Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
.' ' COMMUNITY DEVELOPMENT Permit#: FPS2020-00070
Date Issued: 06/10/2020
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 25101 BA00500
Jurisdiction: Tigard
Site address: 7600 SW DARTMOUTH ST
Project: Walmart Subdivision: HERMOSO PARK Lot: 8
Project Description: Add or alter(4)sprinkler heads.
Contractor: WESTERN STATES FIRE PROTECTION Owner: WAL-MART REAL ESTATE BUSINESS TR
17500 SW 65TH AVE BY PROPERTY TAX DEPT STORE 5935-00
LAKE OSWEGO, OR 97035 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 503-657-5155 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/10/2020 $123.72
12%State Surcharge-Building 06/10/2020 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 06/10/2020 $49.49
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 06/10/2020 $1.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Unknown
Standpipe Required: Hazard: ORD2
Density: 2 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 $189.56
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $4,497.00
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 NC 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 AnPlicati EC F NiI F 7
Fire Protection System l{{��t(,l� ,1 p FOR OFFICE USE ONLY
�3UN 0 9 2020
City of Tigard Received
pp Date/By: /D/Ze0 ,/16 PerrmtNFPS7- 2F1-00070
13125 SW Hall Blvd.,Tigard,OR 9nn't/ 0 F {I a(IIlt') Plan Review
' II: Phone: 503.718.2439 Fax: 503.598.'Y960 ` ni Date/a Other Permit:
T 1 G A R t7 Inspection Line: 503.639.4175 \"�^ ')\��•5 ,., Date Ready/By: //raj n form, ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: �V Supplemental Information
TYPE OF WORK °' U TARED DATA:I-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: $
❑ I-and 2-family dwelling ,Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:7600 SW Dartmouth New dwelling area: square feet
City/State/ZIP: Tigard/OR Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Tigard Walmart Covered porch area square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
RI QUIdI I)DATA:COMMERCIAL-USE CHEC a
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
a'x-F
equipment,materials,labor,overhead,and the profit for the
72,
DESCRIPTION OF WORK _ work indicated on this application.
Add upright sprinkler to match existing Valuation: $4,497
where room was removed Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax. ( ) New:
CANT ❑ CONTACT PERSON NOTICE
Business name: Western States Fire Protection All contractors and subcontractors are required to be
Contact name: Alex Webb licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:17500 sw 65th ave jurisdiction in which work is being performed.If the
city/state/ZIPLake Oswego/ OR/ 97205 applicant is exempt from licensing,the following reasons
apply:
Phone:(971) 645 5099 Fax: :( )
E-mail: alex.webb@wsfp.us
CONTRACTOR - „i
', BUILDING PERMIT FE
Business name: Western States Fire Protection IPlease refcrtofeeschedrf4.a"s,..
Permit fee:
Address:17500 sw 65th ave
City/State/ZIP:Lake Oswego/ OR/ 97205 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(971) 645 5099 Fax:( ) (Due upon application submittal.)
CCB lie.:104570 Total permit fees:
Amount received:
Authorized signature: "'- _
This permit application expires if a permit is not obtained
Print name:Alex Webb Date: 6/9/20 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I_\Buitding\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
Describe work to be don:-:
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:
El Addition or Cl 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
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line El Yes ❑ No
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_PemiitApp_031016.doc 2
CityTi , E Ei!I L
of Tigard Permit No.: FPS 20 20 UCH 0 7
• 13125 SW Hall Blvd.,Tigard,OR 97223
m_ Phone: 503.718.2439 Fax: 503.598.1960 JUN 0 4 2020 Date Received: e%/zQ
Inspection Line: 503.639.4175 �nf '
I( kI) CITY 'l T v B Internet: www.tigard-or.gov (,�� I ;, ,� `,.�}I��) y:
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Tigard Walmart Occupancy:
Job Address: 7600 SW Dartmouth Type of Construction:
Suite:
Contractor: Western States Fire Protection Phone: 9716455099
Number of Proposed or Altered Heads: 4
Type: Tyco Upright Hazard: OH2 Density: .2
I Alex Webb Oregon Construction Contractors Board No. 104570
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.
'u�pM.jc Wnw.w.m
Alex Webb `, w:-e" 6/1/20
Signature: : 2020 W 0,„39�.m Date:
Print Name: Alex Webb
I:1Building\FormslFireSprinklerAffidavit_071514.docx Page I of I