Permit (73) INCITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
� COMMUNITY DEVELOPMENT Permit#: FPS2019-00071
T i(;A it,1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13/2019
Parcel: 2S102AA00906
Jurisdiction: Tigard
Site address: 12084 SW MAIN ST
Project: Kimberly Berg's Rebel Fit Subdivision: Lot: 4
Project Description: Fire sprinkler. Adding and relocating(18)fire sprinkler heads for TI.
Contractor: WYATT FIRE PROTECTION INC. Owner: BSM REALTY LLC
9095 SW BURNHAM BY RITE AID
TIGARD, OR 97223 PO BOX 3165
HARRISBURG, PA 17105
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/11/2019 $112.96
12%State Surcharge-Building 06/11/2019 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 06/11/2019 $45.18
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 06/11/2019 $2.00
Occupancy Grp: A-2 Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 06/11/2019 $12.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: 0.1 Design Area: 1500
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 $185.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,290.00
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 calling 503.232.1987 or 1.800.332.2344.
Issued By: , '-rmittee Signature: ��y� pit_
Call 503.639.4175 by7:00 a.m.for the next available inspection date.
P
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required en the job site at the time of each rgepocno►.
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard Received / L �//
■ 13125 SW Hall Blvd.,Tigard OR 97223 1 _ Date/By: //7 / 1 P ,00/! 'Z 7/
g Plan Review
INI 1 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: _,..c--- o9 I 4/4 G y'-00�p?�
T I G A R D Inspection Line: 503.639.4175 Date Ready/ y: / Juris: Ei See Page 2 for
Internet: www.tigard-or.gov otified/Method:f�/l lj't /�� Supplemental Information
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0 ! '4 a I l.1 i } -�' Ir .je`g l•ti+ U
❑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 ❑Other: equipment,materials,labor,overhead,and the profit for the
.. CATEOOR'Y UE CONSTRUCTION '" work indicated on this application.
Valuation: $
1=11-and 2-family dwelling ❑■ Commercial/industrial
❑Accessory building 1=1 Multi-family Number of bedrooms:
1=1Master builder ❑Other: Number of bathrooms:
JOB SITEINFORMATION AND LOCATION Total number of floors:
Job site address:12084 Main ST New dwelling area: square feet
City/State/ZIP:Tigard OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Rebel Fitness Club Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:CO 'IMERCIAL*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 OFWox work indicated on this application.
Add and relocate 18 fire sprinkler heads for new TI . Valuation: $3290
Existing building area: square feet
New building area: 0 square feet
❑ PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
[1 APPLICANT 0 CONTACT PERSON E, - C
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ronin Campbell licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:( )503.684.2928 Fax::( )503.684.9657
E-mail:r.campbell@wyattfire.com
O+l' 0I`O1i BIIII IG PERMITPEES*
Business name:Wyatt Fire Protection Permit fee:
Address:9095 SW Burnham
State surcharge(12%of permit fee):
City/State/ZIP:Tigard, OR 97223 FLS plan review(40%of permit fee):
Phone:( )503.684.2928 Fax:( )503.684.9657 (Due upon application submittal.)
CCB lic.:64077 Total permit fees:
Authorized signature: trx)ja��. Amount received:
p,V This permit application expires if a permit is not obtained
Print name:Ronin Campbell Date: within 180 days after it has been accepted as complete.
* Fee methodolo8y s'tby -Co.,.,ty,Rr.;kt;Pg-bv4..et'y
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
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City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
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Eiescribe vvotk'to be
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 1 8 Number of alarm devices:
❑■ Addition or ❑ 1-10 heads: Affidavit required and El 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 requireduired and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type of System(Complete B;C ar 0 as applicable):
A.) Co*nxnercial Sprinkler
Sprinkler Type ❑■ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group light
Density .1
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $3290
B.) .Type 1 . Hood fire Suppression Syste
Hood Project Valuation: $
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C, Fixe latrn
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
kesdential S ti. er Stan: tie .s temp
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.
Pire'Protecton at l e s.
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: $
W:\Permits\Permit Application Forms(Updated July 2017)\Tigard lire Yerrrut App.doc 2
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12084 SW MAIN ST, TIGARD, OR, 97223 July 3, 2019 at 12:12:42 PM
Record Type: Record ID:
Commercial - Fire Protection System FPS2019-00071
Inspection Type: Inspector:
999 Sprinkler final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor