Permit (71) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 1 COMMUNITY DEVELOPMENT Permit#: FPS2016-00126
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 11/02/2016
Tf[;AIFt=� 9
Parcel: 2S 101 BA00101
Jurisdiction: Tigard
Site address: 7500 SW DARTMOUTH ST 110
Project: Joy Teriyaki Subdivision: None Lot: None
Project Description: Fire sprinklers-Add(10)heads for TI
Contractor: COSCO FIRE PROTECTION INC. Owner: WAL-MART REAL ESTATE BUSINESS TR
2501 SE COLUMBIA WAY SUITE 100 BY PROPERTY TAX DEPT STORE 5935-00
VANCOUVER,WA 98661 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 360-816-8418 PHONE:
FAX: 360-883-6390
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/27/2016 $102.20
12%State Surcharge-Building 07/27/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 07/27/2016 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 07/27/2016 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 07/27/2016 $4.00
11x17)
Misc Administration Fee 07/27/2016 $5.00
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 $166.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,200.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / Permittee Signature:
all 503.639.4175 by 7:00 a.m.for the next available i ection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
43uilding Permit Application
Fire Protection System
" ' VF'
City of Tigard *? Received ��
IN
Date By: 74,4_/6 .'/ Permit No.: /2A:904-QC/
13125 SW Hall Blvd.,Tigard,OR 9724 Plan Review
C Phone: 503.718.2439 Fax: 503.59811196(1 2 fb 2016 kit/96,:904,....65,,/7 9
Date/By: Other Permit:
a Inspection Line: 503.639.4175
Date Ready/By: ^ ".
us: I RI See
Page 2 for www.tigard-or.gov s i 'y1Iaa t ;° Notified/Met��7 Supplemental Information rmation
BUIL ii3 (ar, t/ as* ? e �
' *,- 1
a
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
Addition/alteration/replacement ❑Other Indicate the value(rounded to the nearest dollar)of all
,� � �� � Y � equipment,materials,labor,overhead,and the profit for the
�.- b�®,. i l of a t$s 4. • , work indicated on this application.
❑ 1-and 2-family dwelling Commercial/industrial Valuation: $
ElAccessory building ❑Multi-family Number of bedrooms:
❑Master builder ElOther: Number of bathrooms:
ow _ . J I 6 !'41804111),I .. -
0 r * * 3 Total number of floors:
Job site address: 7cc c Ste/ 0.-71 !- o J 1i+ New dwelling area: square feet
City/State/ZIP: ter24-Ak- j) cje._ Garage/carport area: square feet
Suite/bldg./apt.no.: 1/0 I Project name:J t y -T e!yak I Covered porch area: square feet
Cross street/directions to job site: 1 Deck area:
square feet
Other structure area: square feet
, .
Subdivision: I
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
� .� a equipment,materials,labor,overhead,and the profit for the
. ". a a q ,�. work indicated on this application.
VI OF' KIEla.-I t,Et�9LE1 .. P
1( 5 el f1 K.LE 24 . NE Valuation: $ Z 1Z CX 0-0
L-1 o �� t....tt....I L i GFF E x I. I�[?- Existing building area: square feet
OV } A t'I�� e,I til k S -1-E, c New building area: square feet
7 ' u " . p„ ... - 4Number of stories:
Name: -Joy ---reel ye&k 1 Type of construction:
Address:
Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax ( )
New:
Business name: �. j r _'� 1 F . ; ' , � * �:�;
G OSGd RK.F -TEcLit Ofd/ All contractors and subcontractors are required to be
Contact name: Ec �_�(..i-. licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:
ZSV k j c...45,....,_,0,...\1&!!L1 V.!A y jurisdiction in which work is being performed.If the
City/State/ZIP: VAI.1C. WA of a Co 4, applicant is exempt from licensing,the following reasons
Phone: po) 7►8-Sl c , Fax::( ) apply:
E-mail: ..---.1C.-04-/ .l,..ISCZ CaSC-it) eE C..,6p-"
N r. ..- CONTRACTOR Mw 4. -;., BUI D11411b PERMIT FEES .4 .µ >
Business name: , ' (Pleasere ertde
e�selreatale) r
GoSLn 1-12.1=
•
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
D
n
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
El New system Number of sprinkler heads: Number of alarm devices:
Addition or heads: Affidavit required and El1 5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (13-)5
3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
El 11+ heads: Plan review required and [I(36)+ devices: Plan review required and
(3) sets of plans. sets of plans.
Additional description of work:
4
xo, 9
er Type Wet ❑ Dry
Sprinkl
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group pe.O. �2„D
Density
.2-c'
I
Design Area I SL's
K. Factor SC,0
Sprinkler Project Valuation: I $ Z Z�3,`t3
" 4,:,, "'' O� 1r' obi ioe ",fir z .� ,.. ;
Hood Project Valuation: $
ubmittal shall Battery Calculati ❑ Yes
Individual Componentons
include: ❑ Yes
S
Cut Sheets
Fire Alarm Project Valuation: $
�
I)) .enti$ p der( nd 1 one y'Ste't
Square Footage: Permit Feer � '
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 Prot of a Fe
mow= ��„ �
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: $
http://www.tigard-or.gov/document_center/Building/FPS_PermitApp.doc 2
t:
City of Tigard ( /6°_Y) p a E `, Permit No.: nn
5;-v t DD/.
IR 71
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.190, 016 Date Received: 7/8-c/, '
Inspection Line: 503.639.4175JUL_ (D-0-e-
/, �� /�
TIG A R D Internet: www.tigard-or.gov ,i , By: L►`./-C Le14i3 1
FIRE SPI�� AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS OFFICE COPY
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
LIA't4-r 165Zj3,l .c
Project Name: .,-Joy -T'E21y,!,.k t Occupancy: CSD• P• IL
Job Address: 7500 Sw DiTin rP Type of Construction:
Suite:
Contractor: C—' -b ROE P 6-TE?-Trio tJ Phone: ZGo`7 is-Slog
Number of Proposed or Altered Heads: j(3
Type: PE..40E N.tT Hazard:LI&LrT/ofz(). IT Density: .t e5 Zo
I, r occ.e, 1E Pe..6TECTi o t--.1Oregon Construction Contractors Board No. C7c0
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard 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 of this document with a copy of the sketch attached shall be available for all inspections.
Signature: ' / Date: 7/ Z Ilz o 1 Co
Print Nam-. ��F l..
Gr t•—IS ///
I:\Building\Forms\FireSprinlderAffidavit_071514.docx Page 1 of 1
2501 SE Columbia Way,Suite 100
COSCO
- ancouver,Washington 98661
RECP
*••••••' Ph(360)883-6383 Fax(360)883-6390
Fire Protection
JUL 2 6 2016 WA COSCOFP110NM,OR 67508
Transmittal Crr ° ITGARD
Br
July 21,2016
TO: City of Tigard RE: Joy Teriyaki
13125 SW Hall Blvd.
Tigard,OR 97223
503-718-2439
ATTN: Plan Review Cosco Job Number: PS 7444
Enclosed are the following :
Item Number Copies
Fire Sprinkler Plan FP-1 3
Fire Sprinkler Data Sheet 3
Fire Sprinkler Affidavit Application 1
REMARKS:
THESE DRAWINGS FOR:
1 Preliminary Approval
2 As per your request
3 x Your approval and/or comments
4 Fire Department approval
5 Architect's approval
6 For your use
7 Record set for your files
8 Return(X)copies of each print
9 P.E.Stamp
10
11
12
Sincerely,
Copies To: FILE Cosco Fire Protection
Jeff Collins, Project Manager