Permit (141) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2017-00109
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/31/2017
f g Parcel: 2S 101 DA01900
Jurisdiction: Tigard
Site address: 7000 SW VARNS ST
Project: Madrona Recovery Subdivision: VARNS ACRES Lot: 3
Project Description: Fire sprinkler system
Contractor: DELTA FIRE INC Owner: NELSON VIAL LLC
14795 SW 72ND AVE 7155 SW VARNES ST#120
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503-620-4020 PHONE:
FAX: 503-620-1058
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/26/2017 $346.98
12%State Surcharge-Building 07/26/2017 $41.64
Type of Use: COM Plan Review-Fire Life Safety-COM 07/26/2017 $138.79
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 07/26/2017 $4.00
Occupancy Grp: I-1 Height: 30 ft 11x17)
Stories: 2 Info Process/Archiving-Sm$0.50(up to 07/26/2017 $33.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0.1 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $564.91
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $26,000.00
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: /irkPermittee Signature: (-6)--
l�.�rt_
Call 503.639.4175 by 7:00 a.m.for the next available inspect'. date.
This permit card shall be kept in a conspicuous place on the job site until co - •n of the project.
Approved plans are required on the job site at the time of each inspection.
4 7
Building Permit Application
Fire Protection System dry{ �/ FOR OFFICE USE ONEN`
City of Tigard N l l Date/B: �-�c1,�l Permit No.:r��l��Q��O�
- 13125 SW Hall Blvd.,Tigard,OR 97223 Pian Revie r
' '�
Phone: 503.718.2439 Fax: 503.598.1960)U L 1 9 2.017 Date/By: � Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: 4. Jure ® See Page 2 for
Internet: www.tigard-or.gov CITY
OF:T IGARD Notified/Method7,/,',7
' /O? Supplemental Information
1)11 1 V I ♦ r t-- '-cc
m
t Pw TYPE O�. U ..--.A.54.-C:�x- ��r a 1 o DATA:1AND 2-LI p' Ii.Y D +G
❑New construction El 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 ❑Other: equipment,materials,labor,overhead,and the profit for the
,,,,,,,,,',-...,,p„,,,, r / work indicated on this application.
'''''''.-451'4'''t
x x p,,,": CATEGORY C01 a :<O ' ''s 4
o 1-and 2-family dwelling ®Commercial/industrial Valuation: $
ElAccessory building IIIMulti-familyNumber of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
y., Tr p; L Total number of floors:
JOB SrrE SONS T C1CA3101
Job site address:7000 SW Varns Road New dwelling area: square feet
City/State/ZIP:Tigard,OR Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Madrona Recovery Center S Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
11.0) DATA:CONLMERC4L44 CIIEC A kJ,
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
DESCRIPTIONI,Ok WO j :;` work indicated on this application.
Installation of fire sprinkler system Valuation: $$26,000.00
Existing building area: square feet
New building area: square feet
. 0
PROPERTY ON p , ►e TENANt v Number of stories:
Name:Madrona Recovery Center South Bldg. Type of construction:
Address:7000 SW Varns Road Occupancy groups:
City/State/ZIP:Tigard,OR Existing:
Phone:( ) Fax:( ) New:
r iis It'll
s ,A S r
� K
,
'7.''''../.';',,74,';': eApp ! CONTACT4.O1 ,,142 ''
.
Business name:Delta Fire,Inc. All contractors and subcontractors are required to be
Contact name:Melissa Boughton licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:14795 SW 72nd Ave. jurisdiction in which work is being performed.If the
City/State/ZIP:Portland,OR 97224 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)620-4020x118 Fax: :(503)620-1058
E-mail:melissab@deltafire.com
y 0 . 1t3O PERMrt .
Business name:Delta Fire,Inc. .. ieillereferto feeseh ;
Permit fee:
Address:14795 SW 72nd Ave.
State surcharge(12%of permit fee):
City/State/ZIP:Portland,Oregon 97224 0
FLS plan review(40%of permit fee):
Phone:(503)620-4020 Fax:(503)620-1058 (Due upon application submittal.)
CCB lic.:64174 a-/i///t7 Total permit fees:
Amount received:
Authorized signature: —te°\A(St\i —
This permit application expires if a permit is not obtained
Print name:Melissa Boughton Date:7-18-17 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
tribe WQ to b die mh
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 ❑ 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 o Sy te£i ( omplefe i, B r;;. app ca Ie) •-
Sprinkler Type jg Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line S' Yes ❑ No
Hazard Group L-r"
Density 0.1
Design Area /50 O
K. Factor 5,(p
Sprinkler Project Valuation: $ a(otpve)
�:r StfP' S*40Il S,iterYi; u 007
Hood Project Valuation: $
4/µ Je ,741
4 €' � i � Y.�� nom
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
lIte§ida41 gliri#C11(S�&r }Mon+ / , ' 4n
Square Footage: Permit Fee: M
0 to 2,000
$198.75
2,001 to 3,600 $246.45
3,601 to 7,200i ' .
$310.05
7,201 and greater $404.39 :=
Sprinkler Project Square Footage: sq. ft.
n.
r .'�. t ,.. ' Tre f#esti• P j 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: $
S:AContract File\175707 Madrona Recovery Ctr\Permit\Tigard Permit application-Soutt.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
7000 SW VARNS ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00109
Inspection Type: Inspector:
999 Sprinkler final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor