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Permit (18) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT COMMUNITY DEVELOPMENT Permit#: FPS2018-00186 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/31/2018 T r c ;+ It t� g Parcel: 1S134BC00300 Jurisdiction: Tigard Site address: 12286 SW SCHOLLS FERRY RD A Project: Koba Grill Subdivision: None Lot: None Project Description: Fire sprinkler.Altering(3)sprinkler heads for TI. Contractor: PCI PERSONAL CONSTRUCTION Owner: FW OR-GREENWAY TOWN CENTER LLC 410 BEAVERCREEK RD, STE 513 PO BOX 790830 OREGON CITY, OR 97045 SAN ANTONIO,TX 78279 PHONE: 503-679-3461 PHONE: FAX: FEES Description Date Amount Specifics: Permit Fee-COM 12/31/2018 $51.09 12%State Surcharge-Building 12/31/2018 $6.13 Type of Use: COM Plan Review-Fire Life Safety-COM 12/31/2018 $20.44 Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 12/31/2018 $2.00 Occupancy Grp: Height: ft 11x17) Stories: Commercial Sprinkler System: Sprinkler Required: Sprinkler Type: Wet Standpipe Required: Hazard: LT Density: 0.1 Design Area: 1500 K Factor: 05.6 Commercial Fire Alarm System: Fire Alarm Required: Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $79.66 Valuations: Required Items and Reports(Conditions) Sprinkler Valuation: $300.00 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. Sp-cialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not tatted 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 ar- set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obt.in a copy of the rules or direct questions to OU - : calling 503. 4'.1987 or 1.800.332.2344. Issued By: Si!nature: Call 503.639.4175 by 7:00 a.m.for the next available ins< ction 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 Applicatio ECEIVED Fire Protection SystemFOR OFFICE USE ONLI71 ' City of Tigard I7 t� ). 20 1 Received � Date/B �`� 'r - / �M 111 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review = Phone: 503.718.2439 Fax: 503.5981i( (_)/°, Date/B : �/ L / ` T 1 R D Inspection Line: 503.639.4175 y r T, Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov ttiji ,Di ( 5 IVIS ON Notified/Method: Supplemental Information ' ' TYPE OF WORK - - •,'.1 r -. 4.i REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ''ddition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the ` '�t i � 1-1:-0,: '- r'`" work indicated on this a lication. I CATEGORY OF CONSTRU4"1<'ION -- ❑ 1-and 2-family dwelling commercial/industrial Valuation: $ �,z ❑Accessory building 0 Multi-family Number of bedrooms: 0 Master builder 0 Other: Number of bathrooms: JOB li$10,-"INFORMApOAND LOCATION l''f '. F Total number of floors: Job site address:,.yip S w SGh O// New dwelling area: square feet City/State/ZIP: Garage/carport area: square feet Suite/bldg./apt.no.: Project name: >. , /f '(`! Covered porch area: square feet Cross street/directions to job site: C/ ` Deck area: square feet Other structure area: square feet k '.QU i i 1 ATA COMMERCIAL- E C. i IST"% Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead, and the profit for the OF ; 11 i-PESCRIPTI N OWORK * work indicated on this application. 41-7-e-r]{ , -7 ps At$ z 4, t � Valuation: $ /1 �(7` Existing building area: square feet New building area: square feet 0 PROPERTY OWNER t •• its NANT 2, Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: 0 APPLI0 COMA N ' Business name: p C , Q,Qrso e .it._:: 1,„u ed ,-.7„, All contractors and subcontractors are required to be Contact name: L �� ` licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: t tQ ig Qg.w.e..,, Y,2 Q k. A. .4 „.C___,/ 3 jurisdiction in which work is being performed.If the City/State/ZIP: 0.3r-,s, applicant is exempt from licensing,the following reasons err t ; t R. i9 7 CJ 4e apply: Phone:97,)777'-a.f7fG Fax::( ) E-mail: �_ t " , -w „a C : RifitAito `�./....7,f �_ ,,o ti. , BUILDING:P' ', I FEES* ‘- : rw. ` t-. '(Please re= "..r "schedule) .r,; ... ° Business name: ii) ... 12.4.4,-4 d V N D O ' 4.1 P t.& llll t r1/ �����t-11 Permit fee: Address: „,O I .QD✓t/G-YC'Y.o•e k. ga. L't / 3 City/State/ZIP: ��, � �,11-4,11 '/� State surcharge(12%of permit fee): re (-Die• 9 7e $`''- FLS plan review(40%of permit fee): Phone:(97 tj 7 7,7 ___e�7 c Fax:( ) (Due upon application submittal.) CCB lic.: l 3 6 d Total permit fees: Authorized signatorPC. Amount received: This permit application expires if a permit is not obtained Date: within 180 days after it has been accepted as complete. Print name: I V i'` F. �l� �/3 �‘,41 * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(i1/02/COM/WEB) City of Tigard: Fire Protection Permit Checklist Page 2- Supplemental Information Describe work"to be done: . r. 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: al-Addition or �'.1 10 heads: Affidavit required and C:1 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© Syste. lett' Cor D4yapplcable� M .. ) Commercial"Spr ".: : Sprinkler Type L Wet ❑ Dry Additional Standpipes Information: Sprinkler Supply Line, Er Yes ❑ No Hazard Group 1,, :7Vt` Density �, ���?� �'}/%�' M Design Area ���'� /y.e4' LC' ', K. Factor T, , v SprinklerProject Valuation: $ .,,,,,,,L?: c B.) Type I= Hood' ®Pr � ° :: Hood Project Valuation: $ Eire Alar ,.i . 'W ti µ w' �., ", r„ r'... Submittal shall Battery Calculations ❑ Yes include: Individual Component ❑ Yes Cut Sheets Fire Alarm Project Valuation: $ rankle Alone 5 $ tty.�,{�� 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 $404.39v, , . .:, Sprinkler Project Square Footage: sq.ft. ' . x, litiire<j<'ro ori Perrot M . . ,wf. 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: $ 2, I:\Building\Permits\FPS_PermitApp_031016.doc City of Tigard Permit No.: FfLOI r-oark - . 13125 SW Hall Blvd.,Tigard,OR 97223 / Phone: 503.718.2439 Fax: 503.598.1960 Date Received: An • , Inspection Line: 503.639.4175 / T I G A R D Internet: www.tigard-or.gov By: j ,,, i. .- .. 4 /i./its FIRE SPRINKLER AFFIDAVIT FOR ALTERA l, EI Vi OR TENANT IMPROVEMENTS 'J A-i 3 6).01 (1 to 10 SPRINKLER HEADS WITHOUT PLANS) Or, . CI U TILBi C DIVISION Project Name: 4 ( i 1 Occupancy: (tfS� Job Address: ,.�1.:47/4 g w scAo//g ,/ Type of Construction: Suite: . Contractor: 9 C t 1 & —c av-, e c.,.,,t e...4 ri„„t Phone: Number of Proposed or Altered Heads: 3 Type: Gz -?-F- "4.jgtI, Hazard: •,4.--t1 rte; Density: j•s �2 4, . I, 7C 1 PSS o-K(and ru 3 Lizegon Construction Contractors Board No. / - Go 2.___ 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 coof this docum nt with a copy of the sketch attached shall be available for all inspections. cpy 72 Signature: I Date: /Z/-Wy Print Name: , ,....t_.., ,D e H t -A) I:\Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1