Permit ,, CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
r'. I° COMMUNITY DEVELOPMENT Permit#: FPS2016-00001
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/09/2016
Parcel: 1S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Pizza Oven Subdivision: PALMER ACRES Lot: 3
Project Description: Install of new Ansul R102 fire system into new hood above XL-T chain broiler,and protection said XL-T broiler.
Contractor: METRO SAFETY&FIRE INC Owner: COSTCO WHOLESALE CORPORATION
PO BOX 33650 PROPERTY TAX DEPT 111
PORTLAND, OR 97292 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 503-231-2999 PHONE:
FAX: 503-256-4691
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/09/2016 $134.48
12%State Surcharge-Building 02/09/2016 $16.14
Type of Use: COM Plan Review-Fire Life Safety-COM 02/09/2016 $53.79
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 02/09/2016 $12.50
Occupancy Grp: M Height: ft 11x17)
Stories: 1
Commercial Sprinkler 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 $216.91
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $5,399.25
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.344.
Issued By: � l O Permittee Signature:
low
Call 503.639.4175 by 7:00 a.m.for the next available inspe.ion „ate.
This permit card shall be kept in a conspicuous place on the job site unti ,om•letion of the pr.;•ct.
Approved plans are required on the job site at the time of eac inspection.
f
lix Elate/Tile MAY-GI-ZUU'IINUN) IU.GI 5U359N1960 P. 001
05/21/2007 10:14 FAX 5035981960 CITY OF TIGARD 0001
Building Permit Applicat1RECEIVEI
Fire Protection System FOR Of r l(_1 l L O\I
City Tigard ^'�? 4 2 16 R«rimae ® i•7 /�i°J i/ —i I it
of Ti ar ,/ gyp► Permit No.
■ 13125 SW Hall Blvd.,Tigard,
OR } R - .1-"----.4A
Plane: 303.639.4171 Fax: 503. A�UI' I16ARD Deli ve` 1 (4
La t;
T �i< InspeetiouLine: 503639.4175 BUILDING DIVISION Dec � ? I
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Internet: www.ti�d-orgovNoti5ed/Idetbod , t! G� T' SapplemeetalLd
reato•
' •;•;:.:.........:::•:.:.:......:::.:•i•-:, •_ :' : ..: •:TYPE•"OF'WORK•`:•:•. .• REQUIRED DATA.1-AAND4..*LYDWEIjJNG'.•: •
Permit fees`are based on the value of the work performed.
❑New eoastruction ❑Demolition
Indicate the value(rounded to the nearest dollar)of all
12tAddition/alteratiw✓replacetuent 0 Other: equipment,materials,labor,overhead,and the profit for the
;: •: . ,,. .•. :"•:•`•CATEGORY;OF`COP1$TRUP'T�ON: •, . .. .• Valuation: S
r
Q 1-and 2-family dwelling �;Commerciayindustrial•
-
❑Accessory building CIMulti-familyNumber of bedrooms;
0 Master builder 0 Other: - Number of bathrooms: '
•..:::.."...:::::•'.;•.:•,:.:: Totalnumber of floors-
.::•.....:,.• ..OB 9IlE;;llVl►ORMi#)C10N:.AND:LOCATION� .•':::; : .. .:�.•�.. '
Job site address:-qs 5-0 -,.,,/. iCIW-\--r,,b,_..\..\,.51- New dwelling area: square feet
City/State/ZIP: 9 223 Garage/catport area. square feet
Suite/bldg./apt.no.: Project name: C o 91,72.4 F3Cirr:2-... Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure arca square feet
. • -.:;REQUIRED;DATA:';COMMERCLIL-USE.CHECKLIST ::
Subdivision: 1 Lot no-: Permit fees'are based on the value of the work performed.
I ; _
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
•
•
•
•
':' DESCRWJIOf(OIF:WORK:' • • • work• indicated ons application
Valuation:I399.7r
H ic, , ._.. 1 w 1 ( Z. t.i-ti t ,�\0 ice . J
.Lerr � X L-T C -�^\0r`o,v-i1 'tu't6-:
Existing building arca: l square feet
X: Li.. \n New building area: 'squarefeet
i m
:..:�' °,�P'ROIirBRTY:OWNER. ; : TENANT': .. - Number of stories:
Name: CeiSlCo (iv ttt_. _ Type of construction:
Address: '7.2$"-O S thext.} ,.. Occupancy groups:
City/State/ZIP: Ti. , / i
ty 16. 3 Existing:
Phone:(r-iO3) (3•— 1 i Fax:( ) New:
At>E7.ICAt!rr>:' .:: :;:;': . p CONTACT PERSON "' •' •"
Busincse name: r Y 1d p 4 j'�t.. � All contractors and subcontractors are required to be
Contact name: ��c� ._ (����•/ licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1 5 .. jurisdiction in which work is being performed.If the
Ci /State/ZIP / applicant is exempt from licensing,the following reasons
rye, a�Q 1
� vu
app r•
Phone:(7�3) -2,11z2.999 Fax::(56) 9 ,(tj �`(
E-mail:f 1 1 1 C� '
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:. ff feare
Business name: -acs, -- ex,, a.Pc>' (0,,,,t Permit fee:
Address:
State surcharge(8%of permit fix):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) . (Due upon appiicatbn.
CCB lie.: 63 1j-1 l • Total permit fees: . ,
Amount received:
Authorized signature �� p expires This t application Q a perioit is not obtained
Date: within 180 days after it has been accepted as complete.
Print name: •G>no�'� • Fee methodology set by Tri-County Building Industry
Service Board.
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