Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
a COMMUNITY DEVELOPMENT Permit #: FPS2013 -00050
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/17/2013
T f[ -; A R O 9 Parcel: 2S101CB00500
Jurisdiction: Tigard
Site address: 12670 SW HALL BLVD, BLDG# 3
Project: Canteen Vending Subdivision: 2007 -064 PARTITION PLAT Lot: B
Project Description: Provide fire sprinkler protection at cooler and freezer. Addition of 13 fire sprinkler heads.
Contractor: WYATT FIRE PROTECTION INC. Owner: TCTPI LLC
9095 SW BURNHAM 4260 GALEWOOD ST, STE A
TIGARD, OR 97223 LAKE OSWEGO, OR 97035
PHONE: 503 - 684 -2928 PHONE:
FAX: 503 -684 -9657
FEES
Description Date Amount
Specifics: Permit Fee - COM 04/16/2013 $112.96
12% State Surcharge - Building 04 /16/2013 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 04/16/2013 $45.18
Class of Work: ALT Type of Const: Info Process /Archiving - Sm $0.50 (up to 04/16/2013 $5.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sorinkler 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 $177.20
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $3,200.00
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 b the Oregon
Utility Notific. - nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a ca• th - es
or direc estions to O • -Iling 503.232.1987 or 1.800.332.2344. r
Issu= • By: 1•1i .f / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection • .te.
This permit card shall be kept in a conspicuous place on the job site until co • letion of the project.
Approved plans are required on the job site at the time of each • spection.
Building Permit Application
" Fire Protection System RECEIVED R eceived FOR OFFICE USE ONLY
City of Tigard '(,Q i Permit No.: I/05 / 3 .-
II . �� Date/By: SW Hall Blvd., Tigard, OR 972 Plan R ev i ew Q
' Phone: 503.639.4171 Fax: 503.598.19 R 16 2013 Date/By: / y -. 17— 13 Other Permit: Id u PaeY3—
TIGARD Inspection Line: 503.639 Date Ready/13y: i t ,7 / C � J uris: H See Page 2 for
Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: r �l Supplemental Information
BUILDING DIVISION Split w/ Eli
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
1 24Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
- -f work indicated on this application.
' OF •CONSTRUCTION
k
1- 2-family dwelling mmer ..- . `
Valuation: $
❑ y cial/industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder 1:1 Other: Number of bathrooms:
1 ,. JOB SITE 1NFORMATION AND LOCATION Total number of floors:
Job site address: / i L 23 L_V p New dwelling area: square feet
City/State /ZIP: ''je / 0/2_ 9 7 3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: ,A -7 70 F121 Covered porch area: square feet
Cross street/directions to job site: /2 CDOL�z_ Deck area: square feet
Other structure area: square feet
IEQIJIR1{}1I +OMME <tCTAT. CIIECKLI?
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
l 1, DESCRIPIIO )Ol6 ORK b 1� _��; ' A� work indicated on this application. .31
1�l2r) v i D� Rae-, st° N,- -i-�� L Y E/ t l� 1D -) Valuation: $ j l
4- 240,
, D /! t � (41!) X 01 � }D F Existing building area: square feet
f 5/��� X Z0 / ,. J New building area: square feet
I. . snh - k a s. 5 y z m - r-
w ❑ L PROPERTY OWNE.12 r i g s 4 > g ' IYANTA <, 4 Number of stories:
Name: Type of construction:
Address: • Occupancy groups:
City/State/ZIP: Existing:
g
Phone: ( ) Fax: ( ) New:
r P TG�INT4�`, �Q e zr , :, g 3 :� •
z,. i ., nom.; GPs : , . , ...,. � ., , ., RSON , �1 �a�� 4 . 0 4 - .- ;, xClf" C
Business name: 5e )-72*C/ b/2_ All contractors and subcontractors are required to be '
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and maybe 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:
' 1 1, x € .. ,:; t: .. CONTRACTOR S ' x , i.. , fi g ' i BUILDING 'E IT FEES*
Business name: /A) (f4_ r //,, /7� 1O� - - (Pleas refer to fee schednlg l - ,- „
9 � 5 W I, „) //� 6/ o P fee:
Address: �J�
City/State /ZIP: , i liA6 �� 9 "7ZZ3 State surcharge (12 /o of permit fee):
[ d / FLS plan review (40% of permit fee):
Phone: (c, 3) &2:3,,f___2_9 7 _5 Fax: (57)) 6,6 965-7 (Due upon application.)
CCB lic.: ro49 7 7 Total permit fees:
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name:
ame.) /,...4--// Date: 4 lb 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(11 /02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
ddition El 1 -10 heads: No plan review required.
❑ Alteration '.-11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 13
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System •
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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: 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.
http: / /www.ci.tigard.or.us/ city_ hall/depart meats /cd /docs /FPS- PermitApp.doc 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12670 SW HALL BLVD BLDG 3, TIGARD, OR,
97223
Commercial - Fire Protection System
999 Sprinkler Final
04/24/2013 00:00
FPS2013-00050
PASS - No C of O
Violation Summary:
Inspector Contractor