Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
s COMMUNITY DEVELOPMENT Permitm FPS2022-00110
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/9/2022Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 190
Project: Mintun Media Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Adding 3 new horns and strobes
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:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
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: Yes
Total $0.00
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,632.00
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:
IL
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 REC EI` ,
V
IN FOR OFFICE USE ONLY
City of Tigard AUG 9 202 .Received
Date/B : PennitNo. CLQ 'O
13125 SW Hall Blvd.,Tigard,OR 97223 lan Review
Phone: 503.718.2439 Fax: 503.598.1960 cay OF TIGA D /B .
Other Permit:
99 Inspection Line: 503.639.4175 BUILDING D1VI t Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
o Wow . Rl~QUIttDtlf4:i-AND3IF2�t13iLtTfl'll .IYG
❑New construction Pe h r:
El Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement E]Other: equipment,materials,labor,overhead,and the profit for the
1C (N work indicated on this application.
El1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
` 6 S }� Total number of floors:
Job site address: I 0 (,A) "V,& VU)A VI New dwelling area: square feet
City/State/ZIP: R 0 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 1411*,V hAn ►V l q Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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
` T3EB1"f11►+ 1'4R work indicated on this application.
V /V 1 t CJ4��o.l) C C\/1 Valuation: $
Existing building area: square feet
New building area: square feet
c :OV1tJNt i<l +It1<+IT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
-1 �61! ACT PEPERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: iAs S licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: j K Ev t�W � �� 0 jurisdiction in which work is being performed.If the
City/State/ZIP: Lk C 0 tZ 035 applicant is exempt from licensing,the following reasons
_ apply:
Phone:(�v3) 27 r o I G Q Fax::( )
E-mail: r V ll\A\C.t.-V1�
CON R4CTID$ BUILbIIV` :pERiVli .FEES*
Business name. ��,� ' �U�; pv (_,op
Please re er!o;ee sejaed#e
Permit fee:
Address: 17
�8!1� �1�e V t� Ly V
1 �Q a 1�
/ State surcharge(12%of permit fee):
City/State/ZIP: F--A vc 0_swflo 04
FLS plan review(40%of permit fee):
Phone:(5-05 62 — C)100 Fax:( ) Due upon application submittal.
CCB lic.: -12, C'p Total permit fees:
Authorized s ature. f /
Amount received:
/ This permit application expires if a permit is not obtained
Print nam : S 4� Date: -�—2 O Z within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:ABuilding\Permits\FPS-PermitApp_031016.doe 4404613T(I 1/02/CON/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
►eascneo o b tone h ,
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 ❑ 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:
Ate !#Wi Ypl1,:'k Y: 1 '•t 1: �' 'x ,...5` W tiF' N
r
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
'gym I od' "tee 5 resiion s#eli
Hood Project Valuation: a$
F�re�t1t# I fi E "'ir1, r
r
Submittal shall Batte Calculations ❑ Yes
include: Individual Component Yes
Cut Sheets
Fire Alarm Project Valuation: $
777777
R a 6*1 p0, M
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.
Me
Project valuation subtotal see