Permit (47) CITY OF TIGARD % � �� FIRE PROTECTION SYSTEM PERMIT
Permitd: FP16/20100198
COMMUNITY DEVELOPMENT
Date Issued: 12/16/2015
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Subdivision: PALMER ACRES Lot: 3
Project: Costco
Project Description: Addition/relocation of(9)fire sprinkler heads for optical center remodel.
Contractor: FIRE SYSTEMS WEST INC Owner: COSTCO WHOLESALE CORPORATION
600 SE MARITIME AVE#300 PROPERTY TAX DEPT 111
VANCOUVER,WA 98661 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/16/2015 $102.20
12%State Surcharge-Building 12/16/2015 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 12/16/2015 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 12/16/2015 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .1 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $155.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
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 1 503.232.1987 or 1.800.332.2344. /
Issued By: Permittee Signature: aAl 410 0Z-����D
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.
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2015-00198
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/16/2015Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 3
Project Description: Addition/relocation of(9)fire sprinkler heads for optical center remodel.
Contractor: FIRE SYSTEMS WEST INC Owner: COSTCO WHOLESALE CORPORATION
600 SE MARITIME AVE#300 PROPERTY TAX DEPT 111
VANCOUVER,WA 98661 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/16/2015 $102.20
12%State Surcharge-Building 12/16/2015 $12.26
Type of Use: Plan Review-Fire Life Safety-COM 12/16/2015 $40.88
Class of Work: Type of Const: Info Process/Archiving-Sm$0.50(up to 12/16/2015 $0.50
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 S155.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
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 Notifi ter. 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 estions to OUN by c g 503.232.1987 or 1.800.332.2344.
Issue By: Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. G
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.
Buildinp, Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard RDateBed �p2 l� �s Permit No.: /c-p
2O/ -tx�/9,3,
'� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit-.
Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigai-(I-oi-.gov Notified/Method: Supplemental Information
-. RE ItIREU UATA:1=f1ND 2=FAiV1tI Y DWEE LING
„TYPE gOF'WORK=' Q
- :.,
... ::;, .< � :fix � _ ....,.-. a :
c❑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
� � work indicated on this application.
'• y„ CATEGORY OF_CONSTRUCaTION ,
< R �
❑ Valuation:
I-and 2-family dwelling $
Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
Total number of floors:
�JOWSITE'IN JO[tMATIOIV"°AND:LOGAfIUN=' -
Job site address:7850 SW DARTMOUTH RD. New dwelling area: square feet
City/State/ZIP:TIGARD,OR Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:COSTCO-OPTICAL TI Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA�xCO1bIMERCIAG
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
-^w s..tt,. - i- ,>5 A`x:: ,: 'i r�F.. ,'x rc5••x. wE':, i;
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: 9
Additional description of work:
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In
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rvp Li,Elx mmercS
® Wet ❑ Dry
Additional Standpipes
Information: Hazard Group LIGHT
Density1
Design Area
K. Factor 5.6k
Sprinkler Project Valuation: $ 3000
x--
R
T e h Hood Fire Su session=;S stcmx�e:x =�
Hood Project Valuation: $
'-
C ) Fire Alarm
_ ,. z w
OR
Submittal shall BatteryCalculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
UM
p RE
SID. Residential�S rinkler, S,t�nd-Alone:S stein
;fes _ �, ,s - _- A
Square Footage: Permit Fee: -c
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.
7 _..�y...........7.
_ _','
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.
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