Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1 11 ° COMMUNITY DEVELOPMENT Permit #: FPS2012 -00126
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/06/2012
Parcel: 1 S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: Fire suppression for TI
Contractor: SANDERSON SAFETY SUPPLY CO. Owner: FRED MEYER INC
1101 SE 3RD AVE 3800 SE 22ND AVE
PORTLAND, OR 97214 PORTLAND, OR 97202
PHONE: 503 - 889 -3110 PHONE: 503 - 232 -8844
FAX: 503 - 889 -3192
FEES
Description Date Amount
Specifics: Permit Fee - COM 09/06/2012 $102.20
12% State Surcharge - Building 09/06/2012 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 08/01/2012 $40.88
Class of Work: FPS Type of Const: VB Info Process /Archiving - Sm $0.50 (up to 09/06/2012 $12.50
Occupancy Grp: M Height: ft 11x17)
Stories: 1
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: Atarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
•
Total $167.84
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $2,300.00
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 copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. I�
/
Issued By: 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 completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
° Fire Protection System .1 0 L . FOR OFFICE USE ONLY
City of and
R Received Ell P e rmit No , �q
1
hr f Ti g AUG 01 2012
Date/B : / .%I. S_o/ — D4l°Z fP
a
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ►1 ►' �� ao / / �� O^ � �
' Phone: 503.718.2439 Fax: 503.598.1960 DateB : ii,�� Other Penn . pz
TIGARD g g and -or.
ov
B!l Inspection Line: 503.639.4175 CFI GF '�� �',qQ ga eas : � I / �r —� ® See Page 2for
Internet: www.ti f I 1.�J61� t E" ; {q l �e p i etho . I Supplemental Information
G�IV�J��1` / r�� .'1/`,� ., _ .
TYPE OF WORK / / REQUIRED DATA: I- AND 2- FAMILY DWELLING
0 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.
❑ I- and 2- family dwelling 'Commercial /industrial
Valuation: $
❑ 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: 8546 Sub P&/..46; A „J New dwelling area: square feet
City /State /ZIP: 7; a irq' ( Q V 97 223 Garage /carport area: square feet
Suite/bldg. /apt. no.: �' II Project name: . /.— r e o { Covered porch area: square feet
�Q,��,V � 3 ?S '
Cross street/directions to job site: / Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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
DESC IPTION OF WOR work indicated on this application.
,� —i bla - 17.4 n a aytS( ?/ ,,e. sie# 6S/01
Valuation: S 23C O O° —
<1-(4 L h Of. L / 4d0 . e QAS(/ (S GLS Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: 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: ( ) I Fax::( )
E -mail:
CONT' • CTOR BUILDING PERMIT FEES*
c (Please refer to fee schedule)
v, !
Business name: Gatldei , 7 • P erm i t fee: /1 cl, 3
Address: tlr / 3
City /State /ZIP: gitnn l 7 State surcharge (12% of permit fee): ,32
)
FLS plan review (40 /o of permit fee): 'J
Phone: ( 1�0' ) 01 3 1110 Fax: (5 ) ; gG l { t (Due upon application.) '1 r
CCB lic.: Y (j l l09 Total permit fees: / g t '1��
Authorized Si! a l I re .A
Amount received: —�
`;t I Lli This permit application expires if a permit is not obtained
Print name: 101 MMIll Date: 17Qb ,017, within 180 days after it has been accepted as complete.
f _ • Fee methodology set by Tri- County Building Industry
Service Board.
1:\ Building \Qermits \ FPS-Permit App.doc Rev 01 /05/2012 440- 4613T(t I /02ICOM/WEB)