Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
a
' P COMMUNITY DEVELOPMENT Permit #: FPS2013 00002
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/08/2013
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: Pharmacy consultation room modifications
Contractor: DELTA FIRE INC Owner: TRC MM LLC
14795 SW 72ND AVE 5973 AVENIDA ENCINAS STE 300
PORTLAND, OR 97224 CARLSBAD, CA 92008
PHONE: 503 - 620 -4020 PHONE:
FAX: 503 - 620 -1058
FEES
Description • ,Date Amount •
Specifics: Permit Fee - COM '01/08/2013 $102.20
12% State Surcharge - Building 01/08/2013 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 01/08/2013 $40.88
Class of Work: FPS Type of Const: IIB
Occupancy Grp: M 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 Reg:
Battery Cates Provided: Cut Sheets Required:
Total . $155.34
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 copy of e rules
or direct questions to UNC calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: / / / ■, / 4
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. V
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 Applicatio
Fire Protection System R ECEIVED FOR OFFICE USE ONLY
City of Tigard Received / �,
,l- Permit No
111111 • 13125 SW Hall Blvd., Tigard, O 97223 JAN 0 8 2013 DateBv: - p�?� 3 —0, i 40,2_4
Plan Review
Phone: 503.639.4171 Fax: 503.598.I TIGARD Date/By: Other Pc rt �� /a DQa
T 1 G A k D Inspection Line: 503.639.4175 r � l' Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: 779 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 (rotnded 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 Number of bedrooms:
❑ rY g ❑ Multi - family
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND 1 LOCATION . Total number of floors:
Job site address: ! 55 70 no YQ c4., c i'1►Qvl New dwelling area: square feet
City /State /ZIP: I (rrA 1 Ik G Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: it I(,, - g Covered porch area square feet
Cross street/directions to job site: %j( V\ ern tC.Lt 't' ha e ]r. 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 (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
I� �,, DESCRIPTION I O , F ,, WORK (1 work indicated on this application.
A
/` d d' n a- 1 enci� 4- te,loc a -in i -cor P �� �Li Valuation: S a 311.00
o .0 f fti l Existing building area square feet
11``CG.77 // `` New building area: square feet
Ni PROPERTY OWNER I ❑ TENANT Number of stones:
Name: r+ Type of construction: ,g,13 Address: I (steocuAj-l?' Occupancy groups: Al •
City /State /ZIP: a ackko ma 3 ' - 2 1 q 701 Existing:
Phone: ( ) r Fax: ( ) New
g APPLICANT ❑ CONTACT PERSON
NOTICE
Business name:Te.A.A...a. �t ]nC . All contractors and subcontractors are required to be
Contact name: ��� I licensed with the Oregon Construction Contractors Board
f,P t.rA l ` ca (`o(lil1a �.. under ORS 701 and may be required to be Icensed in the
Address: , (4 1 1 az 7CX C
1 , jurisdiction in which work is being performed. If the
City /State /ZIP: 1Q `,t'LQ t Q 79 apply:
is exempt from licensing, the following reasons
Cop ! PP l Y
Phone: �2l y ' Fax:: A Q (� ��" J O5
E -mail: I .lielI5l�' (JI. itte 11 , corn
ACTOR BUILDING PERMIT FEES*
Business name:�e.�.rx Ire Toc. (Please refer to fee schedule
�` Jl Permit fee:
y
Address: ' 7� 5 ` land
� VCS
U State surcharge (12 %ofpermit fee):
�/�
City /State /ZIP: � Un\ 47 94 e
� �"`- q FLS plan review (40 %ofpermit fee):
i Phone: (53 (9O - ti Fax: ( Gat_ / 5 � (Due upon application.)
CCB lic.: 69141 -71,1 Total permit fees:
Authorized signature: Amount received: /..53, 3
■
x
Al This permit application expires if a permit is not obtained
Print name: �' , Date: within 180 days after it has been accepted as complete.
. % '`� i * Fee methodology set by Tri County Building Industry
Service Board.
1 .Building1Permits\FPS- PermtApp doc 03/23/06 440- 4613T(t l 02,COMLWEB)
City of Tigard; Fire Protection Perrriit Checklist
Page 2 - Supplemental Information
Describe work to be 'clone: ' -
1.) ❑ New 2.) Modification to sprinkler heads only:
S. Addition 14 1 -10 heads: No plan review required.
g Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: . )
Additional description of work: -
Type of System (Complete. A, B, C or D as applicable): .
•
A.) Commercial Sprinkles .
• $ Wet ❑ Dry
Additional Standpipes NA
Information: Hazard Group
Density , 1 0
Design Area i 500
K. Factor . (Q ,l.
Sprinkler Project Valuation: $ Q 311. Q0
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: Allsc
•
•
C.) Fire Alarm.
Submittal shall Battery Calculations El Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ /U
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: M R 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.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
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SPRINKLER PLAN
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HANGER DETAIL RELOCATE DETAIL DROP DETAIL
SCALE - N.T.S. SCALE - N.T.S. SCALE - N.T.S. SCALE - N.TS.
SYM. TYPE A341 1/
TEMP. SIZE FINISH CANOPY WHITE 2 TH O
SAFEWAY 1478
Mq SSP RELIABLE IE MODEL NODEL 0 CS -55 RA3414 155 1/2 CHROME CONC. WHITE 2
•R SSP RELOCATE EKISII80 SPRINIOER - - - - - - 1
PHARMACY PHASE II SSP E10STEIG MOW SPRINKLER LER - - - - - - -
15570 SW PACIFIC HWY TIGARD, OR FIRE, INC.
TITLE FIRE SPRINKLER PLAN FIRE PROTECTION CONTRACTORS
DATE 12 -21 -2012 SCALE 1 /8" = 1' -0" SHEET 1 OF 1 ulucw.lar..ol W .dt 7224 (103) 1 A1030
CONT. 12 -5084 DRWN. J.C. SYSTEM WET
i :: E LT z t 14795 S.W. 72nd AVENUE
PORTLAND, OR
97224 LETTER OF TRANSMITTAL
FIRE, IN
•
��B# 6503-620-4020
DATE 1/8/2013 IJOB NO. 12 -5084
ATTENTION: BUILDING DEPARTMENT
RE: Safeway 1478 Rx Remodel Phase II
TO: City of Tigard
13125 SW Hall Blvd.
Tigard, Or 97223
VIA: Delivery by Heidi
COPIES NUMBER I DESCRIPTION
3 Sheet- 1 -.1 of 1 Drawings
1 Each Check Totaling $155.34 For Permit Fees
1 Pg 1 -1 of 1 Permit Application
THESE ARE TRANSMITTED as checked below:
X For Approval For Review and Comment n
For Your Use _ Approved
X As Requested _Submit copies for distribution
REMARKS:
REPLY REQUIRED: []YES ONO BY DATE:
BY: James Callaham/Heidi Scarbrough