Permit (176) a CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00017
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/04/2016
Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 3
Project Description: Adding(1)and relocating(2)sprinkler heads for Food court alteration. Affidavit submitted and approved for
application.
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 02/04/2016 $112.96
12%State Surcharge-Building 02/04/2016 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 02/04/2016 $45.18
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 02/04/2016 $2.00
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: ORD1
Density: .15 Design Area: 130
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Cates Provided: Cut Sheets Required:
Total $173.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,974.00
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 ifwork is not ed within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you follow the es adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-0 009 You��ayto copy of the ru s
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Perms 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.
Building Permit Application
Fire Protection SystemsFOR OFFICE USE ONLY
City of Tigard Received
DateB : � Permit No.: � _ 7
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
= Phone: 503.718.2439 Fax: 503.598:- q 4 Z016 Date/By: Other Permit: ?go S
Inspection Line: 503.639.4175 11 tLv Date Ready/By: Juris: Rr See Page 2 for
Internet: www.tigard-or.gov ( Notified/Method: Supplemental Information
t il'Y ,.
TYP 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
El Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwellingValuation: $
®Commercial/industrial
❑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:7850 SW Dartmouth New dwelling area: square feet
City/State/ZIP:Tigard,OR Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:Costco Food Court Remodel Covered porch area: square feet
Cross street/directions to job site:SW Dartmouth St.and 99W Deck area: square feet
Other structure area: square feet
REQUIRED',DATA:COMMERCIAL USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Add(1)and relocate(2)fire sprinkler heads for tenant improvement. Valuation: $$3,974.00
Existing building area: 145,12square feet
New building area: 910 square feet
❑ PROPERTY OWNER` ❑ TENANT' Number of stories: I
Name: Type of construction: V-B
Address: Occupancy groups:
City/State/ZIP: Existing: OHI
Phone:( ) Fax:( ) New: OHI
❑'APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax::( )
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name:Fire Systems West Please refer to fee schedul
Permit fee:
Address:600 SE Maritime Ave.,Suite 300
City/State/ZIP:Vancouver,WA 98661 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(360)693-9906 Fax:(503)289-2208 Due upon application submittal.
CCB lic.:49732 Total permit fees: Z�
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name:Dan Furno Date:2/3/16
within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PermitApp_071514.doc 440-4613T(I 1/02/COM/WEB)
Cit3wf Tigard: Fire Protection Permit Checklist
-Page 2- Supplemental Information
Desc'fibe'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: 3 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 System (Complete A, B,C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density .15
Design Area 130 sq. ft.
K. Factor 5.6
Sprinkler Project Valuation: $ 3,974.00
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)
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 onsquare footage see D above): $
State Surcharge 12%of permit fee): $
FLS Plan Review 40% of perrmit fee): $
TOTAL: $
C:\Users\Daniell:\Downloads\FPS_PermitApp(2).doc 2
City of Tigard Permit No.: 7
a 13125 S50 Hall Blvd.,Tigard,OR 9 *'E a f yht.
� Phone: 503.718.2439 Fax: 503.59 �.•..; - Date Received:
Inspection Line: 503.639.4175 �—
Internet: www.tigard-or.gov By: d�LtI qGn
FEB 4 2016
FIRE SPRIJTAVIT FOR ALTERATIONS
01TWAMI iPROVEMENTS
(I to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: LpS+CO TUQnlyJFoA Cpwr+ Occupancy: TO(o(J 17(feP
Job Address: 7$5-0 5W 'POAMO Type of Construction: �01- CpvrlW 51 W 2
Suite:
Contractor: poY2 West Phone:
Number of Proposed or Altered Heads: 3
Type: 5$17 Hazard: Q N Density:
I, RtA TKV-00 Oregon Construction Contractors Board No.
certify the following is true and reasonably defines the scope of work for this project:
v 1i I
a) All work is limited to drops and armovers in a lig*A-howwd-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 this docu t with a copy of the sketch attached shall be available for all inspections.
Signature: Date: Z
Print Name: 120 VI �1
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