Permit (116) CITY OF TIGARD74
FIRE PROTECTION SYSTEM PERMIT
' COMMUNITY DEVELOPMENT Permit#: FPS2017-00157
TtGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/12/2017
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Fire sprinkler permit:Adding and relocating a total of(6)sprinkler heads for Starbucks kiosk within Safeway.
Contractor: FIRE SYSTEMS WEST INC Owner: ROIC OREGON LLC
600 SE MARITIME AVE#300 ATTN: SCHOEBEL, RICHARD
VANCOUVER, WA 98661 8905 TOWN CENTRE DR, STE 108
SAN DIEGO, CA 92122
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/12/2017 $112.96
12%State Surcharge-Building 10/12/2017 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 10/12/2017 $45.18
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 10/12/2017 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: NO Hazard: LT
Density: .10 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 $172.20
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $4,000.00
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 503.232.19: .r .800. 2344.
r
Issued By: ,
Permittee Signature:
_...e" ...ciiie---- ..iiiitgel. ao ..411,11111,
Call 503.639.4175 by 7:00 a.m.for the next available insp•!tion date. ailliw _
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
--Ficee Protection System FOR OFFICE USE ONLY
City of Tigard Received
Permit No.: - I 7
13125 SW Hall Blvd.,Tigard,OR 97223 .A., Plan Review .
Other Permit:
I A
: I Pinhonece:ti5n03L.7inle8..254033963F9a4x1: 503.59 r75ei\I EU
DDaatete/BRea:Ready/By: -; See Page 2 for
I l.;A R D
Internet: www.tigard-or.gov Notified/Method: r Supplemental Information
7
,4YTE.OF WORK .., ,''. -1'•: ,kr= ,,,. ,,,,,,- *C.', : .-,.- .,,4 REQUIREDPattkl-'114Pr-tugwrmY„FLLING
'
Li, ' etagn9, 0.11?„ilic,,rmti Permit fees*are based on the value of the work performed.
New construction ‘.-311-,)1v/ "-"' Indicate the value(rounded to the nearest dollar)of all
El Addition/alteration/rePlacement EI.Ilelffer: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF '60i4sTRbeil6N: '''-
work indicated on this application.
Valuation: $
El 1-and 2-family dwelling El Commercial/industrial
Number of bedrooms:
0 Accessory building El Multi-family
Number of bathrooms:
El Master builder 0 Other:
10B srri)Nioin4A,—,fio AND LOcArKiN', ' A.., ,, ,,,,, _ .., Total number of floors:
Job site address:15570 SW Pacific Highway New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:Safeway#1478 Starbucks Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: il,41 i RCIAL-USE CHECKLIST
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF "iVORE , 4" . 4,-4, ' 14 4' - 'w work indicated on this application.
Valuation: $$4,000.00
Add/relocate heads in tenant improvement
Existing building area: square feet
New building area: square feet
0 pRopskTV glivNEit 1,- 1,,,,, ,w..- 4 c ,,,,, ,- ' -,., 0 TENANT, „, 1:,' '' - Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
1'APPLICANT- 1-'1 ‘'' .:, ' ' ' '6 CONTACT'pERgbrsf ' '., 1/4p. 4.,, N .,„, -ft- NOTICE
.
Business name:Fire Systems West All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:Jackson Zeiner under ORS 701 and may be required to be licensed in the
Address:600 SE Maritime Ave jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:Vancouver,WA 98661 apply:
Phone:(360)693-9906 I Fax::( )
E-mail:jacksonz@firesystemswest.com
CONTRACTOR ' ' ' ' '.4 '' =,„ k,, ' ' ,,,BUILDING rEumg,FEES*
'.(Pkithe'ilfiiio fee schedule)
Business name:Fire Systems West Permit fee:
Address:600 SE Maritime Ave State surcharge(12%of permit fee):
City/State/ZIP:Vancouver,WA 98661 , FLS plan review(40%of permit fee):
Phone:(360)693-9906 I Fax:( ) (Due upon application submittal.)
CCB lie.:49732 Total permit fees: 7) ,0/
/ 6 1
(-; Amount received:
Authorized signature:2,, ,,--, 7
/ 2
• / ------- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
I Print name:Jackson Zeiner I Date:10/12/17
I * Fee methodology set by Tri-County Building Industry
Service Board.
1:\Bui1dingTeI1uits\FPS-Perm1tApp_031016.doc 440-4613T(11/02/COM/WEB)
Protection Permit Checklist
mation e
"^�Z" a �, ' * i cae3s' �` t k' s.' '°` -• r a � x t
,) Addition/alteration only to spriinkler heads: 3.) Addition/alteration only to alarm devices:
Number of sprinkler heads: X� Number of alarm devices:
al 1-10 heads: Affidavit required and El 1-5 devices: Affidavit required and
(3) copies of sketch showing area (3) copies of sketch showing area
,€ulg of work within building structure of work within building structure
system
❑ 11+heads: Plan review required and ID6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
� > as' r" a
' ` � . i4 -Additional description of work: �ANa. ra."I
s[
Sprinkler Type Wet El Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group 1.....; cjl
Density , i
—
Design Area
K.Factor r.k.
,
Sprinkler Project Valuation: $ /00 0
,` X ''''.."I''''':;'''
1w e, si €2��t 1€ i{ .> g xa r,''
Hood Pro'ect Valuation: $
`'-`4 ''' ko a`-' �' ''' v' k-t�, ' S
� vi.
Submittal shall Battery CalculatiEl Yes
include: Individual Componons nt e ❑ Yes
i
Cut Sheets
Fire Alarm Project Valuation: $
F y" r "`2` &t c t y e ' - 'b - r e '-::-.7' m „ "' r - '41-101e444144'.'1';41
1e y
Square Footage: Permit Fee:
198.75 _
0 to 2,000 $ x '
2,001 to 3,600 $246.45 ;11 � �
-,,t-
3,601 to 7 200 $310.05
7,201 and : eater $404.39 :: 4, '
Sprinkler Project Square Footage: sq,ft.
a s-'''''''''''
S- S 4+s.- k -
n a 4.w, .. . .sr x..a.�_ .< .. :1" ,°",. G f R L44 1:---
.'i.Y- . - } --
'
,,,,:,,,c
�s �a
Project valuation subtotal (see A,rB&C above): $
Permit fee based on roject valuation see fee schedule : $
Permit fee bas • .• , ••
State Surcharge (1 .o o permit ee
FLS Plan Review(40% of permit fee): $
TOTAL: $
2
I:\Building\Permits\FPS_PermitApp_031016.doc
Cityof Tigard RECEIVES Permit No.: FAS
00? cc I5 7
III
13125 SW Hall Blvd.,Tigard,OR 97223
V Phone: 503.718.2439 Fax: 503.598.1960( T 017 Date Received: a ti l; 17
Inspection Line: 503.639.4175
T I G A R D Internet: www.tigard-or.govU u"t
+�iT1°OF ����A �.> By: /3,?vvr.te".i r�,9 ,r+--
BUILDING DIVISION
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Safeway #1478 Starbucks Occupancy:
Job Address: 15570 SW Pacific Highway, Tigard OR Type of Construction:
Suite:
Contractor: Fire Systems West Phone: (360)693-9906
Number of Proposed or Altered Heads: 6
Type: Hazard:Light Density:
i, Jackson Zeiner Oregon Construction Contractors Board No.49732
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.
0
Signature: A ., ------ - Date: 10/12/17
Print Name: ackson Zeiner
I:\Building\Forms\FireSprinklerAffidavit_071514.docx Page 1 of 1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15570 SW PACIFIC HWY, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00157
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor