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Permit r �r CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 11/ • COMMUNITY DEVELOPMENT Permit#: FPS2015-00156 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2015 Parcel: 25101 BA00101 Jurisdiction: TIGARD Site address: 7500 SW DARTMOUTH ST 110 Project: Tigard Retail Center Subdivision: WEST PORTLAND HEIGHTS Lot: Project Description: Fire alarm: Add(1)device and relocate(3)devices in 3 suites: 110 Joy Teriyaki, 120 Great Clips, 130 Icon Nails& Bar Contractor: PORTER ELECTRIC INC Owner: WAL-MART REAL ESTATE BUSINESS TR 7320 NE ST JOHNS RD BY PROPERTY TAX DEPT STORE 5935-00 VANCOUVER,WA 98665 PO BOX 8050 ATTN MS 0555 BENTONVILLE,AR 72716 PHONE: 360-574-1366 PHONE: FAX: 360-573-3723 FEES Description Date Amount Specifics: Permit Fee-COM 10/07/2015 $59.16 0 12/o State Surcharge-Building 10/07/2015 $7.10 9 9 $ Type of Use: COM Plan Review-Fire Life Safety-COM 10/07/2015 $23.66 Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 10/07/2015 $3.00 Occupancy Grp: B Height: ft 11x17) Stories: 1 Cash Over 10/07/2015 $28.37 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: Yes Alarm Type: Automatic Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $121.29 Valuations: Required Items and Reports(Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $715.00 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 1.800.332.2344. Issued By: 4411' 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. BuildinE Permit ApplicationRECE1 rVEP Fire Protection System l' j�) F� rot(oFF I( I•. I sy ON II City of Tigard p Date/By: /6/7//5� Permit No.f/a_�/s AW.cb 11,1 I 13125 SW Hall Blvd.,Tigard,OR 972230 C 1 7 7015 Plan Review Other Permit: Phone: 503.718.2439 Fax: 503.59 1 Date/By: Inspection Line: 503.639.4175 1 VF 11GARI) Date Ready/By: Juris ® See Page 2 for I I C, K U p Internet: www.tigard-or.gov BUILDING DIVISION 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(rornded to the nearest dollar)of all 7:. 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: A Job site address: _45-0 d 5 :A1.T,,4'lo m7--A. 5- / New dwelling area: square feet o City/State/ZIP: 7.-14 AiLd (fit 99 41,2 3 Garage/carport area: square feet Suite/bldg./apt.no.:/ 9/29Qroject name: (A1i Ike- oar zi_y Covered porch area square feet Cross street/directions to job site: -77G1726 -4)L LE%7l/7E Deck area: square feet l/C J y 7 ,-> -/c-j Other structure area: square feet /e2-0 Cr/.e- r e G(ft)--5- REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: / 3d /e./A/ 6/-&- S Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: 4 4/9-/L Indicate the value(rotuded to the nearest dollar)of all / equipment,materials,labor,overhead,and the profit for the • DESCRIPTION OF WORK work indicated on this application. Add Q N ea&vi 4� Valuation: $ -115., 00 0 JZ f.to Ci4 ' CY/F V/ <.. Existing building area square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: • )6 APPLICANT ❑ CONTACT PERSON NOTICE Business name: pc,.rot, E/e _7 ttC /✓C All contractors and subcontractors are required to be Contact name: // /l,6)av$O N licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 3�0 � 5 5-r „7-2,A p5 tej jurisdiction in which work is being performed.If the City/State/ZIP: VA'r'COLA vi - 14/464- 9664 5- applicant is exempt from licensing,the following reasons apply: Phone:(36(r) 5 7y - /3L b _ Fax: :( ) E-mail: © CONTRACTOR BUILDING PERMIT FEES* Business name: PO 27 y'` E7-E-e//--t C1 (Please refer to fee schedule) Permit fee: 59, ,b Address: City/State/ZIP: State surcharge(12%of permit fee): ' 7 /V FLS plan review(40%of permit fee): a 3 (0 , Phone:( )) Fax:( ) (Due upon application submitta.l CCB lie.: 7(p(p 7,f a//O//? Total permit e tir 3 Amount received: p g, Authorized signature. This permit application expires if a permit is not obtained Print name: 04 VC Date:/6 7 -i 51 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_071514.doc 440-4613T(11/02/COM/WEB) City of Tigard: Fire Protection Permit Checklist Page 2- Supplemental Information Describe work to be done: 1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices: ❑ New system Number of sprinkler heads: Number of alarm devices: ❑ Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and Alteration (3) copies of sketch showing area (3) copies of sketch showing area to existing of work within building structure of work within building structure system ❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and (3) sets of plans. (3) sets of plans. 