Permit INa CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
$ COMMUNITY DEVELOPMENT Permit#: FPS2021-00141
Date Issued: 12/13/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 170
Project: WWEX Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: Fire sprinkler permit-adding(3)sprinkler heads for TI.AFFIDAVIT SUBMITTED.
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES L P
9095 SW BURNHAM ATTN: N PIVEN
TIGARD, OR 97223 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/09/2021 $61.85
12%State Surcharge-Building 12/09/2021 $7.42
Type of Use: COM Plan Review-Fire Life Safety-COM 12/09/2021 $24.74
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 12/09/2021 $0.50
Occupancy Grp: 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 $94.51
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $848.00
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: H V D���� Permittee Signature: Qw Air �,
ailyCall 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 ApplicatioTiECE'VED $
Fire Protection System DEC2 FOR OFFICE USE ONLY
Cityof Tigard EC 2 Z02� Received / �/ji- ^� 0n
g Date/By: / 20 I .tea! Permit No.: F1. 2UZ!-W (41
III 4 13125 SW Hall Blvd.,Tigard,OR 9722 OF IUHND Plan Review
f ' Phone: 503.718.2439 Fax: 503.598.19 ( Date/By: N/
OtherPermit�� l-�2Z�
TIGARD
Inspection Line: 503.639.4175 3UILDING DIVISION Date Ready/By: / p lnrjs,.6 _ See Page 2 for
Internet: www.tigard-or.gov Notified/M thod:1 QQ�4 4el �I Il/.•,/I'�' Supplemental Information
;°atillir
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
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
ElI-and 2-family dwelling ❑■ Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
ElMaster builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:12909 SW 68th Parkway#170 New dwelling area: square feet
City/State/ZIP:Tigard OR 9223 Garage/carport area: square feet
Suite/bldg./apt.no.:#170 Project name:WWEX TI 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.
Add fire sprinkler heads for TI Valuation: $848
Existing building area: square feet
1 New building area: square feet
1
0 PROPERTY OWNER
❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( )
New:
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ronin Campbell licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard, OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:( )503.684.2928 Fax: :( )503.684.9657
E-mail:r.campbell@wyattfire.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Wyatt Fire Protection
Permit fee:
Address:9095 SW Burnham
State surcharge(12%of permit fee):
City/State/ZIP:Tigard, OR 97223 FLS plan review(40%of permit fee):
Phone:( )503.684.2928 Fax:( )503.684.9657 (Due upon application submittal.)
CCB lic.:64077 Total permit fees:
Authorized signature: A 6,
Amount received:
' `� ✓ This permit application expires if a permit is not obtained
Print name:Ronin Campbell Date:12/2/21 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_03 I016.doc 440-4613T(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:
❑ New system Number of sprinkler heads: 3 Number of alarm devices:
❑� 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:
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 light hazard
Density (.1
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $848
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): $
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: $
W:A Permits\Permit Application Forms(Updated July 2017)\Tigard Fire Permit App.doc2
RECEIVED City of Tigard Permit No.: FPG2 22- 9(1-1,I
13125 SW Hall Blvd.,Tigard,OR 97223 DEC 2 /1)2E Phone: 503.718.2439 Fax: 503.598.1960 Date Received: (2/02/.iOZ/
1 1 t, tt t) Inspection Line: 503.639.4175 ['(iv OF i it mtiD
Internet: www.tigard-or.gov By: C list Of 7761 0
3UILDING DIVISION
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS CO�
71
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) ICt
Project Name: WWEX TI Occupancy:
Job Address: 12909 SW 68th Parkway Type of Construction:
Suite: #170
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: 3
Type: SSP-QR Hazard: Light Density: 0.1
I Wyatt Fire Protection Oregon Construction Contractors Board No. 64077
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.
Signature: 16n(4. Date: 12/2/21
Print Name: Ronin Campbell
L\Building\Fonns\FireSprinklerAiidavit_071514.docx Page 1 of 1