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INq CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
�I COMMUNITY DEVELOPMENT Permit#: FPS2021-00093
Date Issued: 9/1/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DC00500
Jurisdiction: Tigard
Site address: 15875 SW 72ND AVE
Project: Northwest Integrative Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: 40
Project Description: Fire alarm permit-24 alarm notification devices
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES LP
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/31/2021 $177.52
12%State Surcharge-Building 08/31/2021 $21.30
Type of Use: COM Plan Review-Fire Life Safety-COM 08/31/2021 $71.01
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 08/31/2021 $4.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 08/31/2021 $12.50
11x17)
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: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $286.33
Valuations: Required Items and Reports(Conditions) ,
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $59,796.00
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: Permittee Signature:
HolyVovvDe/Wee 0 viiApplicat10ii.
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.
r Building Permit Application f— , I
Fire Protection System ECEIVE F�>R OFFICE IL SE ON EN
City of Tigard Date/By: D� /,Z ZOZ! FPtj 2D2/-00093
Permit No.:
IIIPhone:
S50 Hall Blvd.,Tigard,OR 97223 211 Plan Revie ni/PW2r- !1M 13 J
= Phone: 503.718.2439 Fax: 503.598.1960 �( Lii 4,
Date/By: �3Q� OtherPermi W
t ^l;l� Inspection Line: 503.639.4175 L pry Date Ready/By: /j turn ® See Page 2 for
Internet: www.tigard-or.gov i✓lTY Of TIGARL) otified/Me ..:, //2/ / I me, Supplemental Information
• , • ak. /Ltar'�t � /i
❑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 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
il ❑Master builder 0 Other: Number of bathrooms:
Total number of floors:
Job site address:15875 SW 72"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
'
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
,; work indicated on this application.
Fire Alarm Notification Devices Valuation: $$9,796.00
Existing building area: square feet
New building area: square feet
Number of stories:
Name:NW Integrative Medicine Type of construction:
Address:15875 SW 72nd Ave. Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:( ) Fax:( ) New:
?`�
/af.' :t l.{ Ql•... tr / e ', t..t-:.= r/�, ",S4"iu1=4,0. . �4 f ,-
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 97035 applicant is exempt from licensing,the following reasons
apply
Phone:(503)627-0100 Fax::( )
E-mail:bwilliams(ie pointmonitor.com
C CONTRACTOR BUILDING PERMIT FEES*
—
(Please refer to fee sckedple)
Business name:Point Monitor Corp.
Permit fee:
Address:5863 Lakeview Blvd#100
State surcharge(12%of permit fee):
City/State/ZIP:Lake Oswego,OR 97035
g ' FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( ) (Due upon application submittal.)
CCB lic.: 135901 Total permit fees:
Amount received:
Authorized signaturi .
This permit application expires if a permit is not obtained
Print name:Ben Breit Date:8/5/2021 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PennitApp_031016.doc 440-4613'r(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
•
eS
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
D New system Number of sprinkler heads: Number of alarm devices: 24
® 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
i " tf tc m omp ete` or as applicable):
A. C >tkaarrcial Sprinkler
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Project Valuation: $
C. I-ite Alarm
Submittal shall Battery Calculations ® Ye
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 9,796
d<'
Square Footage:
9 g 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:\Users\bwilliams\Desktop\PERMIT FORMS\Fire permit-city of tigard.doc 2
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
1111 . Transmittal Letter
i k 1) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439• www.tigard-or.gov
TO: DAT ED
DEPT: BUILDING DIVISION ..,,
AUG 17 2021
FROM: Brooke Williams
CITY OF TIGARD
COMPANY: Point Monitor Corp. BUILDING DIVISION
PHONE: 503-627-0100 By K o
EMAIL: bwilliams@pointmonitor.com
RE: 15875 SW 72nd Av FPS2021-00093
(Site Address) (Permit Number)
NW Integrative Medicine
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: Description: Copies: Description:
3 Additional set(s)of plans. 3 Revisions: Wall Notification Devices Went to Ceiling Devices
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain):
REMARKS:
,. "FORtI+' 'GL':IISE;OILY,
Routed to Permit Technician: Date: g j Initials: ""j")"
Fees Due: III Yes No Fee Description: Amount Due:
Special
Instructions:
Reprint Permit(per PE): ❑ Yes No 0 Done
Applicant Notified: Date: Initials:
I:\Bui Iding\Forms\Transm ittalLetter-Revisions_073120.doc