Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
■ COMMUNITY DEVELOPMENT Permit#: FPS2021-00065
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Date Issued: 6/2/2021
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 320
Project: Riverside Homes Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Fire Sprinkler permit-adding and relocation(5)fire sprinkler.AFFIDAVIT SUBMITTED.
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES
9095 SW BURNHAM ATTN: N PIVEN
TIGARD, OR 97223 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/24/2021 $67.23
12%State Surcharge-Building 05/24/2021 $8.07
Type of Use: COM Plan Review-Fire Life Safety-COM 05/24/2021 526.89
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 05/24/2021 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0.1 Design Area: 1500
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Coles Provided: Cut Sheets Required:
Total $102.69
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,080.00
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: }fo/2yVa.vv'D&wege Permittee Signature: Ofv,a i i,o -
pp
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 Applicatiii EC E IVE D 13— ,di ,
Fire Protection System i+yfe -; 0 in I OR tiff it l.t s1 tiNt-
City of Tigard w�u GI �/ ie2� 1 Pexni'Nn: Fx202/-C J-5'
pt� i3125SW Hall Blvd.,Tigard,®it 97 OFTIGARD anaacmew 7 "� rPaa UPz1J1J'CU/D
i,+t,, 1 Phone• 503,711L2439 Fax: 503.591;.p 2DING DIVISION Da> o y..--
• Lisa: 503.639,4175 Date Ready/Br _ _.. 7 7�.r EN Sea Pees 1 tar
' y': lntcrthai. www.ti r.gnv Natlfted/Adedwd: f[t,7f 5epplearetuai lnfermanea
TYPE OF WORX REQUIRED DATA:I-AND 2-PAMILYDWELLING
D New construction D Demolition Pemeit fees'are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement 0 Uthcr, equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application
D 1-and 2-Tinnily dwelling ®Commvcialliedustrial Valuation: S
fa
D Accessory budding 0 Multi-family Number ofbairnoms
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of fears—
lob site address:15350 SW Sequoia Pkwy,#320 New dwelling arca: square feet
City/State/ZIP:PORTLAND,OR 97224 GarngrJcarpart area: square feet
Suite/bldg./apt.no.: Project name:Riverside Homes Covered porch srca. square feet
Cross street/directions to jab site.: Deck area: square fat
Other structure area square feet
~
REQUIRED DATA-COMMERCIAL-USE CHECKLIST
Subdivision: Lot no Permit fees*arc based un the value of the work performed.
Tax nth ci no.: Indicate the value(rousted to the nearest dollar)atoll equipment,materials,Tabor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
S 1080 Valuation.ADDING AND RELOCATING FIRE SPRINKLERS _
Existing building area: square feet
New building area. square feet
T D PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/StaterZIP: Existing:
Phone:( ) Fax:( ) New:
APPLICANT 0 CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ronin Campbell licensed with the Oregon Construction Contractors Rued
under ORS 701 and may be required to be licensed in the
Address:9095 SW Bumham jurisdiction in which work is being performesL If the
City/5tatdZlP:'}iggpd,OR 97223 applicant is exempt from licensing,the following reasons
.._—._ apply:
PMnc ( )503.694.2928 Fex::( )503.684.9657
E-mail:r.campbollkwyattfire.com
CONTRACTOR SUILDING PERMIT FEES`
(P refer m
Business name:Wyatt Fire Protection . �.ew.e
Permit fee:
Address:9095 SW Burnham
.. .,_ State sure (12%of permit fa):
City/StatcJZ1P:Tigard,OR 97223 PL5 plan review(40%of permit fix):
Phone:( )593.694.2928 E f Fax:( )503.684.9857 rDue upon application submittal)
HCCB lie:64077 Total permit fees:
Authorized si �!/� Amount received:
This permit application expires if a permit is not obtained
( Date:05/20f2®21 within Igo days after II has hoes accepted as complete.
1 Print name:Ronin Campbell
• Fee methodology act by Tri-County Building industry
Service Board.
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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: 5 Number of alarm devices:
O 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
El 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):
A.) Commercial Sprinkler
Sprinkler Type ❑■ Wet El Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑■ Yes ❑ No
Hazard Group light hazard
Density 0.1
Design Area 1500
K Factor 5.6
Sprinkler Project Valuation: $1080
B.) Type I - Hood Fite 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: 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: $
W:\Permits\Permit Application Forms(Updated July 2017)\Tigard Fire Permit App.doe2
RECEIVED
City of Tigard r = ' o2 OOO
s° 13125 SW Half Blvd.,Tigard,OR 97223 ti��i ��? Permit No.:
* Inspection 3l�ne 5039639.4175 Far tl3 59a 1 ti✓ITY OF TIGARD Date Received: 5 2 4 2V 2,j' r
�. ..
"f tCi\RiTom.: lrtamet wwwHgatdor.gov Or/ O F TtGrT' � V
BUILDING DIVISIQt�! er•
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) OFFICECO?"Y
Project Name: Riverside Homes Occupancy:
Job Address: 15350 SW Sequoia Pkwy, #320 Type of Construction:
Suite:
Contractor: Wyatt Fire Protection Phone: 503-634-2928
Number of Proposed or Altered Heads: 5
Type: SSP-QR Ilanard: Light Density: 0,1
1 Wyatt Fire Protection Oregon Construction Contractors Board No. 64077
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 ofNTPA 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 1.3,
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: 'C4/ 'i n' Date: 5/20/2021
Print Name: Ronin Campbell
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