Permit (112) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I COMMUNITY DEVELOPMENT Permit#: FPS2018-00102
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/20/2018
Parcel: 2S103DD01100
Jurisdiction: Tigard
Site address: 13939 SW PACIFIC HWY
Project: Providence Retail Clinic Subdivision: None Lot: None
Project Description: Add(4)pendent fire sprinklers for tenant improvement.
Contractor: COSCO FIRE PROTECTION INC Owner: WALGREEN CO#5780
2501 SE COLUMBIA WAY SUITE 100 PO BOX 901
VANCOUVER,WA 98661 DEERFIELD, IL 60015
PHONE: 360-816-8418 PHONE:
FAX: 360-883-6390
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/20/2018 $102.20
12%State Surcharge-Building 08/20/2018 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 08/20/2018 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 08/20/2018 $18.50
Occupancy Grp: M Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard:
Density: 1500 Design Area: 257
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 $173.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,172.00
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:
Call 503.639.4175 by 7:00 a.m.for the next available inspection 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.
Building Permit Application
Fire Protection System jEG FOR OFFICE ESE ONLY
City of Tigard
Received
/ .ennit No.
r 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 2 0 2018 Date B : �i ,�
g Plan Review n,
Other Per..tY. 4
Phone: 503.718.2439 Fax: 503.598.19E044
Date/B : c-/ —pe/�
t
TCGAKD Inspection Line: 503.639.4175 Ut FY 01-- Date Ready/By: Juris: ® See Page 2 for
C !p
Internet: www.tigard-or.gov F31,1 nivlstce Notified/Method: Supplemental Information
TYPE 011i�'WO' ' '' 1 REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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
x❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
� ' CA CATEGORY OF CONSTRUCTION-- work indicated on this application.
0 1-and 2-family dwelling ®Commercial/industrial Valuation: $
ElAccessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
• JOB SITE INFORMATION ANI).LOCATION" Total number of floors:
Job site address: 13939 SW Pacific Hwy. New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Providence Express Care-Tigard Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
99W and SW Gaarde St. Other structure area: square feet
REQUIRED DATA;COMMERCIAL-USE CHECKLIST
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 WORK work indicated on this application.
Add pendent fire sprinklers for tenant improvement. Valuation: 2,172.00 $
Existing building area: square feet
New building area: 257 square feet
❑ PROPERTY O 1'NER
ry r ❑ TENANT' Number of stories: 1
Name: Type of construction: Non-combustible,unobstructed
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New: Light Hazard
❑LAPPLICANT 0 CONTACT PERSON i ; "
1 ',NOTICE
Business name: Cosco Fire Protection All contractors and subcontractors are required to be
Contact name: Dan Furno licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 2501 SE Columbia Way,Suite 100 jurisdiction in which work is being performed.If the
City/State/ZIP: Vancouver,WA 98661 applicant is exempt from licensing,the following reasons
apply:
Phone:( 360 ) 883-6383 Fax: :( 360 ) 883-6390
E-mail: dfurno@coscofire.com
- �'." CONTRACTOR r . BUILDINGP)R T FEES*
Business name. Cosco Fire Protection (Please refer iosekertule)
Permit fee:
Address: 2501 SE Columbia Way,Suite 100
State surcharge(12%of permit fee):
City/State/ZIP:Vancouver,WA 98661
FLS plan review(40%of permit fee):
Phone:(360 ) 883-6383 Fax:( 360 )883-6390 (Due upon application submittal.)
CCB lie.: 67508 Total permit fees:
Authorized signature: 'aw Furw
r- -
Amount received:
This permit application expires if a permit is not obtained
Print name: Dan Furno Date: 8/20/18 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
Desch o. • #P b don i�_a��ii1M(" ' - Iji: ` �i r 6 p�
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: 4 Number of alarm devices:
x❑ Addition or ® 1-10 heads: Affidavit required and 0 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 0 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
a of S stetm Com
�teC or:Daapplca,� j, ,
1.7
lP _ - -: P J�___.A�, ii hi, lii�
A.)-11.Commercial Spwnl e .� .
Sprinkler Type x❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes 0 No
Hazard Group
Density .10/1500
Design Area 257 sq.ft.
K. Factor K5.6
Sprinkler Project Valuation: I $ 2,172.00
-TypoI 'H i .. 5 uppressics ''
Hood Project Valuation: I $
XPi��i i�9 i l., im9�luillLilU iat
C.) Fire Al 'ilJINN ;
Submittal shall Battery Calculations 0 Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: I $
-11111112ARigingt 011P,-;;Nr . 5:
itial Sprinkler (Stand Alone System) '11�1 1111100
1 �,0
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 hP��: G oryia w
Sprinkler Project Square Footage: sq. ft.
Vai' -Fite Protection Permit Pees::
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_031016.doc 2
RECEIV
RECEIVED
City of Tigard AUG 2 0 2018Permit No.: !LT ---G�C?%ll
e 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.196 Date Received: /,//ea'/C/1^'
n
Inspection Line: 503.639.4175LAITY OF g IGARD
T I G A R D k� 1 Internet: www.tigard-or.gov 1 MIS IC)
`$y: ,,
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Providence Express Care - Tigard Occupancy: Medical Office
13939 SW Pacific HwyNon-combustible,unobstructed
Job Address: Type of Construction:
Suite:
Contractor: Cosco Fire Protection Phone: 360-883-6383
Number of Proposed or Altered Heads: 4
Type: QR/SSP Hazard:Light Density: .10/1500
1 Dan Furno Oregon Construction Contractors Board No. 67508
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 sy*tem permit.
• A cl py of this document with, • .opy of the sketch attached shall be available for all inspections.
Signature: / I . - Date: 8/17/18
Print Name: Dan Furno
1:\Building\Fonns\FircSprinklerAtfidavit_071514.docx Page 1 of 1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13939 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00102
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor