Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2021-00090
Date Issued: 8/5/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101 DA00101
Jurisdiction: Tigard
Site address: 13190 SW 68TH PKWY 200
Project: Aspen Capital Subdivision: VARNS ACRES Lot: 9
Project Description: Fire alarm permit-adding new notification device and a conventional smoke detector
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC NW PROPERTIES LIMITED PARTNERSI
5863 LAKEVIEW BLVD STE 100 STERN FAMILY LIMITED PARTNERSHIP
LAKE OSWEGO, OR 97035 STERN FAMILY LLC
6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/03/2021 $51.09
12%State Surcharge-Building 08/03/2021 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 08/03/2021 $20.44
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 08/03/2021 $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 $78.16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $500.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: H 77„vawDeikleeti e PermitteeSignature: 0YVAppLtcao-vi
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application mmilimusiimumil 12$jz j
Fire Protection System qFCEIVED
1111 City of Tigard Received p�D��O� Permit No.:�^
13125 SW Hall Blvd.,Tigard,OR 97223111 JU�, `� s 2021 Date/By: 01"PS202/^000 e2
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 �/ Date/By: Other Permit:
I i ,�1:17 Inspection Line: 503.639.4175 CAP(OF TIGARLJ Date Read)'By: Jun RI See Page 2 for
Internet: www.tigard-or.gov y I� Notified/Method: i16- Su lementalInformation
1IJI�_fINr f!VISIONI' PP
a ,a..
TYPE OF WORK PIP Print name:Ben Breit Illti!��'111110
❑New construction ❑Demolition REQUIRED DATA:1-AND 2-FAMILY DWELLING
®Addition/alteration/replacement 0 Other: Permit fees*are based on the value of the work performed.
--- — Indicate the value(rounded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION equipment,materials,labor,overhead,and the profit for the
El1-and 2-family dwelling IS]Commercial/industrial work indicated on this application.
ElAccessory building 0 Multi-family Valuation: $
❑Master builder 0 Other: Number of bedrooms:
JOB SITE INFORMATION AND LOCATION Number of bathrooms:
Job site address: 13190 SW 68'h Parkway Total number of floors:
City/State/ZIP:Tigard,OR 97223 New dwelling area: square feet
Suite/bldg./apt.no.:200 Project name:Aspen Capitol Garage/carport area: square feet
Cross street/directions to job site: Covered porch area: square feet
Deck area: square feet
Other structure area: square feet
Subdivision: Lot no.:
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Tax map/parcel no.: Permit fees*are based on the value of the work performed.
DESCRIPTION OF WORK Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
ADD MONITORING OF ALARM,TROUBLE AND SUPERVISORY work indicated on this application.
STATUS OF THE NEWLY ADDED Valuation: $$500.00
PRE-ACTION PANEL.ADD
_ONE CONVENTIONAL SMOKE DETECTOR TO BE CONNECTED TO THE Existing building area: square feet
PRE-ACTION PANEL TO SERVE THE DOUBLE
INTERLOCK FUNCTIONALITY. New building area: square feet
0 PROPERTY OWNER ® TENANT Number of stories:
Name:Aspen Capitol Type of construction:
Address: 13190 SW 68th Parkway Suite 200 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 97035applicant is exempt from licensing,the following reasons
— — —-- apply:
Phone:(503)627-0100 Fax::( ) -
E-mail:bwilliams@pointmonitor.com
T CONTRACTOR ��� —�
BUILDING PERMIT FEES*
Business name:Point Monitor Corp. (Please refer to fee schedule)
Address:5863 Lakeview Blvd#100 Permit fee:
City/State/ZIP:Lake Oswego,OR 97035
State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( ) (Due upon application submittal.)•
_
CCB lie.:135901 Total permit fees:
Authorized signature: Amount received: 76 !C
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
t:Building Permits FPS-PermitApp-011016 doe 440-4613T(I 102 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: Fire Alarm Notification Devices
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
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 ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 500
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: $
C:\Uscrs\bwilliams\Desktop\PERMIT FORA1S\Fire permit-city of tigard.doc 3
3ECEIVED
Cityof Tigard
i Ba darigara,OR 97223 JULi~ 8 2021Permit No.: FPS202/ )9 '
I .
Phone: 503.718 2439 Fax: 503.598.1960 Date Received: D 7/Zej/20 2a
T I t n R I) Inspection Line: 503.639.4175 #i I Y OF TIGARD
Internet: www.tigard-or.gov (AWINO DIVISION By e,7 - N
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS) )3FIC.E COPY
Project Name: Aspen Capitol Occupancy: Same
Job Address: 13190 SW 68th Parkway Suite: 200
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $500
Type of System: (check one) QRequired ENon-required
(check one) DAutomatic ❑Manual DBoth
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(max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) 1 /To be Relocated(max 5)
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: 7/28/2021
Print Name: Ben Breit
I:\Building\Forrns\FireAlarmAffidavit_071514.docx Page 1 of 1