Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
° 3.III '> COMMUNITY DEVELOPMENT Permit#: FPS2020-00094 •
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/10/2020
Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 570
Project: Dr. Henderson Subdivision: None Lot: None
Project Description: Fire sprinkler permit:Adding and relocating(8)sprinklers for TI. Affidavit received.
Contractor: SPRINKIT FIRE PROTECTION INC Owner: LITHIA REAL ESTATE INC
PO BOX 2227 ATTN DEBOER, MARK
OREGON CITY, OR 97045 150 N BARTLETT ST
MEDFORD, OR 97501
PHONE: 503-272-6650 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/03/2020 $102.20
12%State Surcharge-Building 09/03/2020 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 09/03/2020 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 09/03/2020 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 09/03/2020 $5.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0.1 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 $162.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,700.00
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: 4.111)
.y1 n ) n n a Permittee Signature: 1�V1 app. ca. F rwl
�)•t �( yCalll 503.639.4175 by 7:00 a.m.for the next available inspectionJdiatCe�`L\Jf`✓ ` '1
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.
' -Baitdin2 Permit Application , g _
Fire Protection System . R� D
City of Tigard 2 Received �'n��24 j^ Permit No '2020�� .9.--
64
2020 Date/By.y. y
i 13125 SW Hall Blvd.,Tigard,OR I Plan Review A Other PernuT
Phone: 503 718.2439 Fax: vie
^�- Date/Bv /Y
• sl V 1 I�a 1: t`— Sura: ® See Page 2 for
I I G,1 1!a Inspection Line: 503.639.41 t ,� (� `' Date Ready/By:
G Internet www tigard-or.g3l Irl DING. D1`VlDION I Nott d.Mtethod: i1?Lev (' I Supplemental Information
TYPE OF WORK REQUIRED IATA:I-AND 2-FAMILY DWELLING '
❑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: I equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
CATEGORY OP i + 'tUCTION I
1
0 1-and 2-family dwelling ® Valuation: $Commercial/industrial I
Number of bedrooms: 1
❑Accessory building 0 Multi-family
Master builder ❑
Other: Number of bathrooms:
l=s .'* ` ' Total number of floors:
:. wsa.,,k .,.. vi ORMATION AND LOCATION
Job site address:9020 SW Washington Square Rd. I New dwelling area: square feet
City/State/ZIP:Tigard, OR 97223 I Garage/carport area: square feet
Suite/bldg/apt.no.:570 I Project name:Dr.Henderson I Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DA9 A:COMMERCIAL-USE CHECKLIST
Subdivision: I 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.
Add and relocate fire sprinklers for TI Valuation: $$2,700
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER I 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP. Existing:
Phone:( ) Fax ( ) New: 1
❑ APPLICANT ❑ CONTACT PERSON r" % a NOTICE,
Business name:Same as below All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP:ZiP' a
applicant is exempt from licensing,the following reasons
Pp y:
Phone:( ) I Fax: :( ) I
E-mail: riei.6, ei5Nf1Nprticirc.fi441 I I
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee.rdedule
Business name:Sprinklt Fire Protection Inc. I"
Permit fee:
Address: PO Box 2227 Oregon City, OR 97045 I I a
State surcharge(12%of permit fee):
City/State/ZIP: I
FLS plan review(40%of permit fee):
Phone:(503)272-6650 I Fax:( ) (Due upon application submittal.)
I CCB lie.:211320 I Total permit fees:
Authorized signature: 3-'d�/A,Q IJ J'� I Amountreceived:i aper
"'"'(,J} This permit application expires if a permit is not obtained
Print name:Travis Schweitzer I Date:8-21-20 I within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I\Building\Permits\FPS-PermitApp_031016 doe 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to )e 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: 8 Number of alarm devices:
® 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
❑ 11+ heads: Plan review requited and ❑ 6+ devices: Plan review required and
(3)sets of plans. (3) sets of plans.
- — I
Additional description of work:
Type of System (Complete A, B,C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ® Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group Light
Density 1.1/1500
Design Area I
K Factor I 5.6K
Sprinkler Project Valuation: I $$2,700
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: 1 $
C.) Fire Alarm
Submittal shall I Battery Calculations I ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: I $
ma �i%+� r '2 e{t*9a t 3''`�� �"��* 7 s, v p y `sR• x '7
� La dI � g7.v. 1y
D.) Residential Sprinkler (Stand Alone System) 'k 4.xta �
Square I+oota Permit Fee: ' 4 Mik
$198.75 -.
0 to 2,000 n
2,001 to 3,600 $246.45 ami
3,601 to 7,200 $310.05it.W17:s$44-` o .
7,201 and greater $404.39 ~' ',
Sprinkler Project Squate 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: $
C:\Users\Sprinklt Fire\Downloads\FPS_PemritApp.doc 2
City of Tigard Permit No.: fj/Q f ti-4
III 13125 SW Nall Blvd. Tigard,OR 97223
II Phone: 503.718.2439 Fax: 503.598.1960 Date Received:
Inspection Line: 503.639.4175
R f) Internet: www.tigard-or.gov B
FIRE SPRINKLER AFFIDAVIT FOR ALTERATION ; i�a ;� D
OR TENANT IMPROVEMENTS AUG 2 u
2020
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
CITY Y OF TI(: kate
E5.1I'h.lDiN DIVISION
•
Project Name: Dr. Henderson TI Occupancy: Medical office
Job Address: 9020 SW Washington Square Rd. Type of Construction:
Suite: 570
Contractor: Sprinklt Fire Protection Inc. Phone: 503-272-6650
Number of Proposed or Altered Heads: 8
Type: 5.6k Hazard: light Density: .111500
I, Travis Schweitzer. Sprinklt Fire Protection Inc. Oregon Construction Contractors Board No. 211320
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.
1) 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: %d SCALUilleA, Date: 8-21-20
Print Name: Travis Schweitzer
•
I.\Building\FonnsWireSprinklerAffidavit_07I514.docx Page I of I