Permit (120) .111 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2017-00015
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2017
Parcel: 1 S 135 BA00102
Jurisdiction: Tigard
Site address: 10124 SW WASHINGTON SQUARE RD
Project: Costa Vida Subdivision: OAKBURG Lot: 9
Project Description: Type I hood-Ansul R-102 fire suppression system.
Contractor: SANDERSON FIRE PROTECTION INC Owner: PPR SQUARE TOO LLC
1101 SE 3RD AVE PO BOX 847
PORTLAND, OR 97214 CARLSBAD, CA 92018
PHONE: 503-889-3110 PHONE:
FAX: 503-889-3192
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/07/2017 $123.72
12%State Surcharge-Building 03/07/2017 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 03/07/2017 $49.49
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Sm$0.50(up to 03/07/2017 $17.50
Occupancy Grp: A-2 Height: ft 11x17)
Stories: 2
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 $205.56
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $5,000.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,, ZGi Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System1 Received FOR OFFICE USE ONLY
V City of Tigard `Y Date/By: - A /7 1Permit No.: /05 7- i r.
13125 SW Hail Blvd.,Tigard,OR 97223 Plan Re lew f
Phone: 503.718.2439 Fax: 50f ' 31 Date/By: t (( 7 Other Permit vaU/�Q-lXJ�$/
Inspection Line: 503.639.4175 ?017 Date Rea
TIGARD y : orris: 0 SeePage2for
Internet: www.tigard-or.gov r Notified/Method: 3 !7 7—ci, Supplemental information
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tie,
REQUIRED DATA:1-AND 2-FAMILY DWELLING
I 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 0 Other:TI equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-famil Y dwellin Valuation: $
g ®Commercial/industrial
❑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:10124 Washington Square Rd;Suite A07 New dwelling area: square feet
City/State/ZIP:Portland,OR 97223 (� Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Costa Vida Mexican Grill 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(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Ansul R-102-Fire Suppression system installation into Type 1 Kitchen Exhaust Valuation: $5000.00
Hood Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT I Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: ! Existing:
APPLTCANT ►/)CONTACT PERSON
NOTICE
Fax (
Business name:Sanderson Fire Protection f1 All contractors and subcontractors are required to be
Contact name:Geoff Spahr licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:1101 Se 3rd Ave jurisdiction in which work is being g performed.If the
City/State/ZIP:Portland,OR 97214 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)889-3110 Fax::(503-)889-3192
E-mail:geoff@sandersonfire.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Sanderson Fire Protection (Please refer rofee schedule)
Address:Same as Above Permit fee:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lie.:208652
1 Total permit fees:
(„iAuthorized signature: j Amount received:
_ This permit application expires if a permit is not obtained
Print name:Geoff Spahr Date:2/16/17 I within 180(lays after it has been accepted as complete
* Fee methodology set by Tri-County Building Industry
Service Board.
I:ABuildingVPermits\FPS-PermitApp-0310i6.doc a i'.-i613T(I I/02iC'OM'wF',:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10124 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00015
Inspection Type: Inspector:
920 Suppression trip test Chip Barnett
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor