Permit (103) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
S.. COMMUNITY DEVELOPMENT Permit#: FPS2017-00172
Date Issued: 11/07/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: None Lot: None
Project Description: Add or relocate(7)sprinkler heads for TI
Contractor: WESTERN STATES FIRE PROTECTION Owner: FRED MEYER STORES INC
17500 SW 65TH AVE STORE#375
LAKE OSWEGO, OR 97035 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503-657-5155 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/07/2017 $123.72
12%State Surcharge-Building 11/07/2017 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 11/07/2017 $49.49
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 11/07/2017 $2.00
Occupancy Grp: M Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 11/07/2017 $4.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: UNK
Density: 0 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Cafes Provided: Cut Sheets Required:
Total $194.56
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $4,439.00
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 0 C by calling 503.232.1987 or 1.800.332.2344.
Issued By: c.:1 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 SystemKt ''�� FOR OFFICE USE ONLY
City of Tigard Received/, w� Permit N 7-� , ' . ��
a 13125 S W Hall Blvd.,Tigard,OR 97223 NOV Date B . r
g Plan Review Other Pernar // C '
INPhone: 503.718.2439 Fax: 503.598.1 ,6q r �`
/ , ,� Date/13
TIGARD Inspection Line: 503.639.4175 ,ii1 i.. . ` ( t J Date Ready/By:
turfs: 0 SeePage2for
Internet: www.tigard-or.goV �t g �.* ;� ; n, Notified/Method: Supplemental Information
�; a
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❑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: equipment,materials,labor,overhead,and the profit for the
1� �« 1 kik k ti p work indicated on this application.
0 1-and 2-family dwelling Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
;' p a [ Total number of floors:f ..IEi �aa ► 0 1 E �
Job site address: 1`r"�( 6, y p. ' '\. New dwelling area: square feet
City/State/ZIP: '-c-\cp Y, 17 ZZ3 kAld
Garage/carport area: square feet
Suite/bldg./apt.no.: d 1 Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
Subdivision: Lot no.: Permit fees*are basvalue of the work performed.
Indicate the value(rouned
Tax map/parcel no.: donedthe to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
p-li :AF = ,: _" work indicated on this application.
Valuation: $ it Li
-iok
Aaira), 7 6i3.1-1\-N _LA AT, 4A-Ge..01-1.1m0"-k, ti ' ' ' ' '
Existing building area: square feet
New building area: square feet
Number of stories:
Name: Type of construction: I/ 6
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
a 6i,4a a s u � ' ( F' 1
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may bei required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) I Fax::( )
E-mail:
w I 3 Tl,l V._ S� ..,4,111,7,,,,,:,,,,,,,,,,-_,T,7-i = )It ;�_ �- - 111,1.10 _ _ 'JtA �i ti��',���
ti i' d1 i
Business name: W r, 5;0144 RA,t pt:J
Permit fee:
Address: /5 5 U e rv,
l.� 7‘11- -
City/State/ZIP: . State surcharge(12%of permit fee):
Lc k. OS j e z / >t FLS plan review(40%of permit fee):
Phone:(i,o) 2 7 -5 IS� Fax:( ) (Due upon application submittal.)
CCB lie.: Total permit fees:
U�tS 7t,
�` Amount received:
Authorized signature: —67�t /"�
This permit application expires if a permit is not obtained
Print name:
4
SCS ('t\\ Date: �7 * within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PermitApp_031016.doc 440-4613TQ 1/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
�. n '� ;_'', - a �" r �I� ids
. ^�'C 1 tl. � `. R 'r " _ ,Tar G �, d ry — = ' IIIA .i
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Nu ber of sprinkler heads: Number of alarm devices:
Addition or �1 10 heads: Affidavit required and ❑ 1 5 devices: Affidavit requ7
ired 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:/ ctn,�.��
�n (A/64/1114
\A. T( C�L e
v dry' h _ ( a-5
gii,
114. V ta.t : rpii��i� 1,� 1r x,. 114 ir* _ "ii
— d
S.rinkler T p e '��, Wet ❑ D
Additional Stand.i.es
Information: . .. ❑ Yes ❑ No
Hazard Group
Densi vn[tiG �z�
Desi• Area ''
K. Factor `�
Sprinkler Prosect Valuation: ��
k gip; ,9a'j"'.-----04.::. "'f' e;11'1:.'1!''I::l:
a
Hood Pro'ect Valuation: $
y
w ..'n'N-1- (1i,1' ''''''----:166C''
= 1 � p .,.,i --- ,i'y i��t.-----'''„1,- -,,..--,1-0, �r;��* .. 5E ��'¢_ .'fi n
Submittal shall Batte Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Pro'ect Valuation: $
"�i I�iii I�r ��._ yytiilir ��� `� - �a _' Iii ���� ate'-: ,..„::,"1.1,1_,11„ ,11!,i,_.: 1_:;-
I! ir,
a
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'" t'�.
S.uare Foota•e: Permit Fee: „,,,,,,,,,,,,,,,,,,,,,,,,,,„4,�” � ,, T.
0 to 2,000 $198.75 �� �Qr '�i` �' ' �
2,001 to 3,600 $246.45 ,�� �T ' [
3 601 to 7 200 $310.05 = � ° �ti i� } ��
7,201 ands• eater $404.39 i � 1 ,a ;a jyi1c>�' i
Sprinkler Project Square Footage: sq. ft.
,ra r `i(�d�i( h ar 3+ _ int• - '-a a �a' -- 1l i .
fi �41�,I��B{�Y m .-• �te8 t�1� -gr i ... ix �� I53...
�� J �r z ° i idle
Pro'ect valuation subtotal see A,B&C above : $
Permit fee based on .ro'ect valuation see fee schedule : $
Permit fee based on s.uare foota•e see D above : $
State Surchar•e 12% of.ermit fee : $
FLS Plan Review 40% of ser
mit fee : $
TOTAL: $
C:\Users\Josshua.Miller\Downloads\FPS_PermitApp(1).doc 2
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PA E" ":, yrs , 1 :,
City of Tigard G ?ill; Permit No.: e77.--L,0/ 702_
71 q 13125 SW Hall Blvd.,Tigard,OR 9722 ` r �/
: Phone: 503.718.2439 Fax: 503.584. , A. Date Received: /
Inspection Line: 503.639.4175 k 4 t ' A,I(IsT,i. _§
T I GA Ct Internet: www.tigard-or.gov 5�5 TM By: ,tor
'AILFIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Ffe,. ta, (...,-- .4t 14
Job Address:,j ` IPC�(x,‘ ( 4, Type of Construction:
Suite:
Contractor: h)'c Siffy) Dani-c l.A10t. Phone: )- S 7 5-155-
Number of Proposed or Altered Heads: 7
Type: aR/;R Hazard: L;G1,,,\-- Density: , ,
MIL/I, 4'SL Mt Oregon Construction Contractors Board No. I()Li:576
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: Zvi, jaitt. Date: 7j
lll /17
Print Name: a5-\. NAL,
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