Permit iv CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
s COMMUNITY DEVELOPMENTPermit#: FP S2021 00025
T t G A R.Ll 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/4/2021
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 105
Project: PCC241 Jessica Conwell Va Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Relocate(1)fire alarm
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 03/04/2021 $51.09
12%State Surcharge-Building 03/04/2021 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 03/04/2021 $20.44
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 03/04/2021 $0.50
Occupancy Grp: B 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:
I
Total $78.16
Valuations: Required Items and Reports(Conditions)
1 Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $401.00
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: 110 VartiDe/Wege Permittee Signature:
O w>4 pplizatLan
i 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.
i
Building Permit Application
Fire Protection System RECEIVED FOR OFFICl I tiU o\l \
City of Tigard ® Received
13125 SW Hall Blvd.,Tigard,OR 97223 R 0 3 2Of Date/By: 3I e! 2-\ Permit «�ZS
Pe
■ Plan Review
Phone: 503.718.2439 Fax: 503.598.196Q Datt By: Other Permit: ,,,Z'0Z' )Z3
Inspection Line: 503.639.4175 CITY OF TIGARLy •1 I t i A I:1) p Date Read}By: runs: See Page 2 for
Internet www.tigardor.gov BUILDING DIVISION Notified/Met hod:314\Z1 `1v Supplemental Information
E-rna;\e 1) F3r-cdt..e,_
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
I
0 New construction
0 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.
❑ I-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:15350 SW Sequuoia Parkway New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.:105 Project name:PCC241 Jessica Conwell Va
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.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Fire Alarm Notification-relocate only _ Valuation: $$401.00
--
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER I D TENANT Number of stories:
Name:PCC241 Jessica Conwell Vacancy Type of construction:
Address:15350 SW Sequuoia Parkway Suite 105
Occupancy groups:
City/State/ZIP:Tigard,OR 97224
I Existing:
Phone:( ) Fax:( )
El APPLICANTNew:
❑ CONTACT PERSON
NOTICE
Business name:Point Monitor Corp.
All contractors and subcontractors are required to be
Contact name:Brooke Williams licensed with the Oregon Construction Contractors Board
Address:5863 Lakeview Blvd#100 under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
City/State/ZIP:Lake Oswego,OR 97035 applicant is exempt from licensing,the following reasons
Phone:(503)627-0100 apply:
Fax::( )
E-mail:bwilliams@pointmonitor.com
CONTRACTOR
BUILDING PERMIT FEES*
Business name:Point Monitor Corp. (Please refer tope schedule
Address:5863 Lakeview Blvd#100 Permit fee:
City/State/ZIP:Lake Oswego,OR 97035 State surcharge(12%of permit fee):
Phone:(503)627-0100 Fax: FLS plan review(40%of permit fee):
( ) (Due upon application submittal.)
CCB lic.: 135901 Total permit fees:
Authorized signature: Amount received:
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:3/3/2021
* Fee methodology set by Tri-County Building Industry
I:Building Permiu FPS-PermitApp_031016.doc Sery mice Board.
440.461 31(I t 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: 1
® 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-relocate only
.Tyle of System Com lete A, B, C or D as apklicable):
A.) Commercial Sprinkler
T.Sprinkler Type ❑ \Xet ❑ 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 0 Yes
Cut Sheets
Fire Alarm Project Valuation: $
401
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%ofpermit fee): $
FLS Plan Review(40%of permit fee): $
TOTAL: $
f;:\Users\b% ilhams\Desktop\PERMIT FORMS\Fire permit-cite of tigard.dor 2
Electrical Permit Applicatiotil ECEIVEL I (,lr ()I 1 I( 1. 1 "l (l v l ,
City of Tigard Received
3Dale By: l 1!Z\ Permit 8:f.-LRZOZ‘-C_ 7S41 13125 SW Hall Blvd.,Tigard,OR 97223 rnc q 24
11111
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit ti:�'cS 2.QZ„1-C c c Z S
Inspection Line: 503.639.4175 CITY OF TIGrlflt.i ReadyBy: 3'y'�1 \ I ®See Page 2 for
TIU;1la� Datt fwis:
Internet: www.tigard-or.gov ��I ' (( NotificdRvtethod: Supplemental Information
TYPE OF WRTCDI + C�I�%IPCri\ rw 122, �tl>k�
PLAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wtitems checked):
❑Service or feeder 400 amps or more 0Building over three stories.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or P 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder
0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address:15350 SW Sequuoia Parkway El Addition of new motor load of system.
