Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
•. COMMUNITY DEVELOPMENT Permit#: FPS2022-00023
Date Issued: 2/10/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S113AC01201
Jurisdiction: Tigard
Site address: 17015 SW 72ND AVE
Project: McCormick and Schmicks Subdivision: COUNCIL VIEW ACRES(LOTS 1-20) Lot: 18
Project Description: Fire alarm permit-New panel,annunciator, smoke above panel,new pull station at panel and WP H/S above the
FDC.AFFIDAVIT SUBMITTED.
Contractor: JOHNSON CONTROLS SECURITY SOLUTIONS LLC Owner: BV CENTERCAL LLC
6305 ROSEWOOD ST SUITE A ATTN: FRED BRUNING
LAKE OSWEGO, OR 97035 7455 SW BRIDGEPORT RD
TIGARD, OR 97224
PHONE: 855-201-1482 PHONE:
FAX: 503-675-4412
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/10/2022 $156.00
12%State Surcharge-Building 02/10/2022 $18.72
Type of Use: COM Plan Review-Fire Life Safety-COM 02/10/2022 $62.40
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 02/10/2022 $1.50
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: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $238.62
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $7,100.00
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: "�''�JJJI x �/pQ Permittee Signature: ; �S
���-��K Call 50)3.639.4175 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 ApplicatiolECEIr 1l QED
Fire Protection System FOR OFFICE USE ONL\
Cityof TigardFEB4 q q Received �f •
g I'6U LI�Z o,1 �,• Permit No.�'�^
/L■■ • 13125 SW Hall Blvd.,Ti rd,OR 97223 Date/By:
4 • N�/J
>'� Plan Review
B Phone: 503.718.2439 Fax: 503.598.196fT}' OF I IGARU Date/By: Other Permit:
1-i u i n it 1 t Inspection Line: 503.639.4175 I ry t�I/� DIVISION
Date Ready/By �n tans: 0 See Page 2 for
Internet: www.tlgard-orgov ?I-JILDING DIVISIO Notified.N th V „, 4 --nG Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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.
❑ 1-and 2-family dwelling ®Commercial/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: 17015 SW 72nd Ave Tigard OR 97224 New dwelling area square feet
City/State/ZIP: Tigard OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: MCCORMICK&SCHMICKS 108329620-03 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.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ 7100
Fire Alarm System Uodate• New Panel Annunciator.Smoke above the panel-New Pull Station
At the panel and WP H/S above the FDC Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER Ei TENANT Number of stories:
Name. n,frrpg nnlrx x.CO-iMICx c Type of construction:
Address: 17015 SW 72nd Ave Occupancy groups:
City/State/ZIP: Tigard OR 97274 Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ® CONTACT PERSON NOTICE
Business name: Johnson Controls Security Solutions All contractors and subcontractors are required to be
Contact name: Tjy Helms licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6305 SW Rosewood St. 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:( ) 971-294-1320 Fax: : ( )
E-mail: Tjy.Helms@JCl.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: Johnson Controls Security Solutions (Please refer r°(ee achedulel
Permit fee:
Address: 6305 SW Rosewood St.
State surcharge(12%of permit fee):
City/State/ZIP: Lake Oswego,OR.97035 FLS plan review(40%of permit fee):
Phone:( ) 971-294-1320 Fax:( ) (Due upon application submittal.)
CCB lie.: 197010 Total permit fees:
l r a Amount received:
Authorized signature: 77-&
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Tjy Helms Dale: 2/3/22 *
Fee methodology set by Tri-County Building Industry
Service Board.
IABudding1 Permits 1FPS-PermilApp 031016.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: Number of alarm devices: 5
® Addition or ❑ 1-10 heads: Affidavit required and all-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:Spoke with Jeff Grove and confirmed an Affidavit will suffice for the limited scope of work
Type of System (Complete A,B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type El Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line El 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 Q Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ 7100
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 $
I:\Building\Pemuts\FPS_PermitApp_031016.doc 2
RECEIVED
City of Tigard FEB 4 2022 Permit No.: FFS2o22-E) o23
• 13Phone:125 SW503.71 Hall8.2439 Blvd.,TigardFax:,OR 97 123
503.598. 96Q;I(5( UI- I IIaAH Date Received: O2./OA/2.02.2-
Internet:n www. 503.639.4175r.gov ;UILDING DIVISIOP Y
TIGARD Internet: vvww.tigard-ocgov B : CjIT! OF T�
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: MCCORMICK & SCHMICKS 108329620-03 Occupancy: A-2
Job Address: 17015 SW 72nd Ave Tigard OR 97224 Suite:
Contractor: Johnson Controls SSione: 971 294 1320
Or
Valuation of work: $7100 vi'It y
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(max 5) 1 /To be Relocated (max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) 1 /To be Relocated(m(0x 5)
Number of Proposed Notification Appliances: To be Added(max 5) 1 /To be Relocated(max 5)
I Tjy Helms Oregon Construction Contractors Board No. 197010
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.
Tjy' Helms Digitally signed by Tjy Helms
Signature: Date 2022.02.0311:03:48-08'00' Date: 2/3/22
Print Name: Tjy Helms
C\Building1Forms\FireAlarrAffidavit_071514.docx Page I of