Permit . ; CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
_ COMMUNITY DEVELOPMENT Permit #: FPS2012 00005
13125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Date Issued: 02/10/2012
T� Parcel: 1S136AD06000
Jurisdiction: Tigard
Site address: 11437 SW PACIFIC HWY
Project: Carl's Jr. Restaurant Subdivision: VILLA RIDGE Lot: PTS 1 -2
Project Description: Hood fire suppression system for (3) hoods.
Contractor: SANDERSON SAFETY SUPPLY CO. Owner: EJM PROPERTIES INC &
1101 SE 3RD AVE MAVERICK DECATUR GEORGIA LLC
PORTLAND, OR 97214 3633 E BROADWAY
LONG BEACH, CA 90803
PHONE: 503 - 889 -3110 PHONE:
FAX: 503 - 889 -3192
FEES
Description Date Amount
Specifics: Permit Fee - COM 01/19/2012 $123.72
12% State Surcharge - Building 01/19/2012 $14.85
Type of Use: COM Plan Review - Fire Life Safety - COM 01/19/2012 $49.49
Class of Work: ALT Type of Const: VB Info Process /Archiving - Sm $0.50 (up to 02/10/2012 $15.50
Occupancy Grp: A -2 Height: ft 11x17)
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Unknown
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Yes Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $203.56
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $4,408.00
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 Notifi enter. 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 estions to NC calling 503.232.1987 or 1.800.332.2344.
r
Issued By: k a Permittee Signature: 0 /
/
�/ / •
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. Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard *cal 1 R eceived /B f Permit No.: / ,
—
UPI ` Date : i i�
13125 SW Hall Blvd., Tigard, OR 97223 A �,`` '1 Plan Review "�%!� ,Q �S
' Phone: 503.718.2439 Fax: 503.598.1'0. \ Date /B : ,o'- ? V z.,..... z.,..... V IN Other Permit: 6 : do l/ _ cio J.
TIGARD Inspection Line: 503.639.4175 F1 \GP' f3�\ DateReady /By: _ � j , o � !urns ® See Page 2for
Internet: www.tigard- or.gov C `'� O tAG o\VI \S\ Notified /Methodt? 1� '] Supplemental Information
f ". e s : . �`«,3. TYPE OF RK - y!'1,,,,:117,,,,: :ii ., x c, - _ r i - µ f, � REQU IRED DAT-A 1 AND 2= FAMI DWELLING, ,
t igkleS•eerfs"DeretitTfr j ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
N j4Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
' -, _� '' r 4 i- " ', ° wor i on this a lication
$ `r .- s'CATEGORY OF C K4 ' pp
,�, ,X.- '; :I' . � .;.,rte.: , - :, . . _ t i . m .� . !
dwelling Valuation: $
❑ I - and 2-family g ®Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
' 1 3 :• V•' JOB S ITE INFOR ,FAND LO CATION . i.4 y Total number of floors:
Job site address: 1 1434 SW Pacific Highway New dwelling area: square feet
City /State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Carl's JR Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DAFA COMMERCIAL USE CI- IECKLIST
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
k
1 ,_ ; -° « , tt t D ESCRIPTION x OF WOR - f ^ - - , ' work indicated on this application.
ANSUL R -102 FIXED FIRE SUPPRESSION INSTALLATION FOR THREE HOODS Valuation: $4408
FRYERS, GRIDDLE, & CHAIN BROILER Existing building area: square feet
New building area: square feet
i s $ 1 IIS P `
OWNER ,,t ; " , : t a' ,
® T , •
N c , p . Number of stories:
..�k�a'& ... z c . - � -s,,. a n; . a .,. . �,a:-�...v z.._�rr'.�.� xf�;r .; , .. : ., �;
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
2 , 3 d _ - _ - C' i C. f : e- - s . - 1 y '° ..zs.3.. ".a: a`e. '...Xr; ;Y q -
, .< ® � AP PL ICA NT. d - r ®':CONTA"CTa PERSONI €�, -
"'" :;,u -�
Iv.,:4 M -... , ,. „— „<..2 -_ ._2,. .: g6..) ^ . _,a..�_ .- ,, _. _,., �-:, ? :,. , <._ ,-:. 4M . -... i� : ,, - NOTICE , , ' : z w i
�: ,.... - w� .,., . .ai .r- tf -,,. ,.. «. ,. `
Business name: SANDERSON SAFETY SUPPLY CO. All contractors and subcontractors are required to be
Contact name: GEOFF SPAHR / MITCH CUNNINGHAM 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:
W , I : x - '"� CONTRACTOR * . Ic V `
v _ „ .; ,;a e l” c^ - . . -ra, , . - az T x w t rB , PER FE , E S * - I -
..w 4_ ; xs, - _e i '„„ ,.a,, m.� °-` ,,,,,,r -vsn rt _ .. -.is. ._ .-36t3S'e �7 S r 'A i, - - k T , 'v " n �xr . i ,A
Business name: SANDERSON SAFETY SUPPLY CO. *Kr - - (P<leasereferlo/eescGedule)s mow. .:. _ ;T's;
Permit fee:
Address: 1101 SE 3 AVE
State surcharge (12% of permit fee):
City /State /ZIP: PORTLAND, OR 97214 0
FLS plan review (40% of pennit fee):
Phone: (503) 889 -3110 Fax: (503) 889 -3192 (Due upon application.)
CCB lie.: OR64969 Total permit fees:
Authorized signature: Amount received: /Fr
/,.404.1....., � This permit application expires if a permit is not obtained
( v
Print name: GEOFF R. SPAIIR Date: 1/18/12 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I.\Building\Permits \PPS- PermitApp.doc Rev 01 /05/2012 440- 4613T(I l /02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
1.) ® New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type_of S (Complete 4017: or D as applicable) _R T A a _ _ p,
_E..r,h
&A) FCommercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B °._T `' a74: Hgod�:Fire Suppress on System .1, , , " .;� 7 ` "7 i- r S
f r
Hood Project Valuation: $ 4408
ze
C Fi<re =AlarmF�� x� �r�.` �e
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D) Residential Sprinkler System) e °i F° ~t •ro gy
45, -
Square Footage: Permit Fee: k E 3
0. �y
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
ry� - -'z. 'r, iGv � s' - - ,-t'r ss 'vnfi �-�,, -- -� r,�, - s7,� - ti, � + �' �,ct
. } ., , , mn<: Z •,='. Fire; Protection$Permit_ =Fees _. ° �,. , � 2 - E, ; „r' ,.. :. . l- ,
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 three (3) sets of plans at submittal.
P- lan- review -fees- are- required- at_submittal.
http : / /www.tigard- or.gov /city_hall/ departments /cd /dots /PPS - PermitApp.doc Rev 0 l/15 /2012