Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IIIIIa COMMUNITY DEVELOPMENT Permit#: FPS2021-00094
T r i;A R fl 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/17/2021
Parcel: 2S104AB04700
Jurisdiction: Tigard
Site address: 13401 SW BENISH ST
Project: Our Redeemer Lutheran Church Subdivision: None Lot: None
Project Description: Replace existing fire alarm control panel.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: OUR REDEEMER LUTHERAN CHURCH
7324 SW DURHAM ROAD 13401 SW BENISH ST
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503-641-2222 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/17/2021 $156.00
12%State Surcharge-Building 08/17/2021 $18.72
Type of Use: COM Plan Review-Fire Life Safety-COM 08/17/2021 $62.40
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 08/17/2021 $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 $237.62
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $7,949.55
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
()SiIssued By: — Permittee Signature: C./44°.-- � %-arSo"lt
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 Applicatio,Tl �/ECEIVED - S>>3/
Fire Protection System FOR OFFICE USE ONLY
AUG 13 MI ti
City of Tigard Date/By: / l0 Permit No 3 20
ZI-0 0 0711
;II - • 13125 SW Hall Blvd.,Tigard,OR 97223 +,'�OF TIGAF►L+ Plan Review
• Phone: 503J18.2439 Fax: 503.598.196 DateBy: Other Permit:
t t c.v:a Inspection Line: 503.639.4175 3UILDING DIVISIOP Date ReadyBy: , la See Page 2 for
Internet: www.tigard-or.gov Notified/Method;?//'7/�-1 4 � linesr Supplemental Information
' f t: M/C 4-' C ___. G
REQUIRED DATA:1-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
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1-and 2-family dwellingValuation: $
®Commercial/indust al
ElAccessory building El Multi-familyNumber of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION
Total number of floors:
Job site address: 13401 SW Benish St New dwelling area: square feet
City/State/ZIP: Tigard OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Our Redeemer Church Covered porch area: square feet
Cross street/directions to job site: SW 133rd Ave 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.
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 1MIMIIII- work indicated on this application.
Replace existing fire alarm control panel. Valuation: 7949.55
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: B
Phone:( ) Fax: ( ) New:
El APPLICANT ® CONTACT PERSON NOTICE
Business name: Performance Systems Integration All contractors and subcontractors are required to be
Contact name: Michael Baker licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 7324 SW Durham Rd jurisdiction in which work is being performed.If the
City/State/ZIP: Portland OR 97224 applicant is exempt from licensing,the following reasons
apply:
Phone:( ) 503-713-9856 Fax::( ) 503-641-1464
E-mail: michael.baker@psintegrated.com
CONTRACTOR BUILDING PERMIT FEES*
fee edule
Business name: Performance Systems Integration (Please refer to
fee:
Permit ee:
Address: 7324 SW Durham Rd
City/State/ZIP: Portland OR 97224 State surcharge(12%0l permit fee):
FLS plan review(40%of permit fee):
Phone:( ) 503-641-2222 Fax:( ) 503-641-1464 (Due upon application submittal.)
CCB lie.:227526 Total permit fees:
Authorized signature: Amount received: 3'f, G _
This permit application expires if a permit is not obtained
Print name: Michael Baker 429LEA NICET 97902 Date:8-11-2021 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(11102/COMIWHB)
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 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 ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
C.) Fite Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Mann Project Valuation: I $
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: $
1:\Building\Permits\FPS_Pcrmi[App_031016.doc 2
City of Tigard RECEIVED OFFICE COPY
Permit No.: fPS 2-B 'ZI - 00 09
13125 SW Hall Blvd.,Tigard,OR 97223 AUG 1 3 2071 r/
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: d J 13/Z i
TIGARD Inspection Line: 503.639.4175 6Il Y OF TIGA1J ii
Internet: www.tigard-or.gov By.BUILDING DIVISION ® -
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Our Redeemer Church Occupancy: B
Job Address: 13401 SW Benish St Tigard OR 97223 Suite:
Contractor: Performance Systems Integration Phone: 503-641-222
Valuation of work: $7949.55
Type of System: (check one) ❑■Required ❑Non-required
(check one) ❑Automatic DManual •■IBoth
Total number of devices added or moved under this permit process is 5 total per tenant space.
Replace existing fire alarm control panel.
Number of Proposed Smoke/Heat Detectors: To be Added (mom 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(max5) /To be Relocated (max5)
I Performance Systems Integration Oregon Construction Contractors Board No. 227526
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: 1 Date: 8-11-2021
Print Name: Michael Baker SET
429LEA NICET 97902
1:1Building\Forms\FireAlarrAftidavit_071514.docx Page 1 of 1
fJ: Fif'T a ( -,
RECEIVED
OFFICE COM' AUG 13 2021
i;ITY OF TIGAHV
3UILDING DIVISION
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CITY OF TIGARD
Approved Pr
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For only the work as described in: PLAN NORTH
PERMIT NO. Fr' S 20 Zl—00 Ocj'-/
See Letter to: Follow I I
Attach
Job Addrpss: I3ya i CO0�ltSH- ,
By: ,CV 6 Date: S�O7� /