Permit •
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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COMMUNITY DEVELOPMENT Permit #: FPS2009 -00059
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/07/2009
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Fred Meyer
Project Description: Add /alter (2) sprinkler heads in existing public and employee bathrooms.
Owner: FEES
FRED MEYER STORES, INC Description Date Amount
BY NICKEL & COMPANY LLC, STORE #375, PO
Permit Fee COM 07/07!2009 $62.50
BOX 35547 12% State Surcharge - Building 07/07/2009 $7.50
PHONE:
Contractor:
FIRE SYSTEMS WEST INC
600 SE MARITIME AVE #300 •
VANCOUVER, WA 98661
PHONE: 360 - 693 -9906
FAX: 503- 289 -2208
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
. 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 Cafes Provided: Cut Sheets Required:
Total $70.00
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1100
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. Y:u may obtain a copy of the rules
or direct questions t. OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: , 1 i Permittee Signature: I� 11
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 pr..ct.
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 R eceived , .-�` `�� Permit No �
li
Date /I3 ■ / • . Ile
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Dale /By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Runs: ® See Page 2 for
Internet: www.tigard- or.gov Notified /Method: ' 1 IN Supplemental Information
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.
dwelling Valuation: $
❑ I - and 2-family g ®Connercial /industrial
❑ Accessory building ❑ Multi- family Number 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 Meyers Remodel 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.
Aald/relocate (2) sprinkler heads in bathrooms for tenant improvement Valuation: $$1,100.00
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:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Fire Systems West All contractors and subcontractors are required to be
Contact name: Rich Smiley licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 600 SE Maritime Ave Ste. 300 jurisdiction in which work is being performed. If the
City /State /ZIP: Vancouver, WA 98684 applicant is exempt from licensing, the following reasons
apply:
Phone: (360) 693 - 9906 Fax: : (503) 289
E -mail:
CONTRACTOR BUILDING PERMIT FEES* .
Business name: Fire Systems West, Inc. (Please refer to fee schedule)
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.: 49732 Total permit fees:
Authorized signature: J Amount received:
A
1,g This permit application expires if a permit is not obtained
Print name: VAl ¶1 (Q.1 "IIIII Date: , 1 "I * 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( I I /02 /COM /WEB)