Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2020-00105
Date Issued: 10/12/2020
T I G A I.1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD
Project: One Embassy Centre Subdivision: None Lot: None
Project Description: Fire sprinker permit: Relocating(8)sprinkler heads in second and third floor restrooms. Affidavit submitted.
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 10/09/2020 $88.75
12%State Surcharge-Building 10/09/2020 $10.65
Type of Use: COM Info Process/Archiving-Lg$2.00(over 10/09/2020 $2.00
Class of Work: ALT Type of Const: 11x17)
Occupancy Grp: Height: ft Plan Review-Fire Life Safety-COM 10/09/2020 $35.50
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: No 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 $136.90
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,900.00
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: , / � — 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 ApplicA 9 .4.
Fire Protection System !s.k.,.�ti:r. � 1° '�`° ' FOR OFFICE I SI l'\I 'i
CPICity of Tigard S EP 2 4 2020 Da Y /�j Permit No.: ��5�'
° 13125 SW Hall Blvd.,Tigard,OR 97223 R Plan Review f V/� ` �1
Phone: 503.718.2439 Fax: ..�9t�1OF TIcI +7 DateBy: �//!�� Other Permit:
TIGARD Inspection Line: 503.639.4.175 f,tr ��\��J��N Date Ready/By J` lure: H See Paget for
Internet. wwwtigard-or.gov - Notified/Method: /O k �, Supplemental Information
); 'l- -Get fI%I✓ I'
TYPE OF WORK REQUIRED DATA: 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: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONS I RUCTION work indicated on this application.
Valuation: S
0 1-and 2-family dwelling ®Commercial/industrial
Number of bedrooms:
❑Accessory building 0 Multi-family
❑Master builder ❑Other: Number of ballrooms-
JOB SITE INFORMATION AND. LOCATION Total number of floors:
Job site address:9020 SW Washington Square Rd. New dwelling area: square feet
City/State/ZIP:Tigard, OR 97223#202, 293, 302 and 303 Garage/carport area: square feet
Suite/bldg./apt.no.: Project nameEmbassy Center Restroom Remode Covered porch area: square feet
Cross street/directions to job site: Of-- rr-el ir-Otly eCi4`L Deck area: square feet
Other structure area: square feet
REQUIRED DAT4: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 .a work indicated on this application.
Relocate 8 fire sprinklersen restfeems- F -. 2 ND 4 3 eo -door-te4firots
Valuation: $1900
Existing building area: square feet
New building area: square feet
A `
❑ PROPERTY' OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP. Existing:
Phone:( ) Fax:( ) New.
❑ APPLICANT ❑ CONTACT PERSON 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: applicant is exempt from licensing,the following reasons
apply:
Y
Phone:( ) Fax: :( )
E-mail: ,J
5,-, I wC.,77 c1 C./ '^/L/.t l`1 ,, tcN�
CONTRACTOR Bu ILDING PERMIT FEES'
(Please refer to fee schedule).........
Business name:Spnnklt Fire Protection Inc.
Permit fee:
Address:PO Box 2227 Oregon City, OR 97045
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( 503)-272-6650 Fax:( ) (Due upon application submittal.)
CCB tic.:211320 Total permit fees:
/ �� �� Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name:Travis Schweitzer Date:9-24-20 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:1auildingiPermits'PPS-PermitApp_03 I016.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: 8 Number of alarm devices:
® Addition or ® 1-10 heads: Affidavit required and 0 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:
�afi � *�.vu.xe *a;vet '� t �Y3®�{. ,uSw..w aE fare,ac. ro �'. ,vJklS � r b
.1 i m � .. mn eag wrz w R r, 7 t
2# ,ts, p�h4' £` � a:
'.
d.,.,..71 c f 4V-.ak Fw`�' :zs.-A*1Mt3.
Sprinkler Type ® Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $1900
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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:1 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_PermitApp.doc 2
City of Tigard Permit No.: r�aJ
13125 SW Hall Blvd.,Tigard,OR 97223 �J
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: _____LL� l
Inspection Line: 503.639.4175 r 77��
" �: Internet: www.tigard-or.gov By: / /0-P
~� rro
ID FIRE SPRINKLER AFFIDAVIT FOR ALTERATIIONS
SEP 2 4 2020 OR TENANT IMPROVEMENTS
CITY OF fIGA iD
(1
E��i°I r�:,'1!�C �)�`�I;�iCJi'�I to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Embassy Center Restroom Remodel Occupancy: Restroom
Job Address: 9020 SW Washington Square Rd. Type of Construction:
Suite: #202, 203, 302 and 303
Contractor: Sprinklt Fire Protection Inc. Phone: 503-272-6650
Number of Proposed or Altered Heads: 8
Type: Hazard: Light Density:
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.
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 document with a copy of the sketch attached shall be available for all inspections.
Signature: %2CL(.,l _ c5'G M- Date: 9-24-20
Print Name: Travis Schweitzer
laBuilding\Forms\FireSprinklerAffidavit 071514.docx Nee 1 of 1