Permit (79) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
"7 Permit#: FPS2016 00162
"`7777 COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/17/2016
TIGARD Parcel: 2S 101 BA00101
Jurisdiction: Tigard
Site address: 7500 SW DARTMOUTH ST 110
Project: Joy Teriyaki Subdivision: None Lot: None
Project Description: Hood suppression system.
Contractor: UNIVERSAL FIRE EQUIPMENT Owner: WAL-MART REAL ESTATE BUSINESS TR
18260 SW 100TH CT BY PROPERTY TAX DEPT STORE 5935-00
TUALATIN, OR 97062 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: 503-691-9000 PHONE:
I FAX: 503-691-9004
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/17/2016 $102.20
12%State Surcharge-Building 10/17/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 10/17/2016 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 10/17/2016 $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: $2,850.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
e— /
Issued By: c Permittee Signatur /
all d 3.639.4175 by 7:00 a.m.for the next av ilable' pection d e.
This permit card shall be kept in a conspicuous place on the j site until completion oft e project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System FOR OFFICE USE ON Ll
City of Tigard84%
Received
Date/By G /� /4')/--"-
. Permit No.: �i ' � )
III " 13125 SW Hall Blvd.,Tigazd,OR 97223 Plan Revte�t"
Other Permit: p /,1
I Phone: 503.718.2439 Fax: 503.598.196C Date/By: t � a0/4 g0 i ip -.00 i741
7uris: See Page 2 for
T I G A K U Inspection Line: 503.639.4175 AC Date Ready y: G�� ` rr �,' Supplemental Information
Internet: www.tigazd-or.gov V Notified/Method: /w pp
TYPE OF WO$ � ,f1i� * REQUIRED DATA:1-AND 2-FAMILY DWELLING
ew construction ❑De t�� \ 4'L Permit fees*are based on the value of the work performed.
�^ Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 the : NO-1 equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CO z;yI .TION work indicated on this application.
Valuation: $
0 1-and 2-family dwelling lnercial/industrial
0 Accessory building ❑Multi-family Number of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 75 o v sj,..42 D 4-4 I',lc,c,..‘ 4 New dwelling area: square feet
City/State/ZIP: 7J 11 �i,,'1 ( 17 Z7,3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: _ro
G r/ -t'f 7r 9, ,fir 1 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(rouided 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.
- '��� Valuation: $ 2„Rc-Z rcr
t, r),-(:: ,r4- r E0 ,n, ?CI--4/6 0
(„ �� 41-1r-e— 5.y i .--, Oh Existing building area square feet
ejob!4 h SI- 1_ New building area: square feet
0 PROPERTY OWNER ANT Number of stories:
Name: e---7;:_y 7 -j t f ,: ec �-.fd.� y,,�h . Type of construction:
Address: 7 S -.o S,„/"J
, ��y(4 jyy�4 .-4 Occupancy groups:
City/State/ZIP: 77:7
" / (A.`-I'' 17 X7—'3 Existing:
Phone:g7:;3) /a _C/ 73 Fax:( )g2-10PLICAINT Qt°C'o1QTACT PERSON NOTICE
Business name:di, iv e,/,j:id( fiyyt<_, ti)„L„ c2 -1 e,‘, f All contractors and subcontractors are required to be
Contact name: � � �J licensed with the Oregon Construction Contractors Board
-,_.r...e..;" under ORS 701 and may be required to be licensed in the
Address:/•g2 6 O /5-.,__,;_, /c3 0 i ", jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: /i",„ 4-,(44i->-> 0P.,� J 700 Z_ apply:
_ PPy:
Phone:b--... , ‘.)--/-7 o-d Fax:/:b �3 6 77. ,..6,v y
E-mail.�'Tg1Yar')a(t°fL4't//�ii�il/ NPcr;Gy+�/m-i > Ji G0 14_7l7 /CONTRACTOR BUILDING PERMIT FEES*
Business name: -yyt,7�r, A- -- (.7 e -t„�
Permit
(Please refer tschedule)
Permfee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: o
FLS plan review(40%ofpermit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: : 6 7 Total permit fees:
Authorized signatuK,.,„ ----7/
Amount received:
,.//C '
��� ��/ > This permit application expires if a permit is not obtained
Print name: 6_ ��`�'W Date: l� /FS within 180 days after it has been accepted as complete.
II_ * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_071514.doc 440-4613T(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 ❑ 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:
Type of System (Complete A,B,C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ 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: $
I:\Building\Permits\FPS_PernutApp_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
7500 SW DARTMOUTH ST 110, TIGARD, OR,
97223
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
November 2, 2016 at 9:09:59
AM
FPS2016-00162
Chip Barnett
Tested
Violation Summary:
Inspector Contractor