Permit (187) y y CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2017-00104
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/24/2017
Parcel: 25101 DA01900
Jurisdiction: Tigard
Site address: 7000 SW VARNS ST
Project: Madrona Recovery Subdivision: VARNS ACRES Lot: 3
Project Description: Installation of an Ansul R-102 fire suppression system for an exhaust hood.
Contractor: UNIVERSAL FIRE EQUIPMENT Owner: NELSON VIAL LLC
18260 SW 100TH CT 7155 SW VARNES ST#120
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503-691-9000 PHONE:
FAX: 503-691-9004
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/24/2017 $102.20
12%State Surcharge-Building 07/24/2017 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 07/24/2017 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 07/24/2017 $15.00
Occupancy Grp: 1-2 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 $170.34
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 c•,• of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: Allb
Call 503.639.4175 by 7:00 a.m.for the next availab i i=•ection da. .
This permit card shall be kept in a conspicuous place on the job e until completion of the project.
Approved plans are required on the job site at the time of each inspection.
L r
Building Permit Application
Fire Protection System FOR OFFICE LSF ONE)
City of Tigard -f permitNo.: �y�f ��RECEIVEJI!iew7
' / / I'�PJ; �ti 7 (.�✓f 11i13125 SWHallBlvdTigard,OR 97223
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: ' 3' �� Other Permit: P?`f)7...(Z `)ei
T 1 G A R D
Inspection Line: 503.639.4175 Date Ready/By: kris: See Page 2 for �C�' 17�
Internet www.tigard-or.gov f 161 2017
y tified/Met od: Z �/r Supplemental Information
TYPE OF WOM 1:Jl OF TIG I`RD QUIRED DATA:1-AND 2-FAMILY DWELLING
ew construction }ti . I (D f`S'" 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 OF CONSTRUCTION work indicated on this application.
Valuation: $
El1-and 2-family dwelling mmercial/industrial
1=1Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATON AND LOCATION Total number of floors:
Job site address: 7000 5,.4) ,, New dwelling area: square feet
City/State/ZIP:"i j-•Ci 4.4. / 0 _ C77zz 3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: r Covered porch area: square feet
r .1.1,4.1.1,4 29 e C.tv i.t�, 7 E=1
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 1 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.
Valuation: $ � �
..`�cl.¢A�, 4A/(4 'fit, �y�! ��c�
Existing building area: square feet
h a te s h 6. New building area: square feet
0 PROPERTY OWNER Ig NT Number of stories:
Name: 11igetisin 4 pe4_0 1 f `� f'e�7�0-, _ Type of construction:
Address: "7 u Sc jJx,y,4 J,l Occupancy groups:
City/State/ZIP:7,..-5.-v l„['-( c. .` `TZivz-. Existing:
Phone:b":::,3) -f Sl3 h ! Fax:( )
New:
LICANT NTACT PERSON NOTICE
Business name e,,(vett-4_1 -.y 4 k 7 ,.5 , f- All contractors and subcontractors are required to be� � licensed with the Oregon Construction Contractors Board
Contact name: g
� J under ORS 701 and may be required to be licensed in the
Address: / 3'2_6 Z t,) /C � mit.- jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:--rt.,/Pl l i�To�'� Q . 7t: apply:
Phone:'S ?) 6-51_C3 /.,„ Fax: . j')6 9 f- 9 )
E-mail:un 1021 ':4 f f e-e-OIVTRA✓YLE 6YI4:-It1fr A ?1' LCA.--,
C N.TItACTOR BUILDING PERMIT FEES*
Business name: 5;4_00 4 _# _ j j 6(7 ..e..._ (Please refer to fee schedule,
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP:
Phone: FLS plan review(40%of permit fee):
( ) Fax:( ) (Due upon application submittal.)
CCB lic.: Re 72 s Total permit fees:
X.
Authorized signature Amount received:
This permit application expires if a permit is not obtained
Print name: .S.t % Date: 7``z 7 * within 180 days after it has been accepted as complete.
Y G Fee methodology set by Tri-County Building Industry
Service Board.
I:ABuilding\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
❑ 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.) CommercialSprinklet
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: $ ss SZ `
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El 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\Pemrits\FPS_PermitApp_031016.doc 2