Permit (2) 1,1 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2019-00125
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/26/2019
Parcel: 25101 BA00500
Jurisdiction: Tigard
Site address: 7600 SW DARTMOUTH ST
Project: Walmart Subdivision: HERMOSO PARK Lot: 8
Project Description: Add(1)sprinkler head to for merchandise pickup machine.
Contractor: VIKING AUTOMATIC SPRINKLER CO Owner: WAL-MART REAL ESTATE BUSINESS TR
3245 NW FRONT AVE BY PROPERTY TAX DEPT STORE 5935-00
PORTLAND, OR 97210 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 503-227-1171 PHONE:
FAX: 503-227-1552
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/26/2019 $91.44
12%State Surcharge-Building 09/26/2019 $10.97
Type of Use: COM Plan Review-Fire Life Safety-COM 09/26/2019 $36.58
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 09/26/2019 $16.50
Occupancy Grp: M Height: ft 11x17)
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: ORD2
Density: .45 Design Area: 0
K Factor: 11.2
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $155.49
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,000.00
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.
Vi/
Issued By: Ai j' 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.
,,wilding Permit Application
Fire Protection System I� FOR OFFICE USE ONLY
City of Tigard RR e/ved 9/366 So�O/9—Qp/
,� r Permit No
13125 SW Hall Blvd.,Tigard,OR 97223 SEP 2 6 2019 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 /� Date/B : Other Permit:
r�
Inspection Line: 503.639.4175 CITY OF Ii IGAf i Date Ready/By: Juris: ® See Page 2 for
T I G A R D
Internet: www.tigard-or.gov BUILDING DIVISIO
Method: Supplemental Information
V 7S1 1 '
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑ 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
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ -.-.
❑ 1-and 2-family dwelling ®Commercial/industrial
Number of bedrooms:
❑Accessory building 0 Multi-family
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:7600 SW Dartmouth Street New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Walmart Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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 WORK work indicated on this application.
Add a single sprinler to Merchandise Pickup machine to be fed by exisiting Valuation: $ .j)„,0 L)overhead sprinkler system. Existing building area: !�' square feet
New building area: square feet
0 PROPERTY OWNER ® TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
® APPLICANT 0 CONTACT PERSON NOTICE
Business name:Viking Sprinkler All contractors and subcontractors are required to be
Contact name:Bryan Kelley licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:3245 NW Front Ave jurisdiction in which work is being performed.If the
City/State/ZIP:Portland,OR 97210 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)227-1171 Fax: :(503)227-1552
E-mail:bryan.kelley@vikingsprinkler.net
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Viking Sprinkler
Permit fee:
Address:3245 NW Front Ave
State surcharge(12%of permit fee):
City/State/ZIP:Portland OR 97210
FLS plan review(40%of permit fee):
Phone:(503)227-1171 Fax:(503)227-1552 (Due upon application submittal.)
CCB lie.:64837 Total permit fees:
Amount received: /5:5”o 4/9
Authorized signature:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Bryan Kelley Date:9/23/2019 *
Fee methodology set by Tri-County Building Industry
Service Board.
1:\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 done:
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: 1 Number of alarm devices:
® Addition or ❑ 1-10 heads: Affidavit required and El 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 El 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
® Wet ❑ Dry-
Additional Standpipes
Information: Hazard Group
Density .45
Design Area
K. Factor 11.2
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El 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: $
C:\Users\bryan.kelley\AppData\Local\Microsoft\Windows\INetCache\Content.OutloQk\KO2ZP5IA\City of Tigard FP PermitApp.doc
City of Tigard Permit No.: /47"C / 9 - 10/ 5
111 a • 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 9/.2� /7
Inspection Line: 503.639.4175
T I G A RD Internet: www.tigard-or.gov By:
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS : �+
OR TENANT IMPROVEMENTS
°
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) SEP 2 6 2019
CITY OF TIGARD
BUILDING DIVISION
Project Name: 0 1414-AST :?IC-IL a u Lta IOE Occupancy: DO)
Job Address: 1G,W e.) 17�'�T,rpvo'-0S j Type of Construction: 4>1661.-
Suite: iEEL.Suite:
Contractor: \ 04-10C 5?,2 to n-LC V- C. Phone: 5o3 — i \ 1
Number of Proposed or Altered Heads:
W ET"
Type: eft'131?) Hazard: CI-09-NA E Density: 0,11 S
I, Dt.v 113 C. Oregon Construction Contractors Board No. GE-1 46 3T1
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.
f
Signature: Date: L t' t ��
Print Name: 001114 C i1'L.
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