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: $ I:\Building\Permits\FPS_PernutApp_071514.doc 2 RECEIVE]) City of Tigard OCT 7 2015 Permit No.: / °S'2'/.5 — p0 if:‘1111 • 13125 SW vd.,Tigard, Phone: 503.718.2439 Hall Bl Fax: 503.598.19OR 97223 60, 1 1 V a �y y h Date Received: (4/7`/. x.1 Inspection Line: 503.639.4175 OF 11(AHL �y -- T ^K[) Internet: www.tigard-or.gov BUILDING DIVISIONBY: r"�,y(�/ FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS OR TENANT IMPROVEMENTS (MAXIMUM OF 5 DEVICES WITHOUT PLANS) Project Name: 5935-500 OUTLOT (Wal-Mart Out Bldg) Occupancy: Commercial Job Address: 7500 SW Dartmouth St 97223 Suite: --21-&,220,230 //0` /app/SD / Contractor: PORTER Electric Inc Phone: 360-574-1366 Valuation of work: $$715.00 Type of System: (check one) 0 Required ['Non-required (check one) 0 Automatic ❑Manual ❑Both Total number of devices added or moved under this permit process is 5 total per tenant space. Number of Proposed Smoke/Heat Detectors: To be Added(max 5) /To be Relocated(max 5) Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 5) Number of Proposed Notification Appliances: To be Added(max 5) 1 /To be Relocated(max 5) 3 I, PORTER Electric Inc Oregon Construction Contractors Board No. 46678 certify the following is true and defines the scope of work for this project: a) All work complies with the current state-adopted NFPA-72 and the authority having jurisdiction. b) All notification appliances are located in accordance with the current state-adopted NFPA-72. c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having jurisdiction. d) Exposed wiring will not be covered until inspected. e) Final approval shall be subject to on-site tests and inspections. f) Voltage drop is adequate to operate all appliances. g) Battery supplies are capable of supporting the system modifications. h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications. 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. • Electrical permit. • A copy of this document with a copy of the sketch attached shall be available for all inspections. 1 Signature: t ja I Date: 10/5/15 Print Name: Bill Robinson L:\Building\Forms\FireAlannAffidavit_071514.docx Page 1 of 1 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT q Re uest for Permit Action , , 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermnits @tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) P02T�7Z �ZE ' '� // Mailing Address: 73 2 p f T.Tph`"S , City/State/Zip: V'9WWO G[ t/67e_ ,, <<fff 9'F 6 Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): OID PERMIT APPLICATION. REFUND IT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: C/5 o2p/S—QQ/�(o Site Address or Parcel#: 75.o d Set) 2 97LT-'1,t. T S'T//Q Project Name: T 6tf z-zs /L 7 f,' Subdivision Name: Lot#: EXPLANATION: rgx'1 f7 u,fv ,-i i 7LE r'c. re u s 7V rl BIZ_. C fEele- I .. 4 'L 0 77-fC Riouvr Signature: d/ lir Date: //D/S Print Name: Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. ivory : G et— ' �� , 3 / — -3 Nb. Sir•-uC_A e—E—"/ cae. 3 7. FOR OFFICE USE ONLY Route to S s Admin: Date B Route to Records: Date /ilA® .�� Refund Processed: Date //AIM B x/12 Invoice Processed: Date B Permit Canceled: Date ` ry,��� :ri.r '• cel Ta:Added: Date B I:\Building\Forms\RegPermitAction_09 14.doc � 1 i MN a•: StLGAU City of Tigard November 19, 2015 Porter Electric Inc. 7320 NE St Johns Rd Vancouver,WA 98665 Re: Permit No. FPS2015-00156 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 7500 SW Dartmouth, Ste 110 Project Name: Tigard Retail Center Job No.: N/A Refund: ® Check#219247 in the amount of$28.34. ❑ Credit card "return"receipt in the amount of$ ❑ Trust account "deposit" receipt in the amount of$ Notes: Refund for overpayment of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. l:\Buil ding\RefundsAiii4raMuN8dip! id6L/9regon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request jbr Permit Action foul' (if applicable) must be attached to this request fotm. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Porter Electric Inc. DATE: 11/06/2015 7320 NE St Johns Rd Vancouver, WA 98665 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 202898 Case #: FPS2015-00156 Date: 10/07/2015 Address/Parcel: 7500 SW Dartmouth, Ste 110 Pay Method: CreditCard Project Name: Tigard Retail Center EXPLANATION: Refund overpayment of permit fees. ,12EFUND INFOR bATI -,.i'i, `-Revenue..-'Account Na:�� vk k:,.,:-;=7=;.:ir. >-11- ,;_R_: :Fe `Deci tn Fm�'R 5 _ -_ e:fyuam:.n.: d• q _ _ t Fee�___ .,.• .,..,_. - ,- -- _ ?Esau S le--,_300000-43�10�: ti`sa�;.-::•.:;:,..; �.Ariount Cash over 100-0000-48001 $28.34 TOTAL REFUND: $28.34 APPROVALS: SIGNATURES(DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board 0 R TIDEMARK SYSTEM ADMINISTRATION Case Refund Processed: Date: // /9 /S By:' L\Building\Refunds\RefundReyucst.doc x 09/01/2010