Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11- 4.: COMMUNITY DEVELOPMENT Permit#: FPS2013 00114
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013
Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16165 SW 72ND AVE
Project: CCK Restaurants LLC Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Add(3)fire sprinkler heads and relocate(2)fire sprinkler heads.
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES LP
9095 SW BURNHAM ATTN: N PIVEN
TIGARD, OR 97223 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/08/2013 $53.78
12%State Surcharge-Building 08/08/2013 $6.45
Type of Use: COM Plan Review-Fire Life Safety-COM 08/08/2013 $21.51
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
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 $81.74
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $572.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Noti - • enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain copy of the rules
or dir= questions to O b C by calling 503.232.1987 or 1.800.332.2344. ;
I -ued By: / Permittee Signature:
/
Call 503.639.4175 by 7:00 a.m.for the next available inspectio. date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
r$uilding Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY
311 City of Tigard j Received 9 p 1 ?j !,, PemvtNo.: �JS?Q!3-Vane'
- " 13125 SW Hall Blvd.,Tigard,OR 97223 �\ 1 8 r,113 y /• 1; � V Plao Review Other Permit: p�jg�Q r!'7
Phone: 503.639.4171 Fax: 503.598.1960' Date/13y:
TIGARD Inspection Line: 503.639.4175 OFTIGPD Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov gUl pINGDNISION Notified/Method: Supplemental Information•. ' 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❑Other: equipment,materials,labor,overhead,and the profit for the
' CATEGORY.OF CONSTRUCTION TION,. . work indicated on this application.
ID 1-and 2-family dwelling Commercial/industrial
Valuation: $
111 Accessory building I::Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB. SITE INFOR117ATION AND LOCATION Total number of floors:
Job site address: I Co 1 6s 5 / ''10 � New dwelling area: square feet
City/State/ZIP: i1 64,-4.0 1 Die_ 912.24- Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: C.CP-- Res-rA.0R 0 S 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.
q c./1-T , A-Do 3 F1 sPn/ti,c Valuation: $ 57Z, '
1 S ° Di204.DC:3ZD 111 ,/ . Existing building area: square feet
New building area: square feet
❑. PROPERTY OWNER El TENANT Number of stories:
Name: Type of construction:
Address: • Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
0-APPLICANT . ❑ CONTACT PERSON NOTICE
Business name: $ii' I_D,t)T,e_4$C-rO2 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 .. FEES*. BUILDING PERMIT F
Business name: ' ' (Please refer to feeachedriler
yk7— �_ ,t 1 �t7,�� '' 0� Permit fee: , .3.7'
Address: 91795 s U 73 044)H dy� 5-7-,
City/State/ZIP: r�ji.-46 D4 g 7 ZZ 3 State surcharge(12%of permit fee): ,�S^
22�� / FLS plan review(40%of permit fee): 021! . 6 i
Phone:(523 b elk. - 2_9 Z,5, Fax:(503) 6,e,4_96,67 (Due upon application.)
CCB lic.: (a.4t)77 Total permit fees: # 1, 7 LI
Authorized signature: _
Amount received:
This permit application expires if a permit is not obtained
Print name:,66;6i it! � � J Date: gry/3 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\.Building\Permits'FPS-PermitApp.doc 03/23/06 440-46131(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:
El Addition --g-4-10 heads: No plan review required.
'Er-Alteration LI 11+ heads: Plan review required.
0 Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A,B, C or D as applicake)
AL:)<",v6 • ::•••
D Wet Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Project Valuation:
C) Fire • " ":°-°` "-;
Alarm ;!;; ' ; „- :,,•„
Submittal shall Battery Calculations ! Yes
include: Individual Component Yes
Cut Sheets
Fire Alarm Project Valuation: $
;
..C20
Ridjntial bpiiiiitiOt fr Ye::fY.•
Square Footage: Permit Fee: „
0 to 2,000 $187.50 •
2,001 to 3,600 $232.50 .r!
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
'
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.onus/city_hallidepartments/cd/docs/FPS-PermitApp.doc 2
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