Permit V ,.
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` ` FIRE PROTECTION SYSTEM PERMIT
vp,, CITY OF TIGARD
ss ,-, COMMUNITY DEVELOPMENT Permit #: FPS2009 -00097
e• , iV,1 Date Issued: 10/28/2009
TIGf R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
,, I x,a , , Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HVVY
Subdivision: Lot: 0
Project: Fred meyer
Project Description: Install sprinklers in mezzanine.
Owner: FEES
FRED MEYER STORES, INC Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO
Permit Fee - COM 10/21/2009 $86.06
BOX 35547 Plan Review - Fire Life Safety - COM 10/21/2009 $34.42
PHONE: 12% State Surcharge - Building 10/21/2009 $10.33
Contractor:
CROWN FIRE SYSTEMS INC
7402 SE JOHNSON CREEK BLVD
PORTLAND, OR 97206
PHONE: 503 - 777 -5030
FAX:
Type of Use: COM
Class of Work: ALT Type of Const: IIIB
Occupancy Grp: M Height: ft
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: UNK
Density: 0 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 $130.81
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1800
Residential Square Footage: 0
Fire Alarm Valuation: 0
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 -0100. You may obtain a copy of the rules
or direct questio s t ,ODUNC by calling 503.246.669 or 1.800.332.2344.
Issued By: _ ( /� �� 1 Q„ (� Permittee Signature: ^ V
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Mal 1 ' 1-
Fire Protection System FOR OFFICE USE ONLY
CI of Ti and U . • Received ', permit No.: ?Woos .00 " g . , Date /B
13125 SW Hall Blvd., Tigard, OR 97223 Pl Review `/ O
Phone: 503.639.4171 Fax: 503.598.1960 Date /B : _� �f Other Permit:
�%� �' OF iGARD D ate Ready Q ® See Pa et 2 for
Inspection Line: 503.639 ' 1 y � o: 01p • O4 , g
Internet: www.tigard- or.gov D6i+L O:NG DIVISION Notified/Method: 0 • Supplemental Information
TIGARD
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.
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Nutnber of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11565 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: FRED MEYER ALE MEZZANINE 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 SPRINKLERS TO NEW MEZZANINE Valuation: $1800.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: FRED MEYER Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: CROWN FIRE SYSTEMS, INC. All contractors and subcontractors are required to be
Contact name: DAVID KYLLO licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 7402 SE JOHNSON CREEK BLVD. jurisdiction in which work is being performed. If the
City /State /ZIP: PORTLAND, OREGON 97206 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 777 -5030 Fax: : (503) 777-0659
E -mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: SAME AS APPLICANT
Permit fee:
Address:
State surcharge (12% of permit fee):
City /State /ZIP: FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lic.: 163820 Total permit fees:
0 Amount received: 1 30. 8\
Authorized signature:
This permit application expires if a permit is not obtained
Print name: DAVID KYLLO Date: 10 -21 -09 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
(:\Building \ Permits \FPS- PermitApp.doc 10/01/09 440- 4613T(I1/02 /COM/WEB)