Permit (38) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IL '111 COMMUNITY DEVELOPMENT Permit#: FPS2017-00155
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19/2017
T f �a1 Parcel: 1 S 136C D02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 3
Project Description: Kitchen hood fire suppression system.
Contractor: SIMPLEXGRINNELL LP Owner: COSTCO WHOLESALE CORPORATION
6305 SW ROSEWOOD ST. PROPERTY TAX DEPT 111
LAKE OSWEGO, OR 97035 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 503-683-9000 PHONE:
FAX: 503-675-6521
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/19/2017 $112.96
12%State Surcharge-Building 10/19/2017 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 10/19/2017 $45.18
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Lg$2.00(over 10/19/2017 $2.00
Occupancy Grp: M 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 $173.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,450.00
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 may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: `/`
WI Call 503.639.4175 by 7:00 a.m.for the next available inspection �te.
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
FOR OFFICE LSE O'�Ll
City of Tigard 41 .'
4 ' A t— , Received —
1„,,, . 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B `V Permit No.: s r
= Phone: 503.718.2439 Fax: 503.598.1960 (J C Plan ReviE�ty �►
® Other Permit: I /
Inspection Line: 503.639.4175 Date/B : i �' ,/ �_ .A4
7 I G A R D p Date Ready/ ;� See Page 2 for
Internet: www.tigard-or.gov Notified Method:
iF x, -R ¢ ` SupplementalIn[ormadon
Jr-�Jls. t uZ Li'IVIS
TYPE OF WORK - REQUIRED"DATA:1-AND 2-FAMILY DWELT.NG
0 New construction
❑Demolition Permit fees*are based on the value of the work performed.
rddition/alteration/replacementIndicate the value(rounded to the nearest dollar)of all
0Other: equipment,materials,labor,overhead,and the profit for the
` CATEGORY OF CONSTRIJCTIQI�1 work indicated on this application.
0 1-and 2-family dwelling Commercial/industrial Valuation: $ '��4...t.: �j�'
ElAccessory building EJ Multi-familyNumber of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: �.) 75-z„) New dwelling
Q �e.J �.1�(�'�j?.fC���� weg area:
square feet
City/State/ZIP: I i ,r• Q" G Gara e/ca ort area:
g rP square feet
Suite/bldg./apt.no.: I Project name: C
�51 C C, Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMVIERCIIII.-UE CIIECKL4ST
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
DFSRIPTIO1�i 9FO equipment,materials,labor,overhead,and the profit for the
.''. '' work indicated on this application.
/,7 // 14-//-" .
-//—" . : /2 ic-,s! Valuation: $ 3(_—
Existing building area: square feet
New building area: square feet
''4' PROPERT'Y'OWNER ` " > ' ., � TENS
�
<,., = �� x Number of stories:
Name: -( �
Type of construction: f i 5,-tee I .S (c)n
Address: t
""`ebetc-fik` Occupancy groups:
City/State/ZIP: 'ri CP 72-7---3
\— Existink
Phone:(77/) ",.1.1
Q(j f5-�20 Fax:( ) _
APPL1Cf1NT New:
CONTACT.PERSON`
Business name: �' � NOTICE ��` ��,�
�,mq2 Croy ( tare i t '
- All contractors and subcontractors required to be
Contact name: kgi1 ( licensed with the Oregon Construction Contractors Board
Address: wz\ , GZ�w� under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
City/State/ZIP: bL (6?_ 3 w z �` —�- applicant is exempt from licensing,the following reasons
7 _ �� () 7 7u
Phone:( // ) j�/ S�' 5 -� ) Fax::( ) apply:
Email: �L r✓tie...1 1 ,4i 10/..tom .((J( fl,iz,, , C vr\
Business name: CONTRACTOR - - 'BUILDING PERMIT FEES*
{Please refer to fee sehedule1:. *T ti
Address: / 5ftrirj -
Permit fee:
City/State/ZIP: (\ State surcharge(12%of permit fee):
v
- FLS plan review(40%of permit fee):
Phone:( ) I Fax:( )
cy (Due upon application submittal.)
CCB lic.: 114 )-] Total permit fees:
I
Authorized signature: Amount received:
✓ ' This permit application expires if a permit is not obtained
Print name: K.z i-�1'�.. 11.Ca e 1 I Date: 10 IT/
j i 7I within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
1:\Building\Permits\FPS-PermitApp_031016.doc Service Board.
440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describeotk to be donet „
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
El New system Number of sprinkler heads: Number of alarm devices:
0 Addition or 0 1-10 heads: Affidavit required and 0 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
0 11+heads: Plan review required and 0 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type of System(Coolpiete A,B,C or D as app1ioa41 ). „
-
A.) Coija;:nercial Stirinider • , 1! :11
Sprinkler Type Li Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes 0 No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
B.) Type 1 -- Hood Fire Supp'yeaSiOo'Ssiein
Hood Project Valuation: I $ 3)Lts7Y.
'C.) Fiie Ala6". • - -
Submittal shall Battery Calculations 0 Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: I $
D.) Re;siilential 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_PermitApp_031016.doc 2