Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
t !' Permit #: FPS2012 -00012
. - COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/31/2012
T►x Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: Lot: 0
Project Description: Relocate (3) fire sprinkler heads in remodeled area.
Contractor: WYATT FIRE PROTECTION INC. Owner: COSTCO WHOLESALE CORPORATION
9095 SW BURNHAM PROPERTY TAX DEPT 111
TIGARD, OR 97223 999 LAKE DR
ISSAQUAH, WA 98027
PHONE: 503 - 684 -2928 PHONE:, •
FAX: 503 - 684 -9657 '
FEES
Description Date Amount
Specifics: Permit Fee - COM 01/31/2012 $53.78
12% State Surcharge - Building 01/31/2012 $6.45
Type of Use: COM Plan Review - Fire Life Safety - COM 01/31/2012 $21.51
Class of Work: ALT 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 $81.74
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
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 cosy of the rules
or direc • estion : • UNC by calling 503.232.1987 or 1.800.332.2344. f
Issued :y: / & Oi l Permittee Signature: . i
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 ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
,, Buittling Permit Application
Fire Protection System CEJV • FOR OFFICE USE ONLY
City of Tigard 4 ', Received �/ /
�
9 13125 SW Hall Blvd. Tigard OR 97223
I Permit No.: �u al —G /�
/ �Sao� , , AN 3 1 Pl /7
7
_ ' Phone: 503,639.4171 Fax: 50 ��� Datean BRyev : ew Other Permit: !'P /1•1:04g/
TIGARD Inspection Line: 503.639.4175 ITy Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard- or.gov BULIMIA "tip/WS/am
CARD Notified/Method: Supplemental Information
,.. � *. ��' '... �" ,. ,e.. .x�a, y r•'- ;- -..p'� -�. -^ -R� . %�,F'''��``'� "�' <r .5�'' ,�F t?. nS 4-xL k'�' ,. Snt - .. �;
c . - :,� TYPE OE V )RIB, ' ,n'" -= ' °I 2E • U1RED,DATA ,4 1 ANU 2 FAIIIILY DWELILING
��.,.�,>,_ �` .. ,.<� >��x�.T, >�,.._p,.�,�� = - <.- air. .��s�"�`�.�. A,�s o..�.� _ - �.r_>aR�.� �, . _ax =� <'.
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
O . Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
s;> _ ,�,'- -: .x.:a�- sew >^ `':
:- ;'�� ',,.,,�-,v' ": - �� ��� work indicated on this application.
>:CAEGORY;,;:Op CONSTRUCTION _ „,; .
<4 -�;; :..." .m., "'�'�e� . ....2w,‘„,,,„,,,- .,; . .,'�r.w•�':«- , %�c� -��. �..._ .-. . < . .�,..� -.. ..a ._ s�r�:�...,..,.� .. ��.:_. >:;��3'�'v�ttr. -•c='
Valuation: $
El 1 -and 2- family dwelling �mmerciaUindustrial � '
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
,:prc . �: w
4 . +:. ' " '3 OC g :4 -x.;� '�;.: < " rA,
e Total number of floors:
= ' J ` „A I;A TION,. • °� �” ' �• . ,�^`
Job site address: r e3 G e J/(1 A i ih, S' New dwelling area: square feet
City/State /ZIP: I 1 rr2 ) 1~, /2- 7 zZ 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: ( 757' , ,_ 7 4-T Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
R RREx` =" D A TA.,.COIVIMERG -I3SE;'<CHECIftii `'
_ 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
' -t'._ . ^. ; '.: . w DE SCR) yi p. ` 9 A V )IW ,:k�3� % ` x „3 '.. ;•<- work indicated on this application...
s'tAs,,,,,,,, :�:;,', r.::?�•_ -:.t- ' .& S?��4 'so•; s�s°7't.A�,.., <£.'..r�;5x�”, :; �i`�:•,.,, ,.,., ,5�;: ,�..�.<. >,.Lx, ,, .xi?
