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n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2022 00063
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/9/2022
Parcel: 2S 101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 460
Project: Cetera Subdivision: None Lot: None
Project Description: Fire Alarm Permit-Adding(3)strobes.AFFIDAVIT SUBMITTED
Contractor: FIRE PROTECTION SERVICES Owner: G&I X TRIANGLE CORPORATE PARK LLC
9950 SW ARCTIC DRIVE BY DRA ADVISORS LLC
BEAVERTON, OR 97005 ATTN TAX DEPT
575 FIFTH AVENUE 38TH FL
NEW YORK, NY 10017
PHONE: 503-590-3732 PHONE:
FAX: 503-628-6214
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/04/2022 $67.23
12%State Surcharge-Building 05/04/2022 $8.07
Type of Use: COM Plan Review-Fire Life Safety-COM 05/04/2022 $26.89
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 05/04/2022 $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: Automatic
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required.
Total $102.69
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,100.00
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: Edgardo-Ma.(alovta.da- Permittee Signature:
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 Applicatio EVl rE
D
Fire Protection System FOR OFFICE USE 0\1.)
2022 Received
City of Tigard APR 2 5 5 3 2 t Permit No.: _ / $ ,'
Date/B � ,,,+
• 13125 SW Hall Blvd.,Tigard,OR 9722 OF
} ti Plan Review
v I I �Hki- Other Permit:
Phone: 503.718.2439 Fax: 503.598. 9 Date/B
I t ci A R D Inspection Line: 503.639.4175 UILoiruG DIVISION Date Ready By: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: CI Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
D 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.
El1-and 2-family dwelling NICommercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 13221 SW 68th Parkway New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Suite 460 Project name: Suite 460 T.I. 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.
Installation of 3 addition strobes for Tenant Improvement Valuation: $ 1,100.00
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:
0 APPLICANT 0 CONTACT PERSON
NOTICE
Business name: Fire Protection Services,Inc. All contractors and subcontractors are required to be
Contact name: David Phipps licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 9950 SW Arctic Dr. jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
tY Beaverton,OR 97005 apply:
Phone:( 503 ) 590-3732 Fax: :( )
E-mail: Fire2112@ymail.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: Fire Protection Services,Inc. (Please refer to fee schedule
J
Permit fee:
Address: 9950 SW Arctic Dr. —
City/State/ZIP: Beaverton,OR 97005 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( 503 )590-3732 Fax:( ) (Due upon application submittal.)
CCB lie.: 154333 Total permit fees:
Authorized signature: J�*t ' Amount received:
�/ ' This permit application expires if a permit is not obtained
Print name: David Phipps Date: 4/25/2022 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I\Building\Permds\FPS-PermitApp_03 1016.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: 3
❑ Addition or ❑ 1-10 heads: Affidavit required and ❑x 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: $ 1,100
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: $
1:\Building\Permits\FPS_PemvtApp_031016.doc 2
E EI E:
City of Tigard APR 2 5 2022 Permit No.: 2-0 3
13125 SW Hall Blvd.,Tigard,OR 97223
• II Phone: 503.718.2439 Fax: 503.598.19.6q Date Received: 4 1251 22.
Inspection Line: 503.639.4175 4✓1 �/�� �1I � ^L �';/1 r-
TIGAKI) Internet: www.tigard-or.gov UILDING DIVISION By: � Of r ial a
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
COW
Project Name: Suite 460 T.I. Occupancy:
Job Address: 13221 SW 68th Parkway, Tigard OR 97223 Suite: 460
Contractor: Fire Protection Services, Inc. Phone: 503-590-3732
Valuation of work: $ 1100.00
Type of System: (check one) ORequired ❑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) /To be Relocated (max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) 3 /To be Relocated (max 5)
I, David Phipps Oregon Construction Contractors Board No. 154333
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.
0 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 docum t with a copy of the sketch attached shall be available for all inspections.
Signature: Sri Date: 4/25/2022
Print Name: David Phipps
1\Building\Forms\FireAlarmAffidavit 071514.docx Page 1 of 1