Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
III 3 COMMUNITY DEVELOPMENT Permit#: FPS2015-00106
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/21/2015
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15989 SW 72ND AVE
Project: Dominos Pizza Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Adding and relocating a total of 21 sprinkler heads for T.I.
Contractor: DELTA FIRE INC Owner: PACIFIC REALTY ASSOCIATES
14795 SW 72ND AVE ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-620-4020 PHONE:
FAX: 503-620-1058
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/21/2015 $112.96
12%State Surcharge-Building 07/21/2015 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 07/21/2015 $45.18
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 07/21/2015 $2.00
Occupancy Grp: A-2 Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 07/21/2015 $15.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: ORD2
Density: .10 Design Area: 1500
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 $188.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,600.00
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 Not . ion Cen- . Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire •uestions to OUNC b calling 503.232.1987 or 1.800.332.2344.
Issu d By: I Permittee Signature:
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.
Fire Protection System
Building Permit Application �t FOR OFFICE USE ONLY
Received
City of Tigard DateBy: '� 4 S - Permit No.: Fj1,S i2 D its'-eo lap
IIIII " 13125 SW Hall Blvd.,Tigard, Plan Revi
Phone: 503.639.4171 Fax: 98.1960 ��
Date/By: 11' t Other Permit:
ti0 A 7 ((.�r t 4cnp�a c -r no lc
T I G A R D Inspection Line: 503.639.4175 Date Ready : �lur is:i See Page 2 for
Internet: www.tigard-or.gov 0. 1:�V Notified/Method:7 //s ue /�G Supplemental Information
i� S1�r 1(4 lJ/ ai
TYPE OF� 43 v- REQUIRED DATA:1-AND 2-FAMILY DWELLING
Permit fees*are based on the value of the work performed.
construction � citCiolition 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.
El I-and 2-family dwelling fn Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 15989 SW 72nd Ave. New dwelling area: square feet
City/State/ZIP: Portland, Or 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:Domino's 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Add and relocate sprinkler heads for tenant improvement/remodel. Valuation: $3,600.00
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:Delta Fire, Inc. All contractors and subcontractors are required to be
Contact name: Heidi Scarbrough licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 14795 SW 72nd Ave. jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: Portland, OR 97224
apply:
Phone:( 503)620-4020 Fax::( 503)620-1058
E-mail: heidis @deltafire.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: Delta Fire, Inc. Permit fee:
Address: 14795 SW 72nd Ave.
State surcharge(8%of permit fee):
City/State/ZIP: Portland, OR 97224 FLS plan review(40%of permit fee):
Phone:(503)620-4020 Fax:( 503) 620-1058 (Due upon application.)
CCB lic.: 64174 Total permit fees:
Authorized signature: — Amount received:
_ This permit application expires if a permit is not obtained
Print name: Heidi Scarbrough Date: 7.9.15 within 180 days after It has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pamits\FPS-PermitApp.doc 03/23/06 440-4613T(11/02/COM/WEB)
L
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ 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: 21
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
j Wet ❑ 1)r\
Additional Standpipes N/A
Information: Hazard Group Ord.Haz Group II
Density 0.1
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $3,600.00
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 (8% 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.
1:\BuildingPmnits'FPS-PermitApp.doc 03/23/06 440-4613T(11/02/COM/WEB)
I: D E LTLL 14795 S.W.72nd AVENUE
PHONE 09-620 4020 LETTER OF TRANSMITTAL
FIRE, I NC. ��B 503-620-1058
DATE: 7/9/2015 1 JOB#: 15-5439
ATTENTION: BUILDING DEPARTMENT
RE: Domino's Pizza
TO: City of Tigard
13125 SW Hall Blvd.
Tigard,OR 97223 REC I TrP
VIA: Delivery By Heidi JUL 9 2015
CITY OFTIGAIH)
BUILDING DIVISION
COPIES I NUMBER I DESCRIPTION
3 Sheet 1-1 of 1 Architect Approved Drawings
3 Pg 1-37 of 37 Architect Approved Data Submittal
1 Pg 1-of 1 Architect Approval Letter
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: DYES ONO BY DATE:
BY: Steve Cartales/Devin Ganz/Heidi Scarbrough
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15989 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
August 18, 2015 at 1:08:40
PM
FPS2015-00106
Mark VanDomelen
Violation Summary:
Inspector Contractor