Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
;1'! • COMMUNITY DEVELOPMENT Permit#: FPS2015-00135
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/25/2015
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10108 SW WASHINGTON SQUARE RD
Project: Cost Plus Subdivision: OAKBURG Lot: 9
Project Description: Fire sprinklers,plug(3)heads and add(1)head.
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR SQUARE TOO LLC
9095 SW BURNHAM PO BOX 847
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/25/2015 $51.09
12%State Surcharge-Building 08/25/2015 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 08/25/2015 $20.44
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 08/25/2015 $5.50
Occupancy Grp: Height: ft 11x17)
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 $83.16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $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 t.- rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yo obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B
Y� � � 'ermittee Signature: I � /
C. 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 Applicati n
Fire Protection System �iECE1VED FOR OFFICE USE ONLY
City of Tigard AUG 2 4 2015 Received a5'/� 0 PermitNo.:/tS�/S_oo135
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review t
i ■ Other Permit:l P o/5--eP`n
Phone: 503.718.2439 Fax: 503.ei1 °OF TIGARD Daze/By.
TIGARD Inspection Line: 503.639.4175 BUILDING DIN/I0 Date ed/MeBy: =//I luds: Fa See Page 2for
Internet: www.tigard-or.gov .SIGN Notified Method: Supplemental Information
I 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:10108 SW Washington Square Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Cost Plus World Market 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: I 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.
Plug 3 sprinklers and add 1 for store TI Valuation: $$500.00
Existing building area: square feet
New building area: 0 square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Type of construction: IIIB
Address: Occupancy groups:
City/State/ZIP: Existing: Ordinary 1
Phone:( ) Fax:( ) New: "
0 APPLICANT 0 CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ashley Payne licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham Rd jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)684-2928 Fax::( )
E-mail:a.payne @wyattfire.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection (Please refer to fee schedule)
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.) 1
CCB lic.:64077 Total permit fees: 3.
Authorized signature: / Amount received: S.--,/ This permit application expires if a permit is not obtained
Print name:Ashley Payne , Date:8/21/15 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 Rev 01/05/2012 440-4613Tt11/02/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: 4
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes 0
Information: Hazard Group Ordinary 1
Density 0.15
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 500
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.
C:\Users\Ashley\Desktop\Permit Applications\Tigard App.doc Rev 01/05/2012 2
114 CITY OF TIGARD RECEIPT
4
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 202319 - 08/25/2015
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
FPS2015-00135 Permit Fee-COM 230-0000-43104 $51.09
FPS2015-00135 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $5.50
11x17)
FPS2015-00135 Plan Review-Fire Life Safety-COM 230-0000-43108 $20.44
FPS2015-00135 12%State Surcharge-Building 100-0000-24001 $6.13
Total: $83.16
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 21750 BTAGGART 08/25/2015 $83.16
Payor: Wyatt Fire Protection, Inc.
Total Payments: $83.16
Balance Due: $0.00
Page 1 of 1
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City of Tigard �� Permit No.: t''�5�GI5�� /3�
13125 SW Hall Blvd.,Tigard,OR 97223
114
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: OZ(//�
TI G AR[> Inspection Line: 503.639.4175
Internet: www.tigard-or.gov By:
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS,
OR TENANT IMPROVEMENTS h C .yVE®
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) AUG 2 4 2015
CITY OF TIGARD
BUILDING DIVISION
Project Name: Cost Plus World Market Occupancy: Retail
Job Address: 10108 SW Washington Square Rd Type of Construction: IIIB
Suite:
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: 4
Type: SSU Hazard: Ordinary I Density: 0.15
I, Ashley Payne, Wyatt Fire Protection Oregon Construction Contractors Board No. 64077
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits, beams, partitions, walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop (exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads (see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
In addition, I understand the following is required:
• Submit(3) copies of a sketch showing the area of work within the building's structure.
• Building fire protection system permit.
• A copy of this docuri
ith a copy of the sketch attached shall be available for all inspections.
Signature: Ak.04.,t ' Date: 8/24/2015
Print Name: Ashley Payne
I:1Buil ding\Forms\FireS prink lerAffidavit_071514.docx Page 1 of 1
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
10108 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2015-00135
Chip Barnett
Violation Summary:
Inspector Contractor