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Permit
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT III _ COMMUNITY DEVELOPMENT Permit#: FPS2021-00046 Date Issued: 4/22/2021 T t C;,4 R f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AD03200 Jurisdiction: Tigard Site address: 12909 SW 68TH PKWY 100 Project: Quadient TI Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT Project Description: Fire alarm permit-relocate(2)and add(2)alarm devices.AFFIDAVIT SUBMITTED. Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES 5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN LAKE OSWEGO,OR 97035 15350 SE SEQUOIA PKWY#300 PORTLAND, OR 97224 PHONE: 503-627-0100 PHONE: FAX: 503-627-0110 FEES Description Date Amount Specifics: Permit Fee-COM 04/21/2021 $67.23 12%State Surcharge-Building 04/21/2021 $8.07 Type of Use: SF Plan Review-Fire Life Safety-COM 04/21/2021 $26.89 Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 04/21/2021 $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: Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $102.69 Valuations: Required Items and Reports(Conditions) Sprinkler Valuation: $0.00 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: vGL1NDe,WegC Permittee Signature:crtly Ovt.Appucatwn 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 Application _ , Fire Protection System RECEIVED I•OR oPFI('IC t sh O1I.1' City of Ti and RECEIVED Received g Date/B : 20 ZOZei Permit No.:A9S2-021-0005Z II • 13125 SW Hall Blvd.,Tigard,OR 97223 APR 1 61011 Plan Review i Phone: 503.718.2439 Fax: 503.598.1960 Date/B : 'J© Other Permit. T 1 G A R D Internet: P wwetigatd-or.gov75 CITY OF TIGARD Nrotiled/Method:� �� la �Page 2 for BUILDING DIVISION , P7 4.r;, Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 New construction Cl 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. El1-and 2-family dwelling ®Commercial/industrial Valuation: $ ❑Accessory building 0 Multi-family Number of bedrooms: ❑Master builder 0 Other. Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address:12909 SW 68th Parkway New dwelling area: square feet City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet Suite/bldg./apt.no.: 100 Project name:PPC082-Suite 100 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 Devices Valuation: $$1,009.00 Existing building area: square feet New building area: square feet 0 PROPERTY OWNER ® TENANT Number of stories: Name:PPC0S2-Suite 100 Type of construction: Address:12909 SW 68th Parkway Suite 100 Occupancy groups: City/State/ZIP:Tigard,OR 97223 Existing: Phone:( ) Fax:( ) New: ® APPLICANT 0 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 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: I : Phone:(503)627-0100 Fax: :( ) E-mail:bwilliams@pointmonitor.com CONTRACTOR BUILDING PERMIT FEES* Business name:Point Monitor Corp. (Plceae refs.to fee schedule) Address:5863 Lakeview Blvd#100 Permit fee: State surcharge(12%of permit fee): City/State/ZIP:Lake Oswego,OR 97035 FLS plan review(40%of permit fee): Phone:(503)627-0100 Fax:( ) (Due upon application submittal.) CCB lie.: 135901 Total permit fees: Authorized signate: Amount received: �� This permit application expires It permit is not obtained Print name:Ben Breit Date:4/16/2021 within 180 days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board. I.Building Permit,FPS-PemilApp 031016.dnc 440.4613T(1I 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: 4 ® 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 requited and ❑ 6+devices: Plan review required and (3)sets of plans. (3)sets of plans. Additional description of work Fire Alarm Notification Devices Type of System (Complete A,B, C or D as applicable): A.) Commercial Sprinkler Sprinkler Type ❑ Wet 0 Dry Additional Standpipes Information: Sprinkler Supply Line ❑ Yes ❑ No Hazard Group Density Design Area K.Factor S S.rinkler 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: $ 1,009 D.) Residential Sprinkler(Stand Alone System) ■ Square Footage: Permit Fee: 0 to 000 $198.75 2,001 to 3,600 $246.45 3,601 to 7,200 $310.05 7,201 and greater $404.39 Sprinider Project Square Footage: sq. ft. Fire Protection Permit Fees Project valuation subtotal (see A,B &C above): $ Permit fee based onproject 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\b cilliams\Desktop\PERMIT FORMS\Fire permit-city of tigard.dot 2 City of Tigard RECEIVED Permit Permit No.: IN I • 1 6 Z02�all 81vd., , R flPk / Phone:13125 503swH.718.2439 FaxTigard 503.598.19O97223 Date Received: � �/(e Z�J2-/ Inspection Line: 503.639.4175 CITY OF TIGARD �7 /� T f L A R D Internet: www.tigard-or.gov By: /! 'rT7�� BUILDING DIVISION FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS OR TENANT IMPROVEMENTS �7 (MAXIMUM OF 5 DEVICES WITHOUT PLANS) PPC082 - Suite 100 Same Project Name: Occupancy: Job Address: 12909 SW 68th Parkway Suite: 100 Contractor: Point Monitor Corp. Phone: 503-627-0100 Valuation of work: $ 1,009 Type of System: (check one) ORequired ]Non-required (check one) ❑Automatic ['Manual MBoth 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(.5) /To be Relocated(max 5) Number of Proposed Manual Alarm Stations: To be Added(mas 5) /To be Relocated(max 5) Number of Proposed Notification Appliances: To be Added(mu 5) 2 /To be Relocated(max 5) 2 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: 04/16/2021 Print Name: Ben Breit 1:1Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1