Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111 COMMUNITY DEVELOPMENT Permit #: FPS2013 -00067
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 06/06/2013
Parcel: 2S102AA00906
Jurisdiction: Tigard
Site address: 12080 SW MAIN ST
Project: Rite Aid Subdivision: PAYLESS SHOPPING CENTER Lot: 4
Project Description: Modification of (25) fire sprinkler heads for TI
Contractor: PATRIOT FIRE PROTECTION INC Owner: BSM REALTY LLC
4708 NE MINNEHAHA ST BY RITE AID
VANCOUVER, WA 98661 PO BOX 3165
HARRISBURG, PA 17105
PHONE: 360 - 699 -4403 PHONE.
FAX: 360 - 699 -4485
FEES
Description Date Amount
Specifics: Permit Fee - COM 06/06/2013 $51.09
12% State Surcharge - Building 06/06/2013 $6.13
Type of Use: COM Plan Review - Fire Life Safety - COM 06/06/2013 $20.44
Class of Work: ALT Type of Const: VB Info Process /Archiving - Lg $2.00 (over 06/06/2013 $2.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 06/06/2013 $0 50
11x17)
Misc Administration Fee 06/06/2013 $5 00
Commercial Sprinkler System:
Sprinkler Required. Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density 0 Design Area: 0
K Factor 5 6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $85.16
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation $3,400.00
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, o • •ror• spended for more the 180 days. ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon
Utility . ification Center. •ose rules are set forth in OAR 952 - 001 -0010 through OAR 9 .1 -0090 You may obtain a copy of the rules
or dir-ct questions to OUNC by ng 50 .1987 or 1.800 332.2344.
Issued By: Permittee Sign • ‘.4070.f..417...`16..
\ / Call 503.639.4175 by 7:00 a.m. for the next available inspe '• n 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.
Buildin>w Permit Application
Fire Protection System RECER/ED r oRz oriicr. t. sE o. i_1
eceived : "6,10 /5- aob4
11, . City of Tigard DRateJBv Pe rmu No.:
13125 SW Hall Blvd., Tigard, OR 97223 MAY 3 0 2013 Plan Review y .
C . Phone: 503.718.2439 Fax 503.598.1%0 B : �` AI V� ar�Permit: - Q�p�g 7y*
T A K 1 - ) Inspection lie: 503.639.4175 CITY OF TIGARD Date Ready / vi c e p i3 J " 1®s B See Page 2
Supplemental far
Internet www.tigard- or.gov Nou Information
BUILDING DIVISIOI S-pol rot,
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 wort indicated on this application.
❑ 1- and 2- family dwelling ® Commercial industrial Valuation: S
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORIIL4TION AND LOCATION Total number of floors:
Job site address: 12080 Main Street New dwelling area: square feet
City /State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt no.: I Project name: Rite Aid 5354 Covered porch area: square feet
Cross street/directions to job site: SW Scoffins Street Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL- -USE CHECKIJST
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
DESCRIPTION OF WORK work indicated on this application.
add and relocate sprinklers for new wails Valuation $3400
Existing building area: same square feet
New building area: same square feet
0 PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Rite Aid Corporation Type of construction: metal studs
Address: PO box 839 Occupancy groom
City/State/ZIP: Camp Hill, PA 17011 Existing: same (office)
Phone: ( ) Fax ( ) New: same
® APPLIC ANT ❑ CONTACT PERSON NOTICE
Business name: Patriot Fire Protection, Inc All contractors and subcontractors are required to be
Contact name: Ted Baker licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 4708 NE Minnebaba Street jurisdiction in which work is being performed. If the
City/State/ZIP: Vancouver, WA 98661 applicant is exempt from licensing, the following reasons
apply:
Phone: (360) 699 4403 I Fax: : (360) 699 4403
E -mail: t:ed.balrer@patriotfne.00m
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule/
Business name: same as above
Permit fee:
Address:
State surcharge (1 of permit fee):
City/State/ZIP:
FLS plan review (40% of permit fee):
Phone: ( ) I Fax: ( ) (Due upon application)
CCB lic.: 70822 Total permit fees:
Authorized signature:
Amount received:
This permit application expires if a permit b n o
I Print name: Ted Baker I Date: 5-30-13 I within 180 days after it has been accepted as complete.
• Fee methodology set by Tri- County Building Industry
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
I.) ❑ 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: 25
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Wet ❑ Dry
Additional Standpipes no
Information: Hazard Group ordinary group
Density 20
Design Area 130
K. Factor 5.6
Sprinkler Project Valuation: $ 3,400
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 $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.
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.
C: \Documents and Settings \ ted.baker \ Desktop \ Rite Aid 5354 Tigard \Tigard TI Affidavg see page 2doc 02/01/11
RECEIVED
MAY 3 0 2013
CITY OF TIG,ARD
BUILDING DIVISION
TRANSMITTAL
DATE: 5 -30-13
To : City of Tigard Building Dept.
13125 SW Hall Blvd
Tigard, OR 97223
Aft: Plans examiner
From: Ted Baker
re: Rite Aid 5354 T.I. fire sprinkler submittal
***************************************** * * * * * * ** * * * * * * * * * * * * * * * * * * * * * **
Enclosed you will find (3) sprinkler cut sheets, (3) FP1 fire sprinkler TI plan, (1) •
permit application and (1) permit check in the amount of $. (3,400 valuation)
Please feel free to call with any question.
Thank you,
Ted Baker
OR CCB 70822
WA PATRIFP099CF
P ATRIOT TED BAKER — SERVICE PROJECT MANAGER
FIRE PROTECTION IAG D 360.816.87141 C 360.831.5850 I TED.BAKER(cOPATRIOTFIRE.COM
4708 NE MINNEi MA STREET I VANCOUVER, WA 98661 I P 360.699.4403 I F 360.699.4485