Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
2.• COMMUNITY DEVELOPMENT Permit#: FPS2013-00164
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2013
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10330 SW GREENBURG RD
Project: Red Lobster Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Install Ansul R-102 fixed fire suppression system into kitchen exhaust hood. Hoods shipped from MFG pre-piped
with Ansul system.
Contractor: SANDERSON SAFETY SUPPLY CO. Owner: LINCOLN CENTER LLC
1101 SE 3RD AVE BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97214 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-889-3110 PHONE:
FAX: 503-889-3192
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/12/2013 $77.99
12%State Surcharge-Building 11/12/2013 $9.36
Type of Use: COM Plan Review-Fire Life Safety-COM 11/12/2013 $31.20
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 11/12/2013 $2.50
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 $121.05
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,500.00
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 Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.811 '4.
Issued By: Permittee Signature: /' l
Cal .• .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 RECEIVED FOR OFFICE USE ONLY
City of Tigard Received DateBy If C/) '' Permit No.: MS69a3-ez,gel/
IIq 13125 SW Hall Blvd.,Tigard,OR 97WJv 5 2013 ( 14"r ////
II Phone: 503.718.2439 Fax: 503.598.1960 Date/By: . fJ L1 Other Permit: /t� /�?...Q eci
Inspection Line: 503.639.4175 Date Rea y: 4i�, Juris: ® See Page 2 for
TIGARD Internet: www.tigard-or.gov CITYOFTIGARU Notified/Method//AO/6' IrIr r Supplemental Information
BUILDING DIVISIOPI ill/�!A Ice.g-
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.
❑ 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: 10330 SW GREENBURG RD New dwelling area: square feet
City/State/ZIP:TIGARD,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:RED LOBSTER 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.
INSTALL ANSUL R-102 FIXED FIRE SUPPRESSION SYSTEM INTO KITCHEN Valuation: $$1,500.00
EXHAUST HOOD. HOODS SHIPPED FROM MFG ALREADY PRE-PIPED WITH Existing building area: square feet
ANSUL SYSTEM New building area: square feet
• ❑ PROPERTY OWNER 0 TENANT Number of stories: I
Name: RED LOBSTER Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: .
Phone:( ) Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON .
. . NOTICE•
Business name:SANDERSON SAFETY SUPPLY CO All contractors and subcontractors are required to be
Contact name:GEOFF SPAHR licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1101 SE 3RD AVE jurisdiction in which work is being performed.If the
City/State/ZIP:PORTLAND,OR 97214 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)889-3110 Fax: :(503)1389-3192
E-mail:GSPAHR @SANSAFE.COM
CONTRACTOR • BUILDING PERMIT FEES*•;.
Business name:SANDERSON SAFETY SUPPLY CO (Please refer ro fee schedule) .
Permit fee:
Address:
City/State/ZIP: _ State surcharge(12%of permit fee): I
FLS plan review(40%of permit fee): I
Phone:( ) Fax:( ) (Due upon application.)
CCB lic.:64969 32`0% Total permit fees:
Authorized signature:
Amount received: j
This permit application expires if a permit is not obtained
Print name:GEOFF SPAHR Date: 10-28-13 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-Permit App.doc Rev 01/05/2012 440-4613T(I 1/02/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: $ 1500.00
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.
C:\Documents and Settings\gspahr\Desktop\PPS-PermitApp.doc Rev 01/05/2012 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10330 SW GREENBURG RD, TIGARD, OR, 2013 -11 -27 00:00:00
97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2013 -00164
Inspection Type: Result:
920 Suppression Trip Test PASS
Comments:
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10330 SW GREENBURG RD, TIGARD, OR,
97223
Commercial - Fire Protection System
999 Sprinkler Final
2013-12-10 (null)
FPS2013-00164
PASS - No C of O
Violation Summary:
Inspector Contractor