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Permit . �• CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 1111 2 ,. COMMUNITY DEVELOPMENT Permit #: FPS2009-00016 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/21/2009 Parcel: 1S136DC04500 Jurisdiction: Site address: 7501 SW DARTMOUTH ST 100 Subdivision: Lot: 0 Project: WINCO Project Description: Bakery Department - Plug (1) head, add (4) heads. Owner: FEES WINCO FOOD, LLC Description Date Amount ATTN: SUSAN BUSCHE, PO BOX 5756 Permit Fee - COM 04/21/2009 $62.50 BOISE, ID 83705 Tax - 12% State Surcharge 04/21/2009 $7.50 PHONE: Contractor: PACIFIC FIRE SYSTEMS LLC 6704 RIVERIA CT WEST LINN, OR 97068 PHONE: 503 - 710 -6646 FAX: Type of Use: SF Class of Work: FPS Type of Const: Occupancy Grp: Height: ft Stories: Commercial Sprinkler System: Sprinkler Required: Sprinkler Type: Standpipe Required: Hazard: 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 $70.00 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: 0 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 issuan , it work . 'ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon U y Notification Center. T' • ru - . re set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy,'f the rules slued By: k / I Permittee Signature: Call 503.639.4175 by 7:00 a.m. for an inspection that busine 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. 7 Buil ding Permit Application Fire Protection System ���-1) ��jj j�ED Received / FOR O FFICE'USE.ONLY. ., . .. • +WCBJ e1 City of Tigard DateBv: Permit No LL 1 11 13125 SW Hall Blvd., Tigard, OR 97223 �(� �O � r boo, � g APR 21 Plan Review '' a Phone: 503.639.4171 Fax: 503.598.1960 2009 0�9 DateBy: Other Permit: TI GARD Inspection Line: 503.639.4175 Date Ready/By. lay ® See Page 2 for • Internet: www.tigard - or.gov CITY OF TIGARD Notified /Method: % l 4 Supplemental Information BUILDING DIVISION . 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 4 ddition/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 Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: a - °- 'JOB SITE INFORMATION ANDS LOCATION _ Total number of floors: Job site address: '75 Di ale-010u t i 5-7— / New dwelling area: square feet City /State /ZIP: / QP + Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: ali p a . 4 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. 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. Valuation: $ `a �r rx J e : e d / ti-egLj. / . ,¢oI(ie . � 9 A -ee.ds / 1 1<. ZCk '/ � l f) ) Existing building area: square feet iC � e7 New building area: square feet ❑ PROPERTY OWNER , . ',0 TENANT - Number of stories: Name: �A �, u 0 dS K � �/ e W e , Type of construction: Address: V 7 /- 0 I O o � - t (S T Occupancy groups: City /State /ZIP: a d / (9 /Z Existing: Phone: ( ) Fax: ( ) New: ❑ APPLICANT - ❑ `CONTACT PERSON ' NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: BUH DINGPERMTI FEES* CONTRACTOR .' Business � � (Pleas e. ref& toJeeschediule) usiness name: �GZL! p C irT � / z 53 Permit fee: Address: Cm 7 9 �l (/l' e t2eA. C/ State surcharge (12% of permit fee): City /State /ZIP: al Z f u cZl eV 97© FLS plan review (40% of permit fee): Phone: (So3 ) 710 - 6 G 4'.6 Fax: (o 5 )77 i4 ,95- (Due upon application.) CCB lic.: L--c3i /47,6 Total permit fees: Authorized signature: Amount received: f70 i • This permit application expires if a permit is not obtained . Print name: 4 /2,,/c/7 Q 7 7 f c„--,... Date: 9 —ZU ,-� s 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 doc 03/23/06 440- 4613T(t 1 /02 /COM/vEB) ii City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information .';Describe be' `done 1.) ❑ New 2.) Modification to sprinkler heads only: ❑ Addition 1 2 1 -10 heads: No plan review required. Alteration ❑ 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: Additional description of work: `QType ;of,System'(.C;omplete`'A B, C D' as applicable): A_ ) Commercial Sprinkler' Ea Wet ❑ Dry Additional Standpipes Information: Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B:)'° 'Type- I, Hood,Fire Suppression System Hood Project Valuation: $ C). Fire 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 $187.50 2,001 to 3,600 $232.50 3,601 to 7,200 $292.50 7,201 and greater $381.50 _ 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: $ Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal. I:\ Building \Permits \FPS -Pcr itApp.doc 06/25/08 2