~, 77 3 r/ e- �Pj� J y i/c_:C_ C�"C_ 1 . 7 4 L� Valuation: $ 5 1 , pc , i(r ! /�-c -i / � / tL' / Cam" � IJ i
J 'f J ,14-- Existing building area: square feet
' New building area: square feet
;` .,�';.x;".,a �sw, y 'a},y°�t.:�'rs'. - -'.- .I�':. �, "''��F'.', ;s :,i '�v`: >.�';y:€; �'�..; �:1 - -
`- "'''' = `O
1'RP.E R.TY- OW1 -74' '° ,i: ° -:•. ' " - ;2. ? G N' it ,.:� . > . Number of stories:
Name: Type of construction:
Address: • Occupancy groups:
City/State /ZIP:
Existing:
Phone: ( ) Fax: ( )
New:
x t^a -
v, -
,S',. <x . ; <:a.n "`;.o e et ss „- 's,�;..�, „z,,, , 3<'f v;:`i;-
<., „ ^. x,.. „ nil / � ♦� T K,',,, ;. ,,,, nn �a�w
PPLICAN' '> k= Y.., "',kw ,.�., �k, ,� �3' .. h,, .,, :et�..�- x:x?s. .x.�•.3;.'Hen ?[:�•_ ",
- ,. ,. .. e,S�'' =,x ,s;,a„ =; ,, ter, r..< .i>,., L,. .fi „ >.
„,,,wn :fit _, x .,,.r >t Aa..,. ,_ < , , , :.a. 2�... ., .,. .,... ., k, nn;.; �,,,.:...,y..jyadx'*. :.. :x•¢ ,,, ,$ -',,�. ' .:3,:, fix^ <x. ,, 4L�, ,:_
�nx w.,�,< s`�� >, ,,, .. ,:;>�>�" ,� � "_, ., �<,;:�s;: ° ., y � ' ,r�'� ;_,�,;I�IOT'ICE+`u ° "' p
'? �°' n:=:,: e` a'"" F;,.:::,'; ✓��,- '�C:4i&'?, %�'�k.�38:'' � a' iei,`', M.::'+`< p> 9>., S_ y,_,_. T" a<„ si�3 ::'k;�ffi�RS;"C: %.�£::�J�^? >b: e K- :�'
Business name: ee rite4 .---7 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:
._�.,<;;M ^ms's . „� i �;<" - "rx; . "
�� ,� ........... . .. .. . .. s ., . _ ;;� ., ," 33 ,_ ..,:,. , .: -- .w - ��� =�' BUILDIN. G�PERIVIIT ;�":EE5r�`;;: >- :`�_ " s":;�
'Xw � , :.d`"�b - '%`"wY ,. " -;;, J:i:/iex .., :: ^X: , �':k :, �., a , } �
�r' :e�u��i "��°<v" i� i`wA� -?n
Business name: W y4..-r� �/ Pp L/ /Q/ `-) 4 Ag.' , " 3 . . fee s 6:NrAii`.�;�;`'�H`P: t,..A;n4: `;
Permit fee: 0
r Q
,� l 1 I l , 7 g
Address: 91)9 iv V?ZJ 'j4 5,,
City/State /ZIP: 1/6t-/Z0 C/� % 7 z Z - � State surcharge (12% of permit fee): r
l FLS plan review (40% of permit fee): ��
Phone: (50 .) b 54-- Z`�2- S Fax: (503) 6. 54 - 9 , '7 (Due upon application.) At
CCB lie.: & 4z)7 '7 Total permit fees: g j .1
Authorized signature: �- _- ���r L — Amount received:
This permit application expires if a permit is not obtained
Print name: 6..) - c' / - � � J) Date: 01 — , 1 - / 4 — within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
L \Building\Permits \FPS - PerrnitApp.doc 03/23/06 440- 4613T(11 /02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ,r -1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
T e o£S .stems .Com lete'.A ;A .u.0 ,� �.
