Permit a
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permitf: FPS2016-00003
Date Issued: 01/07/2016
s 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 101 BA00101
Jurisdiction: TIGARD
Site address: 7500 SW DARTMOUTH ST 190
Project: Which Wich Subdivision: WEST PORTLAND HEIGHTS Lot:
Project Description: Fire alarm for new tenant: Add(1)and relocate(2)fire alarm horn strobes.
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 01/07/2016 $56.47
12%State Surcharge-Building 01/07/2016 $6.78
Type of Use: COM Plan Review-Fire Life Safety-COM 01/07/2016 $22.59
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 01/07/2016 $2.50
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: Yes Alarm Type: Automatic
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $88.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $685.00
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. / p
Issued By: /// Permittee Signatu
Alll SSSCCCre: �\ ``A //l 4J,
.G,
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 Application
Fire Protection System RECEIVED
Cl OtTI Tigard Received Permit No
•J g p Date/B : 7 C0�(�"eee�
• 13125 SW Hall Blvd.,Tigard,OR 97223 7 'to'i6 Plan Revie
Phone: 503.718.2439 Fax: 503.598.1960 JAN _ Date/B Otherpennhtt17
Inspection Line: 503.639.4175 Date Ready/By: m.i,: 13 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION _
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 CONSTRUCfION work indicated on this application.
❑ I-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: ftZA New dwelling area: square feet
City/State/ZIP: 'T•I y C� U Z �') X13 Garage/carport area: square feet
Suite/bldg./apt.no.: Project time: o L&)n i c.l-. - vV Covered porch area square feet
Cross street/directions to job site: Deck area: square feet
W frl rwt?it-a- OUT { 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(routded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
�7
f Valuation: $ /_U 5 OV
NSC9l � IZX lY L
I HQ.i, Imo+ _J 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:
❑ APPLICANT CONTACT PERSON NOTICE
Business name: Por V-c � All contractors and subcontractors are required to be
Contact name: , �\ N S atf licensed with the Oregon Construction Contractors Board
_ ` under ORS 701 and may be required to be licensed in the
Address: `�`3�pj NV 3T M4,, I2v jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:
Rh L'00 Y t2 W Yr L(-- apply:
Phone:()6o) Ito& Fax: :(3�,L 573 -, 77Z3
E-mail:
CONTRACTOR BUILDING PERMIT FEES-
P(tars
Business name: �-'C�� I.¢.lJ("'K� x.1.71✓ ab tee
-�� II Permit fee::
Address: -732b No- ST � h, 3 K--t� State surcharge(12%of permit fee):
City/State/ZIP: gN(,0 V r4Z VJ A 9 8 (G(p FLS plan review(40%of permit fee):
Phone:O 5-7L/ Fax:(XQ) S73 3,7-23 (Due upon o lication submittal.
CCB lic.: % -7 Total permit fees:
/
Authorized signature: Amount received:! ?
This permit application expires if a permit is not obtained
Print name: K'fAie &q, Date: `— �'�� within 180 days after it has been accepted as complete.
" Fee methodology set by Tri-County Building Industry
Service Board
I\11ui1dingTcmmTPS-Pm it pp 071514 doe 440-0 13T(1IIOV(70 /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:
T e of S tem (Complete A,B, C or D as a &cable
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 Batte Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler(Stand Alone System)
S uare 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 onsquare footage see D above): $
State Surcharge 12%of permit fee): $
FLS Plan Review 40% of permit fee): $
TOTAL: $
1:ABuilding\PemvtsVPPS_PermitApp_071514.doc 2
RECEIVED
• City w H 1 Ba daTigard,OR 97223 JAN 7 2016 Permit No.: .So2Q/ --DO 0 03
Phone: 503.7182439 Fax: 503.598.1960 - Date Received: ZZ
Inspection Line: 503.639.4175 CITY OF TIGARD
Internet: www.tigard-or.gov BUILDING DWISIONBy:
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Which-With (Wal-Mart Out Bldg) -# I9C) Occupancy: Commercial
Job Address 7 5W 5W Dartmouth St 97223 Suite: "Which-Wich Sandwiches"
Contractor: PORTER Electric Inc Phone: 360-574-1366
Valuation of work: $685.00
Type of System: (check one) [KRequired ❑Non-required
(check one) QAutomatic ❑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) 2
1 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.
Signature: S w22 Date: 12/21/15
Print Name: BIII Robinson
1:\Building\Forms\FireAla=Affidavit_0715I4.dmx Page I of I
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
7500 SW DARTMOUTH ST 190, TIGARD, OR,
97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2016-00003
Jeff Grove
Violation Summary:
Inspector Contractor