Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
_ a COMMUNITY DEVELOPMENT Permit#: FPS2022-00009
Date Issued: 3/28/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 140
Project: Avanti Marketplace Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Fire alarm permit-add(1)new horn strobe and modify alarm notification circuit.AFFIDAVIT SUBMITTED.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES L P
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/15/2022 $77.99
12%State Surcharge-Building 03/15/2022 $9.36
Type of Use: COM Plan Review-Fire Life Safety-COM 03/15/2022 $31.20
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 03/15/2022 $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: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $119.05
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,500.00
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:
1-1c-U.1 Va-w Pe.Welter Ow Apt ,
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 RECEIVED
Fire Protection System FOR OFFICE USE ONLY
City of Tigard JAN 10 2022 Received Permit No:
II13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:0/ �2/2Q� s� ( i'V2 2Z C L�9
s Phone: 503.718.2439 Fax: 503.598.1960`ITY OF TIGARU Plan�Y iew i0/� Other permit
TIGAItu Inspection Line: 503.639.4175 -3UILDING DIVISION Date Ready/By , / �j kris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method I /L Z,l Jf .� 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
is Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling ®Commercial/industrial Valuation: S
❑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 68th Parkway New dwelling area: square feet
City/State/ZIP:Portland, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:155 Project name:PPC082-Avanti 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.
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.
Modify fire alarm notification circuit and add (1) new strobe. Valuation: 1500.00 $
Existing building area: square feet
New building area: square feet
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:Ponit Monitor Corporation All contractors and subcontractors are required to be
Contact name:Rick Rodrigues licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:5863 Lakeview Blvd 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:( 5031627-0100 Fax::( )
E-mail: rrodrigues@pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name:Point Monitor Corporation
Permit fee:
Address:5863 Lakeview Drive
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 �`l yyy��� /� /��,{� Total permit fees:
l�d / 1 t/G d' Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name:Richard Rodrigues Date:1/10/2022 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
i 1Buildi°g\Perms\FPS-Permit App_0310I 6.dos 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:
❑ Addition or LI 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
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: $
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: $
L\Building\Permits\FPS_PermitApp_031016.doc 2
RECEIVED
JAN 10 2022
City of Tigard Permit No.: FS2O�—°"` �7
13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGAR�
Phone: 5n Line:
Fa,; 503.598.1969UILDING DIVISION'Date Received: OI/t 0 2o22
TIGARD Inspection Line: 503.639.4175
e Internet: ewv.ligard-or.gov By: t.11 / OF 7tGzft
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS OFFICE an
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: PPC082 - Avanti TI Occupancy:
Job Address: 12909 68th Parkway Suite: 155
Contractor: Point Monitor Corporation Phone: 503-627-0100
Valuation of work: $1500.00
Type of System: (check one) D■Required DNon-required
(check one) DAutomatic ❑Manual QBoth
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(ma.si 1 /To be Relocated(me.
Number of Proposed Manual Alarm Stations: To be Added o.. /To be Relocated(.5)
Number of Proposed Notification Appliances: To be Added(max 51 /To be Relocated(ma.s)
I Richard Rodrigues 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 oft ' docu ent wi a co y of the sketch attached shall be available for all inspections.
Signature: ' Date: ///G-/ZL
Print Name: > 2 t t�� Rci.c7
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