Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111
I COMMUNITY DEVELOPMENT Permit#: FPS2020-00082
T t(;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/09/2020
Parcel: 2S101AB03100
Jurisdiction: Tigard
Site address: 12115 SW 70TH AVE 202
Project: Med RX Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: Fire alarm, Adding(3)devices for TI.
Contractor: POINT MONITOR CORPORATION Owner: TIGARD TRIANGLE PARTNERS LLC
5863 LAKEVIEW BLVD STE 100 BY DEERING MANAGEMENT GROUP
LAKE OSWEGO, OR 97035 4800 SW MACADAM AVE STE 120
PORTLAND, OR 97239
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/09/2020 $80.68
12%State Surcharge-Building 07/09/2020 $9.68
Type of Use: COM Plan Review-Fire Life Safety-COM 07/09/2020 $32.27
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 07/09/2020 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
•
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 $123.13
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,538.00
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. ,/J
Issued By: '2� G�'\�` j /� _----Permittee Signature: 65 . / -
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 7/
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 � E i tilt III I t('l USE ONLY
City of Tigard Received
/
�''� 2 2020 PtmRevkw &T_ts AIMI"
,� 13125 SW Hall Blvd.,Tigard.OR 97223 J<_
Phone: 503.718.2439 Fax: 503.598.1960 Date/B r
Inspection Line: 503.639.4175 C - Y yU��ee
rimai
l G,\I:I) Note a/McBo: iliiiS See Page 2 Information
Internet: www.tigerdoegov � . Noti6ed/Mcthod: Supplemental laTormadon
.."` PE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
J
0 New construction illDemolition 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
CATEGORY OF CONSCRUCTION work indicated on this application.
El I-and 2-family dwelling ElCommercial/industrial Valuation: S
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder
❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:12115 SW 70a Ave. New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suitabldgiapt.no.:202 Project name:MED Rx Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE 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
DESCRIPTION OF WORK work indicated on this application.
FIRE ALARM NOTIFICATION DEVICES Valuation: $$l 538.00
Existing building area: square feet
New building area: square feet
AD PROPERTY OWNER ® TENANT Number of stories:
Name:MED Rx Type of construction:
Address: 12115 SW 70th Ave.Suite 202 Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON
., NOTICE
Business name:Point Monitor Corp. All contractors and subcontractors are requited to be
Contact name:Brooke Williamslicensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:5863 Lakeview Blvd#100 jurisdiction in which work is being performed.If the
City/State/ZIP:Lake Oswego,OR 97035 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)627-0100 Fax::( )
E-mail:bwllliams@,pointmonitor.com
CONTRACTOR _ BUILDING PERMIT FEES`
Business name:Point Monitor Corp. (Phase refer ma fee uhedula,
Permit fee:
Address:5863 Lakeview Blvd#100
State surcharge(12%of permit fee):
City/State/ZIP:Lake Oswego,OR 97035 FLS plan review(40%ofpermit fee):
Phone:(503)627-0100 Fax:( ) (Due upon application submittal.)
CCB tie.:135901 Y Total permit fees:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
Print name:Ben Breit Date:6/23/2020 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I.Building Permirs,FPS-PermitApp 031016.doc 4404613T(I 1,02 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: Number of alarm devices: 3
® Addition or ❑ 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
0 11+heads: Plan review required and ❑ 6+devices: Plan review required and
(3) sets of plans. (3)sets of plans.
Additional description of work: Fire Alarm
Type of System (Complete A, B, C or D as a plicable):^ a
A.) Commercial Sprinkle , IPT
AlitiatH
Sprinkler Type ❑ Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes 0 No
Hazard Group
Density _
Design Area
K Factor
Sprinkler Project Valuation: $
B.) Type I - Flood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component CO Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1,538
D.) Residential 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: $
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RE E V
City of Tigard Permit No.: FP ,i0 -6n/,2
• hone S50 Hall.2439 Tigard,OR 97223 J U iV 2 2020 7l 9 j
I Phone: 503.71 A.2439 Fax: 503.598.7960 Date Received:
T I G A It D Inspection Line: 503.639.4175 (jl .' + r--- r
Internet: www.tigard-or.gov BUILD!, By: Ui_ " r
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: MED Rx Occupancy: Same
Job Address: 12115 SW 70th Ave. Suite: 202
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $1,538
Type of System: (check one) ❑■Required [Non-required
(check one) ❑Automatic ❑Manual OBoth
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added Imax 5) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(ma.5) /To be Relocated(ma.5)
Number of Proposed Notification Appliances: To be Added(ma.5) 3 /To be Relocated(maa s)
I Ben Breit Oregon Construction Contractors Board No. 135901
certify the following is true and defines the scope of work for this project:
a) All work complies with the current state-adopted NFPA-72 and the authority having jurisdiction.
b) All notification appliances are located in accordance with the current state-adopted NFPA-72.
c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having
jurisdiction.
d) Exposed wiring will not be covered until inspected.
e) Final approval shall be subject to on-site tests and inspections.
f) Voltage drop is adequate to operate all appliances.
g) Battery supplies are capable of supporting the system modifications.
h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications.
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.
• Electrical permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature:( _ Date: 6/24/2020
Print Name: Ben Breit
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