ox D.Fas..a lica
{ , ., . , _ ;. -: ,, ,<..,,..., , � ,.. , .,,.•,. ,� _�� ,ems � �• z . - r;�t '��'� >��::�, , , :�,
.A ,. , . Y ... . ...: .. ... > :�- ,s:,c,. x,-.. <.,. ....,..�, .�' . -2 ?.._ �. ,es -, ,.�.`.< �•i: ��^',.,, a a':z�S,`,._.�t:; � - ,F kr,,x `.3,. , >+m'v''�P,..,.a� » �>it5 �, i.,�'i S ;'�Y'::': '`•`... ,..
.�„,¢ . E. S"., ., Y . K ;i', 33 , . } . �.,.,x:, <, - t , .>cLi -5 e,''� �:,;L$:?
. x(. S ,: b,?!. �, .i3r,: . ^: ,., :`.<..,. .. . ,., ..e," ,..:4 �....a :r`�,� n �.'� +'%£sL'�w..w..ki,�
r. , ,._.., •', ::, .6fx ,., ..: ,v a,.fi, n,. { Su+.FN " r "� n Fe: ` ?, 3r:.
,v,»,.� ;.Ee,? -- p'k`.r`�:�.�;:. �:� -t:�. s.a' *:n�;y � :;��, .4�y5* ;�4,- .w;�*� ^.. .,�
,x . , ,. „ . . , >,. �:, :-.::..-.:,,.>r,;w.,,aa�'u.�` -- - '`:��<•,v,k '.r� -.' 3 `:ci��s�?,.� °,"�cx.° € 'a
,A.., , Commerci a l..S nnklex, � �" � '� -` t � xa � _~ =��
� ��,.>'�?�s,:: -. � ,., � i .• � 1i�= � �� ' #:-
„,
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
x
13.: zk s� rssxo , s � � '� , �
.,..,, ) YP.,, � =
-., � ,_.. ..P,xe n��ystez�a, „. , _ >�.��::e•:�r' =,'� w'� ��:� ?,... _�t��� ��: •
Hood Project Valuation: $ •
•
” rre �j
mot..'
it .,- R
r,
.,. .w., vin 4y.( ,... r.?�....' .ro ✓,
Y£hy syiY >
- .,�. ,.
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
a,'„ .,
"3I?` - ;�3;a' <.r., ri , .yr •
"'' ?` -; :` ic "L '`G'i`g _ ,:,a °''- ,. a , ,..,r.:. {.
._, j'
.:.$,:,•x�",�iLn.;�> `- ',�.•` � ' . n ": t � 3y, r ' .��s.- .`- .H�,,'s x,�. � §;a_,» ; ..r3,�'. ` ,,,�.
-' °' <,z� xat u'"��'.�= ;-,;.a'k'»;;::
, �. - .= '•�,., ,�„ r t, , eA,,�
= �:�s - :�,;:.:;- :�.:r,�.,:,��':..i , :�� „�� ''fir, ;w >;.,,:��`��=v�?.-
D. <,Reside ti °a'1 S; rinkler <..S,tand l one! S .,s;tem '°.,fA -; - y:
Square Footage: Permit Fee: .„.Fi,;• 'il`; `°Y'
q g ' ' °�`�' „'�"`�,. :tie' °': >r'7.3�Y�'
0 to 2,000 $187.50 =: °a p is i3�-;'° ,Q = `x
2 001 to 60 $232.50 �����:�=; : -�
• o 3, 0 '
3,601 to 7 $292.50
200 T, ��
-
7,201 and greater $381.50 x'R , x3M;:':;4°.-' ,;, :.,,• n FV'°
Sprinkler Project Square Footage: sq. ft.
:Pet
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.
"New” fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
http: / /www.ci.tigard.or.us/ city_ hall /departments /cd /dots /FPS- PermitApp.doc 2