Permit (22) CITY OF TIGARD111
FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016 00182
Date Issued: 10/24/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126CC00200
Jurisdiction: Tigard
Site address: 10065 SW CASCADE AVE
Project: Toys R Us Subdivision: None Lot: None
Project Description: Replace 4"backflow device on fire sprinkler system.
Contractor: UNITED FIRE HEALTH&SAFETY EQUIPMENT CO IN Owner: GIRAFFE PROPERTIES LLC
4611 NE MARTIN LUTHER KING JR BLVD BY TOYS"R"US
PORTLAND, OR 97211 ONE GEOFFREY WAY
WAYNE, NJ 07470
PHONE: 503-249-0771 PHONE:
FAX: 503-249-0572
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/24/2016 $123.72
12%State Surcharge-Building 10/24/2016 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 10/24/2016 $49.49
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
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 $188.06
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $4,200.00
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 calling 503.232.1987 or 1.800.332.2344.
Issued By: er Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next availab = ins vection date.
This permit card shall be kept in a conspicuous place on the jo sit- ntil completion of the project.
Approved plans are required on the job site at the - of each inspection.
,
I,&JI -- S/f 41/,v-' 7
Building Permit Application cEivrEp
ire Protection System JAI'
F
FOR OFFICE USE ONLY
71 City of Tigard 0 C 1 2 4 2016
Received
Dana : ®0 f/ Permit N �S7/� QOIo2,
13125 SW Hall Blvd.,Tigard,OR 97223 n
C Plan Revie
Other Permit:Phone: 503.718.2439 Fax: 503.598.16 t ". ` f . Date/By:
.Ins
Inspection Line: 503.639.4175 Date Ready By: lg
H See Page 2 for
Internet: www.tigard-or.gov BUILDINGDIVISION Notified/Method: Supplemental Information
ME Oli WORK JIEQIIIREDDATAI 1 ANI12 FAM y.OW LLI1!iO..:
❑New construction 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
TEGORY.O CO TRUCTION' work indicated on this application.
0 1-and2-famil Y wellin dValuation: $
g ®Commercial/industrial
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB"SITE INFORMATION..AND LOCATION,N Total number of floors:
Job site address:10065 Sw Cascade Blvd. New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Toys R Ussw Covered porch area: square feet
Cross street/directions to job site:SW Schools Ferry Road Deck area: square feet
Other structure area: square feet
;1 IRZD D4TA:[ MM ML.)S IRC KLjsT
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 WORE work indicated on this application.
Replace 4"Back Flow Device on Fire Sprinkler System Valuation: $4,200.00
Existing building area: square feet
New building area: square feet
0 PROPERTY:OWNER: ►a-TENANT Number of stories:
Name:Toys R Us Type of construction:
Address:10065 Sw Cascade Blvd Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:(503)620-9779 Fax:( )
New:
P''' APPLICANT 0 CONTAt T.PERSON NOTICE
Business name:United Fire and Safety All contractors and subcontractors are required to be
Contact name:Joe Knighton licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:4611 NE M.L.K.Jr.Blvd. jurisdiction in which work is being performed.If the
City/State/ZIP:Portland,OR 97211 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)249-0771 Fax: :( )
E-mail:joek@unitedfireandsafety.com
PW11RAC"TOR. .
Business name:United Fire and Safety :f' f # ryt
Permit fee: /
Address:4611 NE M.L.K.Jr.Blvd.
1r /,a
City/State/ZIP:Portland,OR 97211 State surcharge(12%of permit fee): Al I e7J'
FLS plan review(40%of permit fee): ��
Phone:(503)249-0572 Fax:( ) (Due upon application submittal.) /!• y f
CCB lic.:65290 Total permit fees: /ff`, 0(I
Authorized signature: Amount received:
i
� This permit application expires if a permit is not obtained
Print name: e i ghton Date:10-24-2016 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.doe 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 El 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 El 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type of System (Complete.A,B,.Cor I) as applicable
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet El Dry
Additional Standpipes
Information: Sprinkler Supply Line El Yes El No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.)" Type - Hood Fire Suppression SYsiz
Hood Project Valuation: $
C) Fire Alarm
Submittal shall Battery Calculations 0 Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprier(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: $
C:\Users\Ed\Downloads\FPS_PermrtApp.doc 2