Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
le COMMUNITY DEVELOPMENT Permit#: FPS2021-00003
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/11/2021
T l i;A Iz L7 9 Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 110
Project: Edward Jones Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Fire alarm permit-3 alarm notification devices.Affidavit submitted.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/11/2021 $102.20
12%State Surcharge-Building 01/11/2021 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 01/11/2021 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 01/11/2021 $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: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $155.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,201.00
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 les 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 call' -603.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
his 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 e t 7 z
Fire Protection System RECEIVED roll OFFIC/. ( SF Ovl.�
Received v4� ,J ^�6�,2 -- ,1 m3
City of Tigard Dale:By: D�J�� 2 2i i7� Permit No.: ��✓ (/[J[1
• 13125 SW Hall Blvd.,Tigard,OR 97223 JAN 0 7 2021 Plan Review n
= Phone: 503.718.2439 Fax: 503.598.1960 Date/By: n �C 27 Other Permit:8062U20 c2
T I G A IL D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: / # )Dire' 0 See Page 2 for
Internet: www.tigardor.gov BUILDING DIVISION,
Notified/Method: al /(/�{C.�/ Supplemental Information
SO iJ7 -mob
TYPE OF WORK REQUIRED DATA:1-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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family
Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB STIE INFORMATION AND LOCATION Total number of floors:
Job site address:15350 SW Sequoia Pkwy New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: 110r. I Project name:PCC241 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 Valuation: $$2,201.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER El TENANT Number of stories:
Name:PCC241 Type of construction:
Address: 15350 SW Sequoia Pkwy Suites 110 .. Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:( ) Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name:Point Monitor Corp. All contractors and subcontractors are required to be
Contact name:Brooke Wilfaros licensed 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:bwilliams@pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Point Monitor Corp. (Please refer ro feeachadafe)
Permit fee:
Address:5863 Lakeview Blvd#100
City/State/ZIP:Lake Oswego,OR 97035 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( ) (Due upon application submittal.)
CCB lie.:135901 Total permit fees: /5 QY,
•
Amount received:
Authorized signs—`:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Ben Breit Date: 1/7/2021
* Fee methodology set by Tri-County Building Industry
Service Board.
1.Building-Permits:FPS-PeemitApp 0310I6.doc 440-4613T(I I'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:
0 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 0 6+ devices: Plan review required and
(3)sets of plans. (3)sets of plans.
Additional description of work: Fire Alarm Notification
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type D Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes 0 No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
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: $ 2201
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: $
C:\Users\bwiuiams\Desktop\PERMPI'FORMS Fire permit-city of tigard.doc 2
City of Tigard RECEIVED
Permit No.: /cps 22O2-(-o&dd3
/• 13125 SW Hall Blvd.,Tigard,OR 9722371
JAN 0 ' 2021 1/O7/2_Oz(
Phone: 503.718.2439 Fax: 503.598.1960 - Date Received:
TIGAIiD Inspection Line: 503.639.4175
Internet: www-tigard-or-gov CITY OF TIGARL, By: &it/ 77g4ej)
3IJILDING [VISION,
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: PCC241 Occupancy: Same
Job Address: 15350 SW Sequoia Parkway Suite: 110, . -
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $2,201
Type of System: (check one) ❑■Required Non-required
(check one) ['Automatic ['Manual ['Both
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(max 5) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) 3 /To be Relocated(max 5)
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: 01/07/2021
Print Name: Ben Breit
I:BuildingWorms\FireAlarmAffidavit_071514.docx Page)of