Permit (44) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
. COMMUNITY DEVELOPMENT Permit#: FPS2016 00113
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/01/2016
Parcel: 1 S135CB00100
Jurisdiction: Tigard
Site address: 10130 SW NORTH DAKOTA ST
Project: Koi Fusion Subdivision: None Lot: None
Project Description: Type 1 hood suppression system.
Contractor: UNIVERSAL FIRE EQUIPMENT Owner: NATIONAL SAFETY COMPANY
18260 SW 100TH CT 17010 SW WEIR RD
TUALATIN, OR 97062 BEAVERTON, OR 97007
PHONE: 503-691-9000 PHONE:
FAX: 503-691-9004
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/01/2016 $102.20
12%State Surcharge-Building 08/01/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 08/01/2016 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 08/01/2016 $7.50
Occupancy Grp: A-2 Height: ft 11x17)
Stories: 1
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 $162.84
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
issua , ' ,ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted b the Oregon
U'ity Notification C-,er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a c ../of the rules
r direct questions to OU •, • • -03.232.1987 or 1.800.332.2344.
Issued By: 04
Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available'n ,-ction 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 System ,Q ; ..1 FOR OFF ICI. FSE OyLY
, .,
Cl of Tigard t .�1 Received
City g / Permit No.:
'� 13125 SW Hall Blvd.,Tigard,OR 97223 PlanReview
Date/By: 7 �l /(/ �i��?o��p�� /3
,11114 g Plan Re ►+f 7(�t
Phone: 503.718.2439 Fax: 503.598.1f)[6f t ; Date/By: t` �t ( `, Other Permit:
T I G n R u Inspection Line: 503.639.4175 I ( _1J I P Date Ready/By: - runs: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method ?IA, Supplemental Information
TYPFO 6F �i ' 1 `i•L REQUIRED DATA:1-AND 2-FAMILY DWELLING
ew construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(romded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling mmercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address 0/30 /0,44 Z3#Ah f New dwelling area: square feet
City/State/ZIP: Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:``�:.73-- -1.-1,, 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: 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.
Valuation:
12,0- ,52, 4.1-r-'
.rY.57139-are/47Q-n--1 - /g"7 s-•=t-i k-ifs Zr
4/�s" .,>-„. //0, J L'� 5'c�5.1,t-,.„� Existing building area square feet
6
e r New building area: square feet
El PROPERTY OWNER Ir>r1vANT Number of stories:
Name: K-0 2 1-K 5/1-r-1 Type of construction:
Address:/4)/3 j A/0-11-46) ® 5v,f, Occupancy groups:
City/State/ZIP: 1 I3.X-.[ �y�
City/State/ZIP: / �] � , 5 7 zG. .3 Existing:
Phone ) Ul--,-.16�7 Fax:( )
� � New:
FPLICANT ❑�1‹:4 CT PERSON NOTICE
Business name: ,+ 'rer -"EL ,m,Y, i" All contractors and subcontractors are required to be
Contact name: 6-v4.7 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:'-/Gs..4./ L &l_ t'7c)
i applicant is exempt from licensing,the following reasons
✓ apply:
Phon s3) .7J f, -e,
Cr -4) Fax:,i�';l3) 6,/—,0-0K
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: .. 0-.`, I y, (Please refer to fee schedule)
� Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%ofpermit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: {j '2 3 Total permit fees:
Authorized signature: Amount received: --
This permit application expires if a permit is not obtained
Print name: e + Date: 7- y� within 180 days after it has been accepted as complete.
���JJJ * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp 0 1514.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 El 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: $
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