Permit (38) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
; 2 . '71 COMMUNITY DEVELOPMENT Permit#: FPS2016-00184
13125 SW Hall Blvd.,Ti Date Issued: 11/09/2016
TfC1I. and OR 97223 503.718.2439 9
Parcel: 1 S 135 BC00700
Jurisdiction: Tigard
Site address: 10831 SW CASCADE AVE
Project: Rose City Futsal Subdivision: None Lot: None
Project Description: Installation of an Ansul R-102 3-gallon fire suppression system into an exhaust hood.
Contractor: UNIVERSAL FIRE EQUIPMENT Owner: ICON IPC PROPERTY OWNER POOL 2 L
18260 SW 100TH CT BY INDCOR PROPERTIES
TUALATIN, OR 97062 2 NORTH RIVERSIDE PLAZA, STE 235
CHICAGO, IL 60606
PHONE: 503-691-9000 PHONE:
FAX: 503-691-9004
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/09/2016 $102.20
12%State Surcharge-Building 11/09/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 11/09/2016 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 11/09/2016 $7.50
Occupancy Grp: A-3 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 $162.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,850.00
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: I Permittee Signature:
/.i
503.639.4175 by 7:00 a.m.for the next ay.'abl: nspection d,e..
This permit card shall be kept in a conspicuous place on the '<. 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 ONI.I
City of Tigard Received ,tt 9 n
g �
Date/By: L` / j 1°- Permit No.: Y/'`�`ao�I., e)/ji
a 13125 SW Hall Blvd.,Tigard,OR 97223- ,i
-d Plan Review �� I ✓'" R< GN a
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: C 1 ` Other Permit:/0Il / ��,._ 1 'j
T I G A ti D Inspection Line: 503.639.4175 Date ReadyB . l��� cis: /0 See Page 2 for
Internet: www.tigard-or.gov OCT 2 5 2016 Notified/Method: f/ V 1� i, Supplemental Information
ify -"----
TYPE OF WWI/OF 1 I(1AR 3 REQUIRED DATA:1-AND 2-FAMILY DWELLING
ew construction IP MOOG DilifSION Permit fees*are based on the value of the work performed.
Indicate the value(romded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling ommercial/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: /a 36 t 5.{uJ C -Sc,9G Ad-C.1, New dwelling area: square feet
City/State/ZIP: ' ,z, /�,, Z_ ,7223
�--' / Garage/carport area: square feet
Suite/bldg./apt.no.: 2 r Project name: Q,3 SGC/ 7 %L y-,5/.- porchq
Covered area square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 1 Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value romded 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.
$
Valuation:
4�i7 ' -1 ii- r te SI-- X-1.1 1�/75 i /O e 79,--.9`/ `% ��r ��c
fi c- :5,,,,P e-SJ /� h 51 S]/Z"-sn-,. / h 1/2) A-4-7Existing building area square feet
ei/h.414.2 S._i- #‘--r.)- ' New building area: square feet
0 PROPERTY OWNER ( -4=LNANT Number of stories:
Name: !S r7 s.. Ci'/.7 , ,_j - / Type of construction:
Address:/pG/ $ ) L,.I-j$G-,
7„6'-� "Ay e.._ Occupancy groups:
City/State/ZIP: Ti.7 ,` OR_, ci'7 a Z 3 Existing:
Phone: 9 (�.4/t.) ( )
p % Fax: New:
LICANT ..
[�.�$NTACT PERSON
NOTICE
Business name: an,V e4,-,9---/ /-7,t-e..... j Yie"-ki<Pr7 74 All contractors and subcontractors are required to be
Contact name: p� ev� (� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:/S72_60 5,x,.1 /co C-I-, jurisdiction in which work is being performed.If the
City/State/ZIP: 1.9.--1-i- applicant is exempt from licensing,the following reasons
Tit.
pg .9 i d 20 6 z apply:
Phone:±57;,j7) 6%/ J.�--D , Fax: : ) G 7/9.04._`J T"
E-mail: —
Lie)at) es S r9-i4S- j 't y/s✓h,..,r/ 4 2a141-Ai- L u it
CLONTliACTOR BUILDING PERMIT FEES*
Business name: "n"-e- 4J-r 416 0 pe-e..._ (P/e Ft•rslertoJeeschedule�
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.: 6 72 3Total permit fees:
Amount received:
Authorized signatur . �!/ i
This permit application expires if a permit is not obtained
Print name: eC=t /„�„��( Date: `Q . /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_071514.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be dons'
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
0 New system Number of sprinkler heads: _ Number of alarm devices:
❑ Addition or 0 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
0 Wet 0 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 ❑ 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: $
I:\Building\Permits\FPS_PermitApp_071514.doc 2
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
10831 SW CASCADE AVE, TIGARD, OR, 97223
Record Type:
Commercial - Fire Protection System
Inspection Type:
999 Sprinkler final
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
FPS2016-00184
Inspector:
Jeff Grove
Contractor