Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit# FPS2014-00009
Date Issued: 01/15/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S1028D00100
Jurisdiction: Tigard
Site address: 12520 SW GRANT AVE
Project: St Anthony Subdivision:RTH TIGARDVILLE ADDITION.AMEND Lot: 52
Project Description: Fire suppression for Type I hood
Contractor: SANDERSON SAFETY SUPPLY CO Owner: ST ANTHONY CATHOLIC CHURCH TIGAR
1101 SE 3RD AVE 9905 SW MCKENZIE ST
PORTLAND OR 97214 TIGARD, OR 97223
PHONE: 503-889-3110 PHONE.
FAX- 503-889-3192
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/13/2014 $69.92
12%State Surcharge-Building 01/13/2014 $8 39
Type of Use: COM Plan Review-Fire Life Safety-COM 01/13/2014 $27 97
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 01/13/2014 $19 00
Occupancy Grp: A-3 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 Requiredl Alarm Type
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required
Total $125 28
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,200.00
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 952-00 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or ••
Issued By: . Permittei3 Signature: ).4 "V 7
Call 503.639.• 75 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 dECEIVED FOR OFFICE USE ONLY
R
City of Tigard l ste/e t / �...„/ Permtl No ii--alder/-7
13125 SW Hall Blvd.,Tigard,OR 972? A N 1 3 2 014 Alan lli Review /� Permit:
a ' Phone: 503.718.2439 Fax: 503.598.1960 Oate r� / , ober
I I<.,\Itl+
Inspection Line: 503.639.4175 CITY OF TIGARD Date Re..w,=:".7 i kris H See Page 2 far
Internet: www.tigard-or.gov Notified/Method: i t of 07 "'G Supplemental Information
'BUILDING DIVISION to p„.....„; cx... .
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.
❑ I-and 2-family dwelling ®Commercial/industrial Valuation: $
12 Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
.108 8171£ INFORMATION AND LOCATION Total number of floors:
Job site address: 415j'ip , 6,49-A)7—• New dwelling area: square feet
City/State/ZIP:TIGARD,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:ST ANTHONYS SCHOOL Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:C RCIAL-USE CHECiM JST
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.
INSTALLATION OF ANSUL R-102 FIXED FIRE SUPPRESSION SYSTEM Valuation: $ 1 200 . 06
INTO KITCHEN EXHAUST HOOD Existing building area: square feet
SYSTEM PRE-PIPED FROM GAYLORD FACTORY New building area: square feet
❑ PROPERTY OWNER I El TENANT Number of stories:
Name: Type of construction:
Address:
Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) i Fax:( ) New:
ril APPLICANT e.CONTACT PERSON - - ICE
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)238-5700 f Fax::(503)889-3192
E-mail:GSPAHR @SANSAFE,COM
CONTRACTOR —ITUULDING P *
Business name:SANDERSON SAFETY SUPPLY CO flYaanre
Permit fee:
Address: 1101 SE 3"AVE -
City/State/ZIP:PORTLAND,OR 97214 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)238-5700 Fax:(503)889-3192 (Due upon application.)
CCB lic.:64969 Total permit fees:
, / f Amount received:
Authorized signature: a'L/Y
This permit application expires if a permit is not obtained
IPrint name:GEOFF SPAHR Date: I f S`1 tk within 180 days Mier it has been accepted as complete.
• Fee methodology set by Tri-County Building Industry
Service Board.
t.lBuildi/l(IytPermitslFPS•PermitApp.duc Rev0I/05/2012 441-3613T(11/02/COMME11)
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.
El Repair
Number of sprinkler heads:
Additional description of work:
Typc of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
El 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: $ 1200
C.) Fire Alarm
Submittal shall Battery Calculations ❑ 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): $ 1200
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 hrer e (3) sets of plans at submittal.
Plan review fees are required at submittal.
C:\Documents and Settings\gspah:\Desktop\FPS-PemvtApp.dot Rev 01/05/2012 2
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
12520 SW GRANT AVE, TIGARD, OR, 97223
Commercial - Fire Protection System
920 Suppression Trip Test
2014-02-25 00:00:00
FPS2014-00009
PASS
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12520 SW GRANT AVE, TIGARD, OR, 97223
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2014-00009
Chip Barnett
Violation Summary:
Inspector Contractor