Permit 14 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2021-00076
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7l27l2021
TIGARD 9 Parcel: 2S112DC00500
Jurisdiction: Tigard
Site address: 15875 SW 72ND AVE
Project: Northwest Integrative Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: 40
Project Description: Fire sprinkler permit-adding/relocating 21 fire sprinklers
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES LP
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 07/15/2021 $102.20
12%State Surcharge-Building 07/15/2021 $12.26
Type of Use: SF Plan Review-Fire Life Safety-COM 07/15/2021 $40.88
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 07/15/2021 $2.00
Occupancy Grp: B Height: 25 ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 07/15/2021 $6.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No 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 Calcs Provided: Cut Sheets Required:
Total $163.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,419.00
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
Issued By: 1-E"`^7 +-V DPzWege Permittee Signature: pp/Ica-act-14
o-
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.
lauiidin Per 2 mit AnPlicatio6?ECEJVE[
Fire Protection System FOR OFFICE USE ONLY
City of Tigard JUN 1 7 2021 Received 7h�
DatelBy:(,JtQ2( ��' ,/I Permit No.: f—F52O21—0007 /
• 13125 SW Hall Blvd.,Tigard,OR 972
Oily OF TIGARL Plan Review
Phone: 503.718.2439 Fax: 503.59�1@ oPia By: 7—13 Other Permit:
TIGARD Inspection Line: 503.639.4175 tst1�DING DNISlCI" Date Ready/By: / / �uris: ® See Paget for
Internet: www.tigard-or.gov N ifiedAlethod: `� / /' Supplemental Information
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
work indicated on this application.CATEGORY OF CONSTRUCTION
ID1-and 2-family dwelling ❑Commercial/industrial Valuation: $
D Accessory building ❑Multi-family Number of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:15875 SW 72nd Ave New dwelling area: square feet
City/State/ZIP:Tigard, OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:NW Integrative Medicine 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: I 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.
ADDING AND RELOCATING FIRE SPRINKLERS Valuation: $2419
Existing building area: square feet
r.
Vrt-e.1 I,/- ./ New building area: square feet
❑ PROPERTY OWNER ❑ 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:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:LEVI POLING licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard, OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:( )503.684.2928 Fax: :( )503.684.9657
E-mail:I.poling@wyattfire.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection - (Please refer to fee schedule
Address:9005 SW Burnham Permit fee:
City/State/ZIP:Tigard, OR 97223 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( )503.684.2928 Fax:( )503.684.9657 (Due upon application submittal.)
CCB lie.:64077 ,/ Total permit fees:
Authorized signature: eiZ L s ZZ He--41-/9/ r Amount received:
This permit application expires if a permit is not obtained
Print name:Levi Poling Date:04/29/2021 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
i/Building\emnts\FPS-Pem,itApp_031016.doc 440-4613TO 1/02/COMrWEB)
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: 21 Number of alarm devices:
❑■ 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):
A.) Commercial Sprinkler
Sprinkler Type ■❑ Wet ❑ 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: $2419
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: $
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 20F7)\Tigard Fire Permit App.doc2
Building Permit Application
Fire Protection System RECEIVE ft,i�ul-i ll i t .l (l'L�
City of Tigard i�[e C }/ C I eived Prm ,bin
13125e Hall Bigd, 3 WISE
Phone:SW 503.7182439lvd,T Fnxar: 503.598.1OR97229(r0 JUL 2021 Mae
iew
Other Permit
t t_ 1,,. Inspection Line: 503.639.4175 Dare Readyley: Jere. ® Ste Page 2 for
Inte net: www.tigard-or.gov CITY OF TIGARL Notified4HMd: Supplemental loferaladr.
:11 110ING NMSIO'
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees'arc based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
( Addition/altemtionfreplacement 0 Other. equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCI'ION work indicated on this application
ElI-and 2-family dwelling II Commercial Valuation: S
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors.
Job site address:15875 SW 72ND AVE New dwelling area: square feet
City:State/ZIP:TIGARD,OR 97224 Garagetarport area square feet
Suite/bldg.rapt.no.: Project name:NW INTEGRATIVE MEDICINE Covered porch area: square feet
Cross strcet/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(he nearest dollar)of all
Tax mnp:jsarecl no.; equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Adding 9 New fire sprinkler heads and relocating 12 fire sprinkler heads Valuation: 52419
Existing building area: square feet
New budding area square feel
❑ PROPERTY OWNER ❑ TENANT Number of stories
Name: Type of construction:
Address: Occupancy groups:
City/Stale/ZIP:
Existing:
Phone:( ) Fax:( ) New:
■ APPLICANT ❑ CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Levi Poling licensed with the Oregon Construction Contractors Board
under ORS 701.and may be required to be licensed in the
Address:9095 SW Bumham jurisdiction in which work is being performel.If the
City/Sta1rJZIP:'rlgafd, OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:( )503.684.2928 Fax::( )503.684.9657
E-mail:I.poling@wyattfire.com
CONTRACTOR BUILDING PERMIT FEES'
(?Lore alter a fee schedule,
Business name:Wyatt Fire Protection Permit fee:
Address:9095 SW Bumham
Slate surcharge(12%of permit fee).
City/State/ZIP!Tigard,OR 97223 FLS plan review(40%of permit fee).
Phone:( )503.684.2928 Fax:( )503.684.9657 IDue upon application submittal I
CCB lie.:64077 Total permit fees
Authorized signature: 4.0_4 r Amount received
This permit application expires if a permit is not obtained
Print name: Polingwithin 180 days after It has been accepted as complete.
LeviLBVI Date:07115/21 • Fees methodology set byTri-County Building Industry
Service Boani
I Puadioarmus,FIS•PmairAAp_031016.da 440-1613TO Ir3,COM WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
Describe work to be done•.
l.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
0 New system Number of sprinkler heads: 21 Number of alarm devices:
® 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 I)as applicable):
A.) Commercial Sprinkler
SprinklerTlpe 0 Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ® Yes 0 No
Hazard Group bld+t hazard
Density 01
Design Area 1506
K. Factor 56
Sprinkler Project Valuation: $2419
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Batted'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 (sec 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\PermeA4mmtt \ppltcatetn Forme(Updated July tall)\'Iignnl 1;tru 1tpp.duc9