Permit III CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2021-00119
Date Issued: 10/6/2021
IF G A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 400
Project: FDIC Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: Fire sprinkler permit. Relocate(6)&add(3)sprinkler head drops to cover new floor plan.AFFIDAVIT SUBMITTED.
Contractor: AFP SYSTEMS INC Owner: PACIFIC REALTY ASSOCIATES L P
19435 SW 129TH AVE ATTN: N PIVEN
TUALATIN,OR 97062 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-692-9284 PHONE:
FAX: 503-692-1186
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/05/2021 $86.06
12%State Surcharge-Building 10/05/2021 $10.33
Type of Use: COM Plan Review-Fire Life Safety-COM 10/05/2021 $34.42
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Sm$0.50(up to 10/05/2021 $0.50
Occupancy Grp: B Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0.1 Design Area: 1500
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $131,31
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,800.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Permittee Signature:
Hath Vo-w De-Wege Ow AYv -
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Applica l EJVFD _ • 2,,I rz
Fire Protection System �/FOROFFICE USE ONEN
Cityof Tigard SEP � Received/O ivc/ 2621 ff2 21 e0 /9
g �� Dates,:
((// `j' Permit No.� f
iis • 13125 SW Hall Blvd.,Tigard,OR �9'► ��-r� Plan Review
g Ui t u t Other Permit:
Phone: 503.718.2439 Fax: 505,$,�9O�n �'�/� l�n' Date Br: Y Y t t ® See Page 2 for
1 I(:;A It f) Inspection Line: 503.639.4175 CS L1` G Date Read:B /)
Internet: www.tigard-or.gov Notified'Meth60![ in ter*anistaEve
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 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.
❑1-and 2-family dwelling ElCommercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:12909 SW 68u'Pkv y New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:400 Project name:FDIC TI Covered porch area: square feet
Cross street/directions to job site:Pacific Parkway Center Bldg.B 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.
Relocate 6,&add 3 fire sprinkler head drops to cover new floor plan. Valuation: SS1,800.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER 0 TENANT Number of stories: I
Name: Type of construction: 11-B
Address: Occupancy groups:
City/State/ZIP: Existing: B
Phone:( ) Fax:( ) New: no change
® APPLICANT 0 CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: appicant is exempt from licensing,the following reasons
apply: ---- -----------
Phone:( ) Fax::( )
E-mail:permitski afpsys.com
CONTRACTOR BUILDING PERMIT FEES*
(Pleare refer to fte schedak
Business name:AFP Systems Inc.
Permit fee:
Address:19435 SW 129th Ave --
State surcharge(12%of permit fee):
City/State/ZIP:Tualatin,OR 97062 0
FLS plan review(40%of permit fee):
Phone:(503)692-9284 F v:(503)692-1186 (Due upon application submittal,
CCB lie.:6753 Total permit fees:
s' Amount received: R,5/
Authorized signature. 'k" This permit application expires if a permit is not obtained
J,f P/ _ within 180 days after it has been accepted as complete.
[Print name:Steve Frost Date:09/29/2021
_ 1 * Fee methodology set by Tri-County Building Industry
Service Board.
1 i.Building,Pennils\FPS-PermitApp_071514.dor 440-4s 1 IT(1102'COM'WSB)
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: 9 Number of alarm devices:
g Addition or ® 1-10 heads: Affidavit required and 0 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
® Wet ❑ Dry
Additional Standpipes
Information: Hazard Group LH
Density 0.10
Design Area 1500 _^
K.Factor 5.6
Sprinkler Project Valuation: $ 1,800.00
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: $
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): $ 1,800.00
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: $
a:\Permits Steve new\Tigard\MAC'TI-FPS_PerrnitApp.doc 2
RECEIVED
City of Tigard SEP 2 9 1021 Permit No.: ►S '00 (
• 13125 SW Hall Blvd.,Tigard,OR 97223 s
I Phone: 503.718.2439 Fax: 503.598.1@ t OF TIGARD Date Received: i 0
Inspection Line: 503.639.4175 t�
TIGARD Internet: www.tigard-or.gov BUILDING DIVISION By:
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS C �"®
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) I
Project Name: FDIC TI Occupancy: B-office
Job Address: 12909 SW 68th Pkwy., Tigard, OR 97223 Type of Construction: II-B
Suite: 400
Contractor: AFP Systems Phone: 503-692-9284
Number of Proposed or Altered Heads: 9
Type: wet Hazard: light Density: 0.10
1 Steve Frost/AFP Systems Oregon Construction Contractors Board No. 67534
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits, beams, partitions, walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop(exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads(see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
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.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Digitally signed by Steve Frost
Steve Frost DN:cn=Steve Frost,o=AFP Systems,ou,
Signature: email=Steve@afpsys.com,c=US Date: 09/29/2021
Date.2021.09.2908.20.40 07'00'
Print Name: Steve Frost
I:\Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1