site address: 12700 SW NORTH DAKOTA ST 100
Project: Sesame Donut Subdivision: 1995 - 073 PARTITION PLAT Lot: 3
Project Description: Bring current fixed fire suppressions to code
Contractor: FIRE EXTINGUISHER SERVICE CTR Owner: PACIFIC CREST PARTNERS SCHOLLS L
3460 SW 209TH AVE 7000 SW HAMPTON ST, STE 130
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 643 -3309 PHONE:
FAX: 503 - 356 -1736
FEES
Description Date Amount
Specifics: Permit Fee - COM 04/15/2013 $112.96
12% State Surcharge - Building 04/15/2013 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 04/15/2013 $45.18
Class of Work: FPS Type of Const: VB Info Process /Archiving - Sm $0.50 (up to 04/15/2013 $9.00
Occupancy Grp: A - 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 $180 70
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $3,550.00
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 . irk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N• (cation Ce Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or dir= t questions to OUN . . • . ailing 503.232.1987 or 1.800.332.2344.
Is ed By: ' Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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 RECEIVE ], t(,l( t,l l l(, , ..l ().l l
City of Tigard Permi No.:
tY Received
Ilq g DateB : 1 + 15- 1 �i 6 XID► 3 -CVO di
• 13125 SW Hall Blvd., Tigard, OR 97223 APR 1 5 2013 Plan Review � �
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : jo A ssl `a Other Permit:
T I c; n K D Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: p p Lori : / H See Pa 2 [or
Internet: www.tigard- or.gov Notified/Method: � i J / � ?j �.�Y/ Y Supplemental Info
BUILDING DIVISION - --
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑Iew construction ❑ Demolition Permit fees* are based on the value of the work performed.
` j( Indicate the value (rolnded 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.
PJ Valuation: $
❑ 1- and 2- family dwelling Commercial /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: i27 00 _ ' ) __ N 70A,K0 T7\ SI New dwelling area: square feet
City/State /ZIP: 4�.b 0 C1 I Z 2). Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: � 'bo tv 'S c) Covered porch area: square feet
Cross street/directions to job site: 1 LL S Deck area: square feet
S - SCt-to ZLS 1 .. `]p y(. 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 (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
P r Valuation: $
V _ .� , 1 a �/ SEW tj e3Z Existing b ilding area square feet
!a� New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: •.b-Q. - Type of construction:
Address: f �1 1 (�� 46 t d o r " �, ' i Occupancy groups:
City /State /ZIP: 1 � q 7J Existing: —
Phone: I17I ,' , g' (,. Fax: ( ) New:
_PLICANT 16i PERSO NOTICE
Business name: -) X-1` .,c.�/k C J �" All contractors and subcontractors are required to be
i .t�( licensed with the Oregon Construction Contractors Board
Contact name: V ..^'
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: der U r f illAt P n � applicant is exempt from licensing, the following reasons
( � 7 � / i / apply:
Phone: (57_7) 6� -3 �� I Fax: : ( )
E -mail: "
CONTRACTOR BUILDING PERMIT FEES*
Business name: - 61 `� /� (Please refer l eschedale
\�--�" 1 Permit fee:
Address:
City /State /ZIP: State surcharge (12% of permit fee):
FLS plan review (40% ofpermit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.: 6 OW Total permit fees:
Authorized signature:
Amount received: l 70
This permit application expires if a permit is not obtained
Print name: J n yr Date: 4 157243 within 180 days after it has been accepted as complete.
L J * Fee methodology set by Tri -County Building Industry
Service Board
I:\Building\Permits \FPS- PermitApp.doe Rev 01/ 05/2012 440- 4613T(I1 /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:
❑ 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
Design Area
K. Factor
Sprinkler Project Valuation: $
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 three (3) sets of plans at submittal.
Plan review fees are required at submittal.
I: \Building \Pemuts \FPS - PermitApp.doc Rev 01/05/2012 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12700 SW NORTH DAKOTA ST 100, TIGARD,
OR, 97223
Commercial - Fire Protection System
920 Suppression Trip Test
04/30/2013 00:00
FPS2013-00049
FAIL
Test for head location, okay
All Electrical needs to power down at trip test. Lighting remained on at test.
Not Approved, due to electrical issue
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12700 SW NORTH DAKOTA ST 100, TIGARD,
OR, 97223
Commercial - Fire Protection System
920 Suppression Trip Test
04/30/2013 00:00
FPS2013-00049
FAIL
Test for head location, okay
All Electrical needs to power down at trip test. Lighting remained on at test.
Not Approved, due to electrical issue
Violation Summary:
Inspector Contractor