Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
" COMMUNITY DEVELOPMENT Permit#: FPS2022-00055
Date Issued: 4/5/2022
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16150 SW UPPER BOONES FERRY RD
Project: Fairway America,LLC Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Fire sprinkler permit:Adding and relocating(9)sprinkler heads.Affidavit submitted.
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES LP
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 04/05/2022 $86.06
12%State Surcharge-Building 04/05/2022 $10.33
Type of Use: COM Plan Review-Fire Life Safety-COM 04/05/2022 $34.42
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 04/05/2022 $2.00
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .1 Design Area: 0
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 $132.81
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,740.00
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 a copy of the rules
Issued By: a Signature: p �
Call . .4175 by 7:00 a.m.for the next available inspection date. U j
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 FOR OFFICE USE ONLY
City of Tigard Received /
.113125 SW Hall Blvd.,Ti ard,OR 97223 1,Plan Date/B : Jr../ , ,�
g E„DateBe: Other Permit:
Phone: 503.718.2439 Fax: 503.598.1961(�ll E
CjEIV
TIGARD Inspection Line: 503.639.4175 i Date ReadyiBy: IfigM
® ee Page 2 for
Internet: www.tigard-or.gov Vat
Supplemental Information
APR
TYPE OF WORK °FY OF TIGARD REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑ New construction ❑Demol kyo n1„ Permit fees*are based on the value of the work performed.
?t j it 1. ��"� ����` ' Indicate the value(rounded to the nearest dollar)of all
❑� Additionialtcration/replacement El 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: $
ElAccessory building El Multi-familyNumber of bedrooms:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:16150 SW UPPER BOONES FERRY RD New dwelling area: square feet
City/State/ZIP:PORTLAND, OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:FAIRWAY AMERICA 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.
Adding and relocating heads for tenant improvement Valuation: $1740
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stones:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax: ( ) New:
APPLICANT El 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
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:I.poling@wyattfie.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 up
on application submittal.)
CCB lie.:64077 Total permit fees:
Authorized signature:
�� Amount received:
This permit application expires if a permit is not obtained
Print name:Levi Poling Date:4/5/2022 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
l:Building':PvmitsVFPS-PermitApp_031016.doc 440-4613T(I 1/02/COM/WEB)
I
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: 9 Number of alarm devices:
❑■ Addition or -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 0 Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes ❑ No
Hazard Group light hazard
Density (Li
Design Area
K. Factor
Sprinkler Project Valuation: $1740
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall BatteryCalculations 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:\Permits\Permit Application Forms(Updated July 2017)\Tigard Fire Permit App.doc2
City of Tigard Permit No.: 0,101j2
111 'I 13125 SW Hall Blvd.,Tigard,OR 97223 (/
• Phone: 503.718.2439 Fax: 503.598.1960 Date Received: !S-/
'1 I :1 U InspectionLine: ador.go 503.639.4175 r��
Internet: www.tigard-or.gov $y; N
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TE NT IMPROVEMENTS
•
(I to 10SPRI '!- '"1.11 ,HOUTPLANS)
APR 5102z
CITY OF TIGARD
Project Name: Fairway America BUILDING DIVISION Occupancy:
Job Address: 16150 SW Upper Boones Ferry Rd. Type of Construction: s IZ -6
Suite:
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: 9
SSP-SR qf EcP -SR
Type: SSP=ark 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 annovers 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: 401. PCr Date: 4/5/2022
Print Name: Levi Poling
I:1Building'Forms\FircSprinklerAffidavit_071514.docx Page 1 of