Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
'"1 COMMUNITY DEVELOPMENT Permit#: FPS2021-00123
Date Issued: 10/14/2021
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503.718.2439
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 400
Project: FDIC Fire Alarm Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Install(4)alarms and relocate(1)alarm
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES L P
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/11/2021 $112.96
12%State Surcharge-Building 10/11/2021 $13.56
Type of Use: Plan Review-Fire Life Safety-COM 10/11/2021 $45.18
Class of Work: Type of Const: Info Process/Archiving-Sm$0.50(up to 10/11/2021 $1 00
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: Design Area:
K Factor
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req.
Battery Calcs Provided: Cut Sheets Required:
Total $172.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation:
Residential Square Footage:
Fire Alarm Valuation:
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:
Ho-tly Va.K.De.W Ow Ap Li,Ga.'/-1,ovx,
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 Applicati ECEI 1/ED : 101(p 2
Fire Protection System FOR OFFICE USE ONLY
OCT 61021 RCCC1,,e� ,_,..
. City of Tigard C� Da1e,B V ('Z1 it Permit No.:�I—�1
" 13125 SW Hall Blvd..Tigard,OR 9'tt�TY OF TIGARU Plan Review 01 I Phone: 503.718.2439 Fax 503.5 60 Date.'13+•: 1 ZI Other Permit:
TIGARD
Inspection Line: 503.E-39.4175 eLDING DIVISION Date Readyi6•: //'ff 0 See Page 2 for
Internet: www.tigard-oegov Notifed'Mcll od: 1 U� Z l .(�i71 Supplemental Information
FA' t 1P� 9
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
❑ 1-and 2-family dwelling Valuation: S
®Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
lob site address:12909 SW 68th l'kwv New dwelling arca: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport arca: square feet
Suite/bldg/apt.no.:400 Project name:FDIC n PPC082 Suite 400 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
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Fire Alarm Notification Devices Valuation: SS3,394,00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories:
Name:FDIC rah PPC082 Suite 400 Type of construction:
Address:12909 SW 68th Pkwy Suite 400 Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
CI APPLICANT ❑ 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 97035 applicant is exempt from licensing•the following reasons
apply:
Phony(503)627-0100 Fax::( )
E-mail:bwilliams!a pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES°
Business name:Point Monitor Corp. Meuse refer to fee schedule)
Permit fee:
Address:5863 Lakeview Blvd#100
City/State/ZIP:Lake Oswego,OR 97035 State surcharge(12%of permit fee):
b FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( ) (Due upon application submittal)
CCB lie.:135901 Total permit fees:
t\ Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name:Ben Breit Date: 10/6/2021 within 180 days after it has bees accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I.`,Building':Pcrnits,FPS-PennitApp_03I011,doc 440-i6I3T111/0'-!CO\FW'EB)
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: 5
® 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: $ 3,394
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 S198.75
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: $
(::AVserAbwilliams\Desktop AVGRAllT I OR\IS\Fire permit•city of tigari.doc
RECEIVED OFFICE Copy
OCT 6 2021
City of Tigard CITY OF TIIGARD Permit No.: 196262.1— C23
1 , 13125 SW Hall Blvd..Tigard.012 9�'�3.Q nING DIVISION
Phone: )03.718.2439 Fax: 503.59 -WW l_a V Date Received: I 01 Ce 1202—
TIGARD Inspection Line: 503.639.4175 1
Internet www.tigard-or.gov By: G-tl (�c.•i 1 ' )Yd
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: FDIC Occupancy: PPC082 Suite 400
Job Address: 12909 SW 68th Pkwy Suite: 400
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $3,394
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,ma.5) /To be Relocated(ma.s)
Number of Proposed Manual Alarm Stations: To be Added on.,s) /To be Relocated(ma.5)
Number of Proposed Notification Appliances: To be Added(ma.5) 4 /To be Relocated(ma.5) 1
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: 10/6/2021
Print Name: Ben Breit
I:1Building\Fonns\FireAlarmAffidavit_07I514.docx Page 1 of 1