Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00008
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/03/2016
Parcel: 1 S136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Winco Subdivision: 1995-013 PARTITION PLAT Lot: 2
Project Description: Fire Sprinklers-Install(3)sprinkler heads in Sushi kiosk.
Contractor: DELTA FIRE INC Owner: WINCO FOOD LLC
14795 SW 72ND AVE ATTN:
TAX DEPARTMENT
PORTLAND, OR 97224 PO BOX 5756
BOISE, ID 83705
PHONE: 503-620-4020
PHONE:
FAX: 503-620-1058
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/03/2016 $123.72
12%State Surcharge-Building 02/03/2016 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 02/03/2016 $49.49
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 02/03/2016 $2.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 02/03/2016 $12.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: ORD1
Density: .10 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 $202.56
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $4,693.00
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 direr estions to UN y calling 503.232.1987 or 1.800.332.2344.
Issu d By: 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.
Building Permit ApplicaMrul
Fire Protection System
Received
City Of Tigard Date/B l I(o PermitNo.:�i�'^/�� 5
13125 SW Hall Blvd.,Tigard,OR+97 t, i,f� 1 j Plan Review P�
Phone: 503.718.2439 Fax: 503.798 k�O a i Date/By: 'y( Other Permit:
Inspection Line: 503.639.4175i °!iAj ';Rl� Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov 6 Notified//Met-h-od:ln /(p 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(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 X 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:7501 Dartmouth Street New dwelling area: square feet
City/State/ZIP:Tigard, Oregon Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Wlnco Store#23 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAI.-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.
Install 3 sprinkler heads in Sushi area Valuation: $4693.00
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ® TENANT Number of stories:1
Name:Winco Foods Store#23 Type of construction:
Address:7501 Dartmouth Street Occupancy groups:
City/State/ZIP:Tigard, Oregon Existing:
Phone:( ) Fax:( ) New:
M APPLICANT EM CONTACT PERSON NOTICE
Business name: Delta Fire, Inc. All contractors and subcontractors are required to be
Contact name:Melissa Boughton 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
City/State/ZIP: Portland, OR 97224 applicant is exempt from licensing,the following reasons
apply:
Phone:( 503) 620-4020 Fax::(503 ) 620-1058
E-mail:melissab@deltafire.com
CONTRACTOR BUILDING PERMIT FEES*
ase re er to ee schMale
Business name: Delta Fire, Inc. Permit fee: 188.06
Address: 14795 SW 72nd Ave.
State surcharge(12%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 submittal.
CCB lic.: 64174 Total permit fees:
Authorized signatAmount received:
ure:
This permit application expires if a permit is not obtained
Print name:Melissa Boughton Date:1-19-16 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
Ir9uildingPe its,FPS-Pe itApp_071514_doc 4404613T(I 1'02/COM-WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 3 Number of alarm devices:
0 Addition or ■❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
I=of S tem nmplete A,B9 C or D as applicable):
A.) Commercial Sprinkler'
0 Wet ❑ Dry
Additional Standpipes
Information: Hazard Group Ordinary Group
Density .1
Design Area
K. Factor 5.62
Sprinkler Project Valuation: $
B. Type I Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Batte 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 onsquare footage see D above): $
State Surcharge 12% of perrnit fee): $
FLS Plan Review 40% of permit fee): $
TOTAL: $
C:\Users\heidis\AppData\Local\"1'cmp\FPS_13cmtitApp.doc 2
FP S'zol
751 5w
I DELT 14795 SW 72nd Ave. LETTER OF TRANSMITTAL
Portland, OR 9722
Phone: 503-62(1-
Fax: 503-F90
DATE 1-19-16 JOB NO.15-5564
' FIRE INC. ��
' ATTENTION:Permit Counter
RE:
V- g�r40.q��r Winco Foods Store#23
TO City of Tigard
VIA:
COPIES NUMBER DESCRIPTION
3 Sht. 1 of 1 Shop Drawing-Architect stamped
3 Data Submittals
1 Permit Application
1 Permit Fee check
THESE ARE TRANSMITTED as checked below:
✓ or Approval For Review and Comment n
For Your Use Approved
s Requested Submit copies for distribution
REMARKS:
REPLY REQUIRED: YES rjN O BY DATE:
BY Melissa Boughton