Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11. . COMMUNITY DEVELOPMENT Permit#: FPS2016-00087
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/03/2016
Parcel: 1S134BC00200
Jurisdiction: Tigard
Site address: 12198 SW SCHOLLS FERRY RD
Project: Baja Fresh Subdivision: None Lot: None
Project Description: Fire suppression for Type I hood
Contractor: UNIVERSAL FIRE EQUIPMENT Owner: ATLAS GREENWAY LLC
18260 SW 100TH CT 333 NW NINTH AVE, STE 1009
TUALATIN, OR 97062 PORTLAND, OR 97209
PHONE: 503-691-9000 PHONE:
FAX: 503-691-9004
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/03/2016 $102.20
12%State Surcharge-Building 05/03/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 05/03/2016 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 05/03/2016 $10.00
Occupancy Grp: A-2 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 $165.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,950.00
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 direct qu _ OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue By: � / Permittee Signature: 411�
Call 503.639.4175 by 7:00 a.m.for the next available ins '•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.
Building Permit AD licatio
Fire Protection Systeme : FOR°III( 1: 1 SF ON LI
City of Tigard Received n p_-,
g Date/By: ii i l / Permit No.: rr5�/6. o
I 41 13125 SW Hall Blvd.,Tigard,OR 9722MAY 0 3 2016 Plan R= t �+ ,
. Date/By:*.�',/ Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960
I I(,;\It a Inspection Line: 503.639.4175 CITY 0/' FI4 I y�) Date Rea.• i loris: ® See Page 2 for
Internet: www.tigard-or.gov d s r' tl Notified/Method: Supplemental Information
BUILDING/Tibias,
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
ew construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(romded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 1-and 2-family dwelling ommercial/industrial
Valuation: $
0 Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /ZI GI y Sc.,? S i`S Fin 6 �,,4 C New dwelling area: square feet
City/State/ZIP: 7'',�7 `( � ��� •-"`/� Garage/carport area: square feet
Suite/bldg./apt.no.: J Project name: ga_j 6 f LSA 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.
Tax map/parcel no.: Indicate the value(romded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ C�7
� -GIA 4-1. . 4' �4 _1 4-s i ,P�l L 495b
46 r 5-5
GddwC y � S190/ 1-/b 57
,S-. ,-, ! Existing building area square feet
1 z�-h. , h��15.,L. , � 1� New building area: square feet
0 PROPERTY OWNER I .11.1 ANT Number of stories:
Name: /?,07.4 4 �er.,C -I. Type of construction:
Address:l2 524,c6A.0,6- 1-e-n•7Qd sly C Occupancy groups:
City/State/ZIP: 77 ! _ t� _ 'ie /7' ,� Existing:
Phone:6'23 a -yap,6 Fax:( ) New:
121-1111 LICANT ACT PERSON NOTICE
Business name:am A jti H./ /"l 1/4,(,`� ,:fy-/3,,,)2,. ..4.4_ All contractors and subcontractors are required to be
Contact name: e�!1-4
�' licensed with the Oregon Construction Contractors Board
iunder ORS 701 and may be required to be li ensed in the
Address: tgtz fi..4.) /oD jurisdiction in which work is being performed.If the
�, _ 1 706 Z
applicant is exempt from licensing,the following reasons
City/State/ZIP: T 4,/4,�y
G apply:
Phone:. )G,--/ /b a
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
n (Please refer to fee schedule)
Business name: 1 •7�- 19-s tom-G Q--2/-e_ Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%ofpermit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: Q'6 7z3 Total permit fees:
Amount received:
Authorized signature.
This permit application expires if a permit is not obtained
Print name: . 41'" Date: 5......--Z---/ within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\BuildingTermitsWPS-PermitApp_71514.doc 440-46I3T(11/02/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: Number of alarm devices:
❑ Addition or ❑ 1-10 heads: Affidavit required and El 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 0 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type of System (Complete A,B,C or D as applicable):
A.) Commercial Sprinkler
❑ Wet 0 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 $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: $
l:\Building\Permits\FPS_PcrmitApp_071514.doc 2
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
12198 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2016-00087
Jeff Grove
Violation Summary:
Inspector Contractor
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
12198 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Commercial - Fire Protection System
920 Suppression trip test
PASS
FPS2016-00087
Jeff Grove
Violation Summary:
Inspector Contractor