Permit „ CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
a • COMMUNITY DEVELOPMENT Permit#: FPS2021-00122
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/6/2021
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 220
Project: Carr Butterfield Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Fire alarm permit.Add(1)and relocate(2)notification devices AFFIDAVID SUBMITTED.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
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 10/05/2021 $67.23
12%State Surcharge-Building 10/05/2021 $8.07
Type of Use: COM Plan Review-Fire Life Safety-COM 10/05/2021 $26.89
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 10/05/2021 $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: No
Total $102.69
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,001.00
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: '.j Va-n,Pe,VJege, Permittee Signature:
Ow Apr-Li-c-ailicrvu
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.
'y ECEIVED
Building Permit Applicati E-IOCt 12
Fire Protection System OCT 12011 FOR OFFICE USE O\l l
City of Tigard Rue'°ea
g CITY OF TIGARD Date'By: /0 OJ 2tl� Is
Permit No.:�202('"(X)j Z�
13125 SW Hall Blvd.,Tigard,OR 9�r
= Phone: 503.718.2439 Fax: 503.59 Wd1>_DING DIVISION Plan Review Other Permit
Date/B
T I G A R D Inspection Line: 503.639.4175 Date Rcady.'By: 1upF ® See Page 2 For
Internet: www.tigard or.gov Notified/Method: �Iter Supplemental Information
TYPE OF WORK 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling ®Commercial/industrial Valuation: $
0 Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:6650 SW Redwood Lane New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.:220 Project name:Carr Butterfield @ PCC24 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 rnap/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Fire Alarm Notification Devices Valuation: $$1,001.00
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ® TENANT Number of stories:
Name:Carr Butterfield @ PCC240 Type of construction:
Address:6650 SW Redwood Lane Suite 220 Occupancy groups:
City/State/ZIP:Tigard,OR 97124 Existing:
Phone:( ) Fax:( ) New: —
0 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 97035 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)627-0100 Fax::( )
E-mail:bwilliams@pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Point Monitor Corp. (Please refer w/ec schesuN
Permit fee:
Address:5863 Lakeview Blvd#100 -
State surcharge(12%of permit fee):
City/State/ZIP:Lake Oswego,OR 97035
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:
_ This permit application expires if a permit is not obtained
Print name:Ben Breit Date:10/1/2021 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
i.Building'Permits FP5-Pem,itApp,.031016.doc 440-4613T1 11 02'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:
0 New system Number of sprinkler heads: Number of alarm devices: 3
.® Addition or 0 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 a• •licable): _ s
A.) Commercial Sprinkler
Sprinkler Type 0 Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes 0 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: $ 1,001
D.) Residential Sprinkler(Stand Alone System)
Square Footge: 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 (sec 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:\ttsers\bcrilliams\Desktop\PERMIT FORMMS\Fire permit-city of tigard.doc 2
RECEIVED
OCT 12021
City of Tigard Permit No.: F?82021^0 0 12 Z
• 13125 SW Hall Blvd.,Tigard,OR 97t1TY OF TIGARD
I Phone: 503.718.2439 Fax: 503.5 Date Received: 1 p lO I/2014
Inspection Line: 503.639.4175 DING DIVISION A t t
.11 ,A R 1) Internet: www.tigard-or.gov By: 1
cAleD
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS VICE C° '
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Aspen Capitol Occupancy: Same
Job Address: 6650 SW Redwood Lane Suite: 220
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $1001
Type of System: (check one) ❑Q 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 s) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(mar 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) 1 /To be Relocated(max 5) 2
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: 10/1/2021
Print Name: Ben Breit
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