Permit (38) INCITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
i� . COMMUNITY DEVELOPMENT Permit#: FPS2017-00089
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/26/2017
Parcel: 2S 101 C B00500
Jurisdiction: Tigard
Site address: 12670 SW HALL BLVD, BLDG#3
Project: Canteen Vending Subdivision: None Lot: None
Project Description: Fire sprinkler modifications for high pile storage.
Contractor: FIRE SYSTEMS WEST INC Owner: MCLELLAN ESTATE CO
600 SE MARITIME AVE#300 BY CHRISTOPHER M CAVE ESQ
VANCOUVER, WA 98661 707 OLD COUNTY ROAD
BELMONT, CA 94002
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/26/2017 $379.22
12%State Surcharge-Building 06/26/2017 $45.51
Type of Use: COM Plan Review-Fire Life Safety-COM 06/26/2017 $151.69
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 06/26/2017
Occupancy Grp: S-1 Height: ft 11x17) $4.00
Stories: Info Process/Archiving-Sm$0.50(up to 06/26/2017 $10.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard:
Density: .495 Design Area: 2000
K Factor: 11.2
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $590.42
Valuations:
Required Items and Reports(Conditions)
Sprinkler Valuation: $30,000.00
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 N• • . io .- ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir, t questions to 0 C . :.fling 503.232.1987 or 1.800.332.2344.
I ued By: 0 40:10 / 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 System REC,EIVED
FOR OFFICE USE ONLY
City of Tigard Received / / G
11111 II ' 13125 SW Hall Blvd.,Tigard,OR 97223JUN Date/By: Ler / � Permit No.:695 17 (1`9
Phone: 503.7182439 Fax: 503.598.1960 3 Q 7 Plan Revte
Date/By: 1I� '� Otheauris. Permit:/ /0c9.617_60/67ASe
T I(.A It f) Inspection Line: 503.639.4175CIP(OF I��ryt y Date ReaBy:, .
Internet: www.tigard-or.gov i7! SI J ' /_ //2 / j°S I Supplemental See Page 2 for
B ILLI G DIVISION No. e L� ( l Information
TYPE OF WORK , REQUIRED DATA:1-AND 2 FAMILY DWELLING
❑
0 New construction " Y ,
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:
equipment,materials,labor,overhead,and the profit for the
' CATEGORY DF' CON TRhUCTIONh' ' ''' '' work indicated on this application.
❑ 1-and 2-family dwelling ®CommerciaUindustrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder
❑Other: Number of bathrooms:
JOB Si'IYt"INFORMATION AND LOCATION Total number of floors:
Job site address:12670 SW Hall Blvd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223
Garage/carport area: square feet
Suite/bldg./apt.no.:3 I Project name:Canteen Upgrade
Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
Subdivision: "REQUIRED;DATA,,COMMERCIAL-USE CHECKJST _.
ILot 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
ff equipment,materials,labor,overhead,and the profit for the
4" . ' DESCRIPTION �F WORK :=t 5, work indicated on this application.
Install new sprinklers and piping over high-piled rack storage area Valuation: $$30,000.00
Existing building area: 10000 square feet
New building area: square feet
I::), PROI"ERTY OWNER" 1
N.; '� ' ►�~.1NAN ' • Number of stories:
Name:Canteen Vending
Type of construction:
Address:12670 SW Hall Blvd Building 3
Occupancy groups:
City/State/ZIP:Tigard,OR 97223
Existing:
Phone:(503)972-4723 Fax:( )
New:
;; .-11E1 APPLICANT, . ''x• :❑ CONTACT PERSON
Business name:Fire Systems West
All contractors and subcontractors are required to be
Contact name:Jackson Zeiner licensed with the Oregon Construction Contractors Board
Address:600 SE Maritime Ave under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
City/State/ZIP:Vancouver,WA 98661 applicant is exempt from licensing,the following reasons
Phone:(360)6939906 apply:
I Fax::( )
E-mail:jacksonz@firesystemswest.com
,, • CONTRACTOR '" BUILDING PERMIT FEES*
Business name:Fire Systems West
�fi� rtsereJerroeesrhedule)
Address:600 SE Maritime Ave Permit fee:
City/State/ZIP:Vancouver,WA 98661 State surcharge(12%of permit fee):
Phone:(360)693-9906 FLS plan review(40%of permit fee):
Fax:( ) (Due upon application submittal.)
CCB lie.:49732
Total permit fees:
Authorized signature: Amount received:
cM...„,..------ r�� This permit application expires iF a permit is not obtained
Print name: I Date: p(/�3//- I within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
I:\Building\PernutsWPS-PennitApp_031016.doc Service Board.
440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done1,,
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
[3 New system Number of sprinkler heads: Number of alarm devices:
1:1 Addition or LI 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
El 11+ heads: Plan review required and Ll 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Typec." or a as appliq4l
*
Cd*metcial Spqnalex,„,,
SprinklerWet 0 Dry
Additional Standpipes
Information:
Type
Sprinkler Supply Line I Yes No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
Type I - Hood Fire'Suppression System
Hood Project Valuation: I $
C.) Fire Alarm , 0
Submittal shall Battery Calculations
Yes
include: Individual Component LI Yes
Cut Sheets
Fire Alarm Project Valuation: $
6.)--,Residential Sptinider(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: $
CAUsers\JacksonZ\Downloads\ITS_PermitApp(3)doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12670 SW HALL BLVD BLDG 3, TIGARD, OR,
97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00089
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor