Permit (48) CITY OF TIGARDIN FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2018-00013
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/27/2018
[GA R g Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16165 SW 72ND AVE
Project: CCK Restaurants Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Adding(1)sprinkler head and plugging(3)SSP sprinklers for TI.
Contractor: WESTERN STATES FIRE PROTECTION Owner: PACIFIC REALTY ASSOCIATES LP
17500 SW 65TH AVE ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-657-5155 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/27/2018 $75.30
12%State Surcharge-Building 02/27/2018 $9.04
Type of Use: COM Plan Review-Fire Life Safety-COM 02/27/2018 $30.12
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 02/27/2018 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 02/27/2018 $1.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
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 Calcs Provided: Cut Sheets Required:
Total $117.96
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
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 ailing 503.23 ,1987 or 1.800.332.2344.
Issued By: • �a�a 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 1
Fire Protection System FOR OFFICE USE ONLN
City of Tigard - -., 2 7 /u1'd Received
II ,,,, ,,
Date/B :Review e/B : ,, / Aerf Permit No.: /
111 13125 SW Hall Blvd.,Tigard,OR 97223
Plan
: I Phone: 503.718.2439 Fax: 503.598.1 vac!''y ()I, I 5 5,. A itti, Date/B : OtherPermit: ,A. i ....of
TI CARD Inspection Line: 503.639.4175 Date Ready/By: Juris: FZI See 'age 2 for
Internet: www.tigard-or.gov '101,DING -ifil\IMO) Notified/Method: Supplemental Information
TYPE OF WORE REQUIRED DATA:1-AND 2-FAMILYDYVELLINO.,
0 New construction 0 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
work indicated on this application.
CATEGORY OF CONSTRUCTION
Valuation: $
0 1-and 2-family dwelling liJ Commercial/industrial
Number of bedrooms:
0 Accessory building El Multi-family
0 Master builder 0 Other: Number of bathrooms:
JOB SITE 1100RMATION AND LOCATION Total number of floors:
Job site address: /i.„,/ 6,,,_.;- „..: L,....) .),:k" 4t)E New dwelling area: square feet
City/State/ZIP: re,fzi—LANt> e-:Q..... c1 s 't Garage/carport area: square feet
Suite/bldg./apt.no.: ,560 Project name: C.,cK- 4t.5-ix k 1(4 la I— Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
1111;:QUIRED;DATA:cOMIRCSE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.:
equipment,materials,labor,overhead,and the profit for the
4:0Esc Rtmolv)6F.,WOW* 4 .0'-
Afi work indicated on this application.
Valuation: $ /
41)1) 1 AN i7 f-L.L. --.3 ..c;.5.P criti Kilc:/ /2-<.
Existing building area: square feet
rilikir-.0.- lied
New building area: square feet
0 PROPERTY OWNER? - 0 TENANT , Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( )
New:
Efrippii&ANT , -y, ,e-,li, 0:::4?"'rfr* PE' ',',0 N ''''' re ' '''''''"' '" ''''''
"' , ., , 4 -. NOTICE
Business name: Lif i:-.:srg:ye tq si--E-_< F
//2.L' ( 41,747- ----- Tfoisi All contractors and subcontractors are required to be
Contact name: 1.,_ Li .—
licensed with the Oregon Construction Contractors Board
ki 4_ t 4-4
under ORS 701 and may be required to be licensed in the
Address: i 7,s--4)(} S L.,..! i.,..., '-Tr' / .-ti - jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: 2_ ra,-..- c„,_s_,,,:_;.-e, 0 ct roc..)35,— apply:
Phone:(5.- 1) i,S?-.5 I.5-4.;."-- Fax::( -.:•!..3) ii.,S. )--S i'01--
E-mail:
tiOT*ITtiA'CTOIU'1 ' f' '4:4-7 1:1" ' '' BUILDING PEIIMIrFEES*
/Please Worth fee sch4ule)
Business name:
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP:
FLS plan review(40%of permit fee):
Phone:( ) I Fax:( ) (Due upon application submittal.)
CCB lie.: /0 ti c 20 316r. fl Total permit fees:
Authorized signature:
Amount received:
This permit application expires if a permit is not obtained
Print name: Zi4.„,L. Date:
within 180 days after it has been accepted as complete.
t, i VI C)c..._
* Fee methodology set by Tri-County Building Industry
Service Board.
I.BuildingWermitsTPS-PermnApp_03 10 16.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: I Number of alarm devices:
Addition or 1Z1_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,I),C of P as .pplicable):
A.) Cor mercial Sprinkler
Sprinkler Type [ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group L "
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
3.)* Type I Hood,Fire Suppr ssjQn System _. , , .
Hood Project Valuation: $
C.)
Fire Alarm.
xn,
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residen44 1 Sprinkler(stand Alone Syatem) ',
Square Footage: Permit Fee:
0 to 2,000 $198.75 `1 ,
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.PermitPees
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
RECEIVE!)
- City of Tigard :$
11 • 13125 SW Hall Blvd.,Tigard,OR 97223 '�� Permit No.: IF
Phone: 503.718.2439 Fax: 503.598.1 6C ,r
Inspection Line: 503.639.4175 k �' , p_ Date Received: /47
1 l t A R(l Internet: www.tigard-or.gov 7
ILDING DIVISION By:
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: G !�
Occupancy: C 0-7/4/z t2L t 4,
Job Address: ,.>(�l(,S- 4J 7. "`� ��L
Type of Construction: 1
Suite:
Contractor: , /Z;5 i an iV STA E-C Fier? i'kc: 7-7v(/ Phone: AL3— —
Number of Proposed or Altered Heads: `'f
Type: Hazard: Density:
I' Oregon Construction Contractors Board No.
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 documegt with a copy of the sketch attached shall be available for all inspections.
Signature: /
Date:
Print Name: 4-41_ L
I:\Building\Forms\FireSprinlderAffidavit_071514.docx
Page 1 of 1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16165 SW 72ND AVE, TIGARD, OR, 97224 March 6, 2018 at 9:20:23 AM
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00013
Inspection Type: Inspector:
999 Sprinkler final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor