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Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT '� COMMUNITY DEVELOPMENT Permit#: FPS2021-00099 Date Issued: 8/24/2021 T t G A R n 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103DC01000 Jurisdiction: Tigard Site address: 11265 SW GAARDE ST Project: Gaarde Christian School Subdivision: None Lot: None Project Description: Fire alarm permit-installation and addition of(1)horn/stroke.AFFIDAVIT SUBMITTED. Contractor: FIRE PROTECTION SERVICES Owner: TIGARD ASSEMBLY OF GOD 9950 SW ARCTIC DRIVE 11265 SW GAARDE ST BEAVERTON,OR 97005 TIGARD, OR 97223 • PHONE: 503-590-3732 PHONE: FAX: 503-628-6214 FEES Description Date Amount Specifics: Permit Fee-COM 08/23/2021 $51.09 12%State Surcharge-Building 08/23/2021 $6.13 Type of Use: COM Plan Review-Fire Life Safety-COM 08/23/2021 $20.44 Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 08/23/2021 $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: Yes Alarm Type: Automatic 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: $350.00 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: 1ioy VavVDe Wege Permittee Signature: On/4pp tern 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 FOR OFFICE USE ONLY Cl of Tigard Received d 1 /� g Date/B �I7 `O�/ Permit No F/4292/,060 509 III • 13125 SW Hall Blvd.,Tigard,OR 97223 AOG 17 7021 Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:'ELtZ'ZQZ,\— eis- T I G A RD Inspection Line: 503.639.4175 CITY OF TIGARG Date Ready/By: mr ® See Page 2 for Internet: www.tigard-orgov �UILDIRIG DIVISIOt`! Notified/Method: 4 �` Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING x❑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 414 CATEGORY OF CONSTRUCTION work indicated on this application. ElI-and 2-family dwelling El Commercial/industrial Valuation: $ ElAccessory building ❑Multi-family Number of bedrooms: ❑ Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 11265 SW Gaarde St. New dwelling area: square feet City/State/ZIP: Tigard,OR 97224 Garage/carport area: square feet Suite/bldg./apt.no.: 160 Project name: Suite 160 T.I. 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 'fax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. installation and addition of 1 Horn/Strobe in Gaarde Christian School Valuation: $ 350.00 Existing building area: square feet New building area: square feet 0 PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: 0 APPLICANT ❑ CONTACT PERSON NOTICE Business name: Fire Protection Services,Inc. All contractors and subcontractors are required to be Contact name: David Phipps licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 9950 SW Arctic Dr. jurisdiction in which work is being performed.If the City/State/ZIP: applicant is exempt from licensing,the following reasons y Beaverton,OR 97005 apply: Phone:( 503 )590-3732 Fax: :( ) E-mail: Fire2ll2@ymail.com CONTRACTOR BUILDING PERMIT FEES* Business name: Fire Protection Services,Inc. (Please refer lofee schedule) Permit fee: Address: 9950 Sw Arctic Dr. State surcharge(12%of permit fee): City/State/ZIP: Beaverton,OR 97005 FLS plan review(40%of permit fee): Phone:( 503 ) 590-3732 Fax:( ) (Due upon application submittal.) CCB lie.: 15t f353 Total permit fees: pi/4 Amount received: Authorized signature This permit application expires if a permit is not obtained Print name: David Phipps Date: 8/17/2021 within 180 days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(I IN2/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 x❑ Addition or ❑ 1-10 heads: Affidavit required and ❑x 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 LI 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 ❑ Ycs include: Individual Component ® Yes Cut Sheets Fire Alarm Project Valuation: I $350.00 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: $ \Building\Permits\I PS PermitApp_U31016.doc 2 City of Tigard RECEIVED Permit No.: Fi°5202/60Y9 III • 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.7182439 Fax: 503.598.1960kb 1 7 2023 Date Received: Og-l7-20Z/ Inspection Line: 503.639.4175 TIGARD Internet: www.tigard-or.gov CITY OFTIGARD By: ear OF 77 9 FIRE ALARM WIVAVIMIDAVIT FOR ALTERATIONS OR TENANT IMPROVEMENTS (MAXIMUM OF 5 DEVICES WITHOUT PLANS) �^�tC 'COVE Project Name: Gaarde Christian School Occupancy: Job Address: 11265 SW Gaarde St, Tigard, OR 97224 Suite: Contractor: Fire Protection Services, Inc. Phone: 503-590-3732 Valuation of work: $ 350.00 Type of System: (check one) ❑■Required ❑Non-required (check one) •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 (max 5) /To be Relocated (max 5) Number of Proposed Manual Alarm Stations: To be Added (ma.5) /To be Relocated (max 5) Number of Proposed Notification Appliances: To be Added (max 5) 1 /To be Relocated (max 5) I David Phipps Oregon Construction Contractors Board No. 154333 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 w' a copy of the sketch attached shall be available for all inspections. Signature: Date: 8/17/2021 Print Name: David Phipps 1:\Building\Forms\FireAlarmAffidavit_07I514.docx Page I of I