Permit Building Permit Application�EC E- 2
Fire Protection System t"i V FOR OFFICE USE ONLY
City of Tigard APR 2 6 ZUZI Deced (29 2€'Z/ !ni Permit No.:FP5202/-000$/
1111 , 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Z,Phone: 503.718.2439 Fax: 503.598.19CITY OF TIGARD Date/B Other Permit:
Inspection Line: g503.639..4175 Date ReadyBy: Ot/ O021iii ® See Page 2 for
TIGARI) Internet: www.ti ardor. ov BUILDING DIVISION' Notified/Metho. ''f 29 LIJ Supplemental Information
/ /7 #,
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 CONSTRUCTION work indicated on this application.
❑ l-and 2-family dwelling ®Commercial/industrial Valuation: $
ElAccessory building El Multi-familyNumber of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9020 SW Washington Square Road New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:301 Project name:Lithia Driveway 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.
Install fire alarm devices per submitted plans. Valuation: $400.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT 0 CONTACT PERSON NOTICE
Business name: 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:
Phone:( ) //�� Fax::( )
E-mail: (.shone((�ii e q4JJJ . COrn
CONTRACTOR BUILDING PERMIT FEES*
Business name:Capitol Electric Company,Inc. (Please refer to fee schedule
Permit fee: 51.09
Address:11401 NE Marx Street
State surcharge(12%of permit fee): 6.13
City/State/ZIP:Portland,OR 97220
FLS plan review(40%of permit fee): 20.44
Phone:(503)255-9488 Fax:(503)255-1966 (Due upon application submittal)
CCB lic.:48748 Total permit fees: 77.66
Authorized signature: +/ � .�d.�+/ Amount received:
This permit application expires if a permit is not obtained
Print name:Shane Tercek Date:4/26/21 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
10Building\Per mits\FPS-PermitApp_031016.doe 440-461311(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: 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
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type of System (Complete A, B, C or D as applicable): IOW
A.) Commercial Sprinkled
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
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: $ 400
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): $ 400
Permit fee based on project valuation (see fee schedule): $ 51.09
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $ 6.13
FLS Plan Review(40%of permit fee): $ 20.44
TOTAL: $ 77.66
Q:\Fire Alarm\I,A f obs\zz210597-45 Lithia 301 @ Embassy Center\lob inf0\1 FPS_Pe2nitApp 2017.0126.doc
City of Tigard RECEIVED PermitNo.: rF'P3202 '00051
1111 • 13125 SW Hall Blvd.,Tigard,OR 97223 s�1
• Phone: 503.718.2439 Fax: 503.598.1960 6 7O7 Date Received: O4/z o/lam021
Inspection Line: 503.639.4175 A� art OF /f
TIGARD Internet: www.tigard-or.gov By: VL' ( 7A'�+)
CITY OF TIGARD
ISION
FIRE ALARM wAF IDAVIT FOR ALTERATIONS COS'
OR TENANT IMPROVEMENTS OFVICV
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Lithia Driveway Occupancy: B
Job Address: 9020 SW Washington Square Road Suite: 301
Contractor: Capitol Electric Co., Inc. Phone: 503-255-9488
Valuation of work: $400
Type of System: (check one) ['Required ❑Non-required
(check one) ff 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 n x s /To be Relocated maz 5
p � � � l
Number of Proposed Manual Alarm Stations: To be Added(msa 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) /To be Relocated(maz 5)
I Shane Tercek Oregon Construction Contractors Board No. 48748
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.
0 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: ' "'" t7 Date: 4/26/21
Print Name: Shane Tercek
l:\Building\Forms\FireAlarmAffidavit_07I514.docx Page 1 of