Permit III CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2022-00012
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/31l2022
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 145
Project: Avanti Marketplace Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,P7 '
Project Description: Fire sprinkle permit-relocate(1)fire sprinkler head.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 01/31/2022 $56.47
12%State Surcharge-Building 01/31/2022 $6.78
Type of Use: COM Plan Review-Fire Life Safety-COM 01/31/2022 $22.59
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 01/31/2022 $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 Reg:
Battery Calcs Provided: Cut Sheets Required:
Total $86.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $633.00
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: Ecgardv Maldmtiado- Permittee Signature: yet,.0.1219-1-4:442....6,0y„
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 Application
Fire Protection System � E
City of Tigard RECEI �q key p/3/ '2�J7G`L'�/Z
Tema,
PhoneSW Hall Blvd,Tigard,OR03 97223 1 9) )1d Plan A
Phone 503.718?439 Fax 503 Dat�y / J Other Permit
e I t;A is I) Inspection Line 503 639.4175 -t 1 f t0 Dale keady6y ? Ivc ¢See Page x far
Internet- www.ttgald-argue tv r,� !v -�I NoaficdM1lglnt J -�7 I SapplrmeNal leformatloe
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TYPE OF WORK REQUIRED DATA:rl-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
®Additiorvalierationireplucemcnt 0 Other equipment,matenals,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application
❑ I-and 2-family dwelling I ®Commeeiatindttstrial Valuation. S
❑Accessory building 0 Multi-family Number of bedrooms
❑Masterbuikkv El Other Number of bathrooms
JOB SITE INFORMATION AND LOCATION Total number of floors
Job site address 12909 sw 58111 pkwy 055• 45 New dwelling area square feet
City'SlateZiP:Tigard,OR 97223 Oumgc.carpon area. square feet
Suitobldg.'apt,no #155 Project name Avant'Marketplace Covered porch area square feet
Cross street'directions to job site Deck area square feet
Other structure area square feet
I
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision. Lot no. Permit fees*arc 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.
Relocating one fire sprinkler head Valuation S633
Existing building area. square feel
New budding area square feet
0 PROPERTY OWNER ❑ TENANT Number of stories.
Name Type of construction
Address:
Occupancy groups
City'SlateZIP: Existing-
Phone:( ) Fax:( ) New
111 APPLICANT 0 CONTACT PERSON NOTICE
Business name.Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name Levi Poling licensed with the Oregon Construction Contractors Board
Address 9095 SW Burnham jurisdiction
ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed lithe
City-SwleZIP Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply
Phone( )503.684.2928 Fax::( )503.684.9657
E-mail.l.poling@wyattfire.com
CONTRACTOR BUILDING PERMIT FEES'
Business name:Wyatt Fire Protection fPfra+r reef se fee
Address.9095 SW Burnham Permit fee
CityStriteZIP:Tigard, OR 97223 Semesurcharge(IZ°.ofpemttttec)
FLS plan review(40",of permit fee):
Phone( )503.684.2928 Fax:( )503.684,9657 (Due upon application submittal.'
CCB lic.:64077 jj''�' Total permit fees:
Authorized signature tff et dY Amount received
VV Thls permit application expires if a permit Is not obtained
within 180 days after it has been acce
pted as complete.
Print name.Levi Poling Date:1/20/2022
' Fee methodology set byTn-County Building Industry
Service Board.
I Roan,Pemal.nK•PmmrApp 5'kn it,din 4ee-e61)TI I IAI COALWEBI
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
Describe work to be done:Relocating one fire sprinlder head
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: 1 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 budding 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,Bt C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ® \Vet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line ® Yes ❑ No
Hazard Group light hazard
Density of
Design Area
K.Factor 5.6
Sprinkler Project Valuation: I $633
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 5198.75
2,001 to 3,600 $246.45
3,601 to 7,200 5310.05
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°'0 of permit fee): $
FLS Plan Review(40°0 of permit fee): $
TOTAL: $
WAlk-rmas\I'rnut Application Forms(Updated July 211171 tgg+nl Fug pert»rr.\pp.d.c2
City of Tigard Permit No.: -099/2
°� • 13125 S50 Hall Blv.24 9 Tigard, 03OR 98223.19 AA• tj i� 072of�2L
S Phone: 503.718.2439 Fax: 503.598.1960)F�•� '� �—� Date Received:
Inspection Line: 503.639.4175 r;
RI) Internet: www.tigard-or.gov ys y i? , w 9. 'Et�7r,� By:
/�/.y�I� of µyy// '
talJl3v''\^'... t..lf� f; �ic! / "'%,1'�-l/
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS [�+�c�j,C�4�
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) "014
Project Name: Avanti Marketplace Occupancy:
Job Address: 12909 sw 68th pkwy# Type of Construction:
Suite: j5
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: 1
Type: SSP-QR Hazard: Light Density: 0.1
1 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: ' In VVV Date: 01/17/2021
Print Name: Levi Poling
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