Permit (68) CITY OF TIGARD74
FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00132
TfGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/06/2016
Parcel: 2S 103 DD00850
Jurisdiction: Tigard
Site address: 13815 SW PACIFIC HWY 110
Project: Blazing Gyros Subdivision: None Lot: None
Project Description: Installation of UL300 wet chemical fire suppression system to protect Type I exhaust hood.
Contractor: HUSER SALES&SERVICE INC Owner: D W SIVERS CO
231 N TILLAMOOK ST 4730 SW MACADAM AVE#101
PORTLAND, OR 97227 PORTLAND, OR 97239
PHONE: 503-248-1948 PHONE:
FAX: 503-248-7077
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/06/2016 $112.96
Type of Use: COM 12%State Surcharge-Building 09/06/2016 $13.56
Plan Review-Fire Life Safety-COM 09/06/2016 $45.18
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 09/06/2016 $5.00
Occupancy Grp: A-2 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 $176.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,900.00
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. ' I ty Codes and all- other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work . o tailed within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow h I adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y.0 m y btain y of the rules
or direct questions to OUNC by calling 503.232.1•: •r .:iv.332.2344.
Issued By: Aztz/" l Permittee Signature: I'
/
all 503.639.4175 by 7:00 a.m.for the next available inspect•n d.
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 FOR OFFICE USE ONLY
CI of Tigard � 't ' ... Receivedt ^�: /2f 2 6 -P' "
g Date/By: ad/,W Permit No.� f�
111111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie
' (illOther Penni
� Phone: 503.718.2439 Fax: 503.598.1960 JJ L 2 8 2016 Date/By. (' 0 I, � 1� �t1eA,/6-h6,173,
7 I ,A It D Inspection Line: 503.639.4175 Date Rea. . . .loris: H See Page 2 for
Internet: www.tigard-or.gov i r I , 1 . Notified/Method LoSupplemental Information
1 i , 3 ` ' ,''''''"`',6%..l+
lol/(o
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING.'.
New construction 0 Demolition Permit fie-.*are based on the value of the work performed.
` Indicate the .lue(rounded to the nearest do'"ar)of all
❑Addition/alteration/replacement 0 Other: equipmdnt,ma.-rials,labor,overhead,an. he profit for the
. CATEGORY OF CONSTRUC' ION workindicated o this application.
" ,
❑ 1-and 2-family dwelling Commercial/industrial Valuation: $ 3
❑Accessory building 0 Multi-family Number of bedroom
❑ Master builder 0 Other: Number of bathroom
JOB SITE INFORMATION.AND LOCATION " Total number of floo
Job site address: i*is S Parr (r N►4y ' New dwelling ar-.: square feet
City/State/ZIP: T , 1ZU 0(2_ q '7 223 3 / /3te7/A/6 Garage/carpo area: square feet
Suite/bldg./apt.no.: //o Project name: I .L 00 r 6 y/c o-c Covered p• ch area: s,uare feet
Cross street/directions to job site: SW IA OorJJ LO i
pjcrf?c,, 1.1(A))/ Deck .;;t: squa - eet
Other structure area: square feet
.REQUIRED DATA:COMMERCIAL-USE CHEC .IST
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
T SCOPYI0N P MOIt( work indicated on this application.
SN Si ALL. A L3Oo 4P?,2'Eo GJ£.1 CZI(M L- S�l�EValuation: $ 3
CiOD
IA) YES 1 f f/.$) OO Existing building area: square feet
New building area: square feet
'RO$RTY OWNER , TEN ., Number of stories: 1
Name: MIKE Type of construction:
Address: I;DISSltd) pitat✓ Jy Occupancy groups:
City/State/ZIP: 15 6 D &R., 17��.by/ Existing:
Phone:( Q ) � C��_��� Fax:( ) New:
t:�55�/'' .�
4. APPLICANT CONTACT:PERSON"
p�
Business name: Nu.,, f(2 5g L“f 5mit,c G All contractors and subcontractors are required to be
Contact name: 04 j Kim. licensed with the Oregon Construction Contractors Board
IJ Imo^ under ORS 701 and may be required to be licensed in the
Address: 2.s 1 iu . -1)1,1..) �0 sr jurisdiction in which work is being performed.If the
City/State/ZIP: P vO o.� Zr.-Z:.) applicant is exempt from licensing,the following reasons
[���'- /)''f apply:
Phone:
5.0S Zy8-' /7t Fax: : C8) 29 70
E-mail:
CONTRACT,
� : � �:H1}lL,D11�VV!G PERMIT FEES*
x... Mem refer EPfee schedu ). w
Business name:
tYt(vw G;;Ls. 4 Y17,.
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP:
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: //6 / <Alt t %�` Pi2o L Total permit fees:
Authorized signature: 001)/ ,
Amount received:
This permit application expires if a permit is not obtained
Print name: ijI c , xt@4 � Date: 1 6�� 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_031016.doc 440-4613T(11/02,COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done: ;1/4
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:
Typesof System (Complete A,B,C or I) applicable),
A.) Commercial Sprinkler``
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
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: $
rr� D.) Residential Sprikler(Stand Alone System)
t
Square Footage: Permit Fee: � iz ii
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.
�;<rc� otecti+�t;i.Ise k�'e�� ' �
n t k.
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: $
l:ABuilding\Permits\FPS_PermitApp_031016.doc 2
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
13815 SW PACIFIC HWY 110, TIGARD, OR,
97223
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
November 2, 2016 at 10:15:51
AM
FPS2016-00132
Chip Barnett
Test approved on October 10th by Jeff Grove
Violation Summary:
Inspector Contractor