100HP or more. ❑"A" "E" `I-2""1-3"
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#:105 Project name:PCC241 Jessica Conwell 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 voltsi
Cross street/directions to job site: nomnal. _
FEE SCHEDULE
Description - tv. ( Each 'Total •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.add sq.ft.orde portion 33.92 1
Limited energy,residential
Fire Alarm Notification Devices-relocate only (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
_ Renewable Energy I ❑ See Page 2
El PROPERTY OWNER El TENANT
Services or feeders installation,alteration,and/or relocation
Name:PCC241 Jessica Conwell Vacancy 200 amps or less I I 100.70 2
Address:15350 SW Sequuoia Parkway Suite 105 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2 City/State/ZIP:Tigard,OR 97224 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less _ 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits-new,alteration,or extension,Rer panel
® APPLICANT ❑ CONTACT PERSON
A.Fee for branch circuits with
Business name:Point Monitor Corp. above service or feeder fee,
each branch circuit 7.42 2
Contact name:Brooke Williams B.Fee for branch circuits without '
Address:5863 Lakeview Blvd.Suite 100 service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP:Lake Oswego,OR 97035 Each add'I branch circuit J 7.42 I 2
Phone:(503)627-0100 Fax:: Miscellaneous(service or feeder not included)
( ) Each manufactured or modular
Email:bwilliamst�a'�,pointmonitor.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 1 2
CONTRACTOR Pump or irrigation circle
67.84 2
Business name:Point Monitor Corp. Sign or outline lighting 67.84 2
Address:5863 Lakeview Blvd.Suite 100 Signal circuit(s)or limited energy
panel,alteration,or extension. ® See Page 2 1 2
City/State/ZIP:Lake Oswego,OR 97035 Each additional inspection over allowable in any`of the above
Additional inspection(I hr ruin) 66.25/hr
Phone:(503)627-0100 Fax:( ) In*estigation(1 hr min) 90.00/hr
Email:bwilliams@pointmonitor.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 135901 Electrical Lie.: 34508CLE ] Suprv.Lie,: 4460LEA specifically listed(tz hr min) 90.00/hr
Suprv. Electrician signature,required: ELECTRICAL PERMIT FEES
Subtotal:
Print name: Ben Breit Date: 3/3/2021 0 Plan Review Required(25%of permit fee):
CState surcharge(12%of permit fee):
Authorized signature: ' TOTAL PERMIT FEE:
c.''- This permit application expires if a permit is not obtained within 180 Print name: Ben Breit Date: 3/3/2021 days after it has been accepted as complete.
Number of inspections allowed per permit. I
I.Building Permits Et.0 PennitApp_ELR_ERE.doc Res 06 I'2015 440-4615T(11 05 COM WEB {
4
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: S75,00 nnMption I Qty. I Each I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
B• urglar Alarm 25.01 to so kva
301.04 2
n Garage Door Opener* 50.01 to 100 kva 552,26 2
'.100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
n H• eating,Ventilation and Air Conditioning
* Solar generation systems in excess of 25 kva:
System
Each additional kva over 25 I 7.42 13
LI Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is
_ specifically listed(G hr min) 90.00/hr
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
I Clock Systems
n Data Telecommunication Installation
® Fire Alarm Installation
(- H• VAC
n Instrumentation
n Intercom and Paging Systems
n L• andscape Irrigation Control*
n M• edical
❑ Nurse Calls
I I Outdoor Landscape Lighting*
r- P• rotective Signaling
n O• ther:
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
Building Permits EL.C_PemiIApp ELR_ERE.dnc Rev Oi•I'2015
OFFICE COPY
RECEIVE[
IIICity of Tigard• �v ?, Permit No.: F PS 2.oZ�- 0002.S
13125 SW Hall Blvd.,Tigard,OR 97223 0 32021 ?
I Phone: 503.7182439 Fax: 503.598.1960 Date Received: J 3`2.1
t G n R D Inspection Line: 503.639.4175 CITY OF TIGARD
Internet: www.tigard-or.gov By: C..iIr-
cc-- TiT19 a b
BUILDING DIVISION
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: PCC241 Jessica Conwell Vacancy Occupancy: Same
Job Address: 15350 SW Sequuoia Parkway Suite 105 Suite: 105
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $401
Type of System: (check one) E1Required []Non-required
(check one) DAutomatic [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 on.s1
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated on.5)
Number of Proposed Notification Appliances: To be Added tmax sl /To be Relocated(max5) 1
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: 3/3/2021
Print Name: Ben Breit
l:\Building\Forms\FireAlarmAffidav it 071514.docx
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