Permit (161) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• • COMMUNITY DEVELOPMENT Permit#: FPS2016 00191
# : k ) !V.
G R. Date Issued: 11/16/2016
T f A C) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243 J �
3 �� Parcel: 26101DD00701
Jurisdiction: Tigard
Site address: 6960 SW SANDBURG ST
Project: Tigard Tualatin School District Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: Fire sprinklers-Add(2)sprinkler heads to walk-in cooler. 3/23/17:REPRINTED permit to include(2)additional
sprinkler heads:Adding(1)and relocating(1).
Contractor: SIMPLEXGRINNELL LP Owner: TIGARD-TUALATIN SCHOOL
6305 SW ROSEWOOD ST. DISTRICT 23J
LAKE OSWEGO, OR 97035 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-683-9000 PHONE:
FAX: 503-675-6521
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/16/2016 $102.20
12%State Surcharge-Building 11/16/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 11/16/2016 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 11/16/2016 $5.50
Occupancy Grp: Height: ft 11x17)
Stories:
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 $160.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,749.00
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 •; or 1.8 4.
Issued By: / Permittee Signature:
Call 0 .• 9.4175 by 7:00 a.m.for the next available insp tion ate.
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.
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00191
13125 SW Hall Blvd.,Ti Date Issued: 11/16/2016
7 4CAft. and OR 97223 503.718.2439 9
Parcel: 2S 101 DD00701
Jurisdiction: Tigard
Site address: 6960 SW SANDBURG ST
Project: Tigard Tualatin School District Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: Fire sprinklers-Add(2)sprinkler heads to walk-in cooler.
Contractor: SIMPLEXGRINNELL LP Owner: TIGARD-TUALATIN SCHOOL
6305 SW ROSEWOOD ST. DISTRICT 23J
LAKE OSWEGO, OR 97035 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-683-9000 PHONE:
FAX: 503-675-6521
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/16/2016 $102.20
12%State Surcharge-Building 11/16/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 11/16/2016 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 11/16/2016 $5.50
Occupancy Grp: Height: ft 11x17)
Stories:
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 $160.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,749.00
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 ons UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i6-7,C Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspec 'on cite.
This permit card shall be kept in a conspicuous place on the job site until co ion of the project.
Approved plans are required on the job site at the time of each inspection.
City of Tigard .4` t• 11 hermit No.: f'S 90/0-60 / 9/
-'i 13125 SW Hall Blvd.,Tigard,OR 97223 -: b , -.' AJ'
AillC Phone: 503.718.2439 Fax 503.598.1960 Date Received: ,( //42N
Inspection Line: 503.639.4175
I I GAR •' Internet: www.tigard-or.gov N O V 16 2016 BY: V"-'. 6q_ i-L-4-L/
iv
FIRE SPRINT LRi"A�+^ IDAIT VIT FOR ALTERATIONS
aa�IaTB X86ViQI ni
OK-TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: li Cttl f'LlGz�l�f�1 l e j7 Occupancy: C 1 G� GLC i t -
Job Address: 6 /60 $t iJ Sa.n h� t , Type of Construction: �,,/Qr('
J
Suite: /
Contractor: _�L L �,pLe(7r.1/ 14,ei Phone: S-(' 53
Number of Proposed or Altered Heads: , ..
Type: Dry Hazard: Q1-11 Density: 6. IS
I, JO V:, MQ.ISQ Oregon Construction Contractors Board No. /q992_.1
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits,beams,partitions,walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop(exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads(see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
In addition, I understand the following is required:
• Submit(3) copies of a sketch showing the area of work within the building's structure.
• Building fire protection system permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature• d.0tai 1........,----._ Date: // /(D
Print Name: 01A_ )o,,,LSoL,t
I:\Building\Forms\FireSprinklerAffidavit_071514.docx Page 1 of 1
Building Permit Application
Fire Protection System F 1 FOR OFFICESL ONLN
City of Tigard Received I Permit No.:
II 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : I A9j5�/lp—CO i 9/
= Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
TI G A R D Inspection Line: 503.639.4175 N O V 1 6 201h
Date Ready/By: 7wis: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
' 4i y�ff.... h Ia
ff
TYPE j I G DIVISION" 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
,Ej Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling g Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 6(i.60 cCA/ _fprl1' I),,f/t,t p- New dwelling area: square feet
City/State/ZIP: 4/4 air Og 9722,32 t Garage/carport area: square feet
Suite/bldg./apt.no.: 1 Project name: / 12 Covered porch area: square feet
Cross street/directions to job site: 7f N t-i Deck area: square feet
Other structure area: square feet
REQUIRED DTA,COMMERCIAT-USE CHECI.%IST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTIO OFaWORK work indicated on this application.
Ad ,s/24�14,k".00 1 o- �/✓�il.G.l`.- 1 too •
Valuation: $
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER \ ❑ TENANT '4'. Number of stories:
Name: ii-f-.,c .-a i ez( il -,4 t( t"')c.s r/ /
c, , Type of construction:
j/ l 6j 00 0lg
Address:
Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( )
New:
APPLICANT `a 0 CONTACT PERSON , :,x
NOTICE;.. , ;,I
Business name: t ii,p(e*(51 rt KoZt7 All contractors and subcontractors are required to be
Contact name: V f/ Ale 60 licensed with the Oregon Construction Contractors Board
Address: /..v C' under ORS 701 and may be required to be licensed in the
( �d�� _5, /^� ,i SE in/� __St jurisdiction in which work is being performed.If the
City/State/ZIP: 4.41,‘,.._e, Os�JQ_0 t �}1 9 f� J applicant is exempt from licensing,the following reasons
66'51� apply:
Phone:($3) , zlo Fax::( )
E-mail t ✓{ cl Jcwtca 3-,AA_p(th l' y r 'e II (7,(.2I r4l..-
: E CO1V�'ItA OR � ...
BUILDINGPE 'IIT FEES*
Business name: /) ��/ / ', , (Please"refer tofee schedule) •
-
S0.4 e, t 5 'HIF� 2 Z(G64,,rd Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
/��� L
CCB lic.: 7 "i Total
---..—.,••-•---1
permit fees: �j . �
„
Authorized signature: > Amount received: �p0
This permit application expires if a permit is not obtained
Print name: Jo k (av\j Date: ((1 /6 %47 within 180 days after it has been accepted as complete.
/ * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.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
1::111+ 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 prink er , - v.
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
/3) Type I` hood Fire Suppression System ;= = f Hood e
Proy ct Valuation: $
yrs
Ct,) plire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
.D.) Residential Sprinkler`(Stand AlSt
r
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_PermitApp_031016.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
6960 SW SANDBURG ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2016-00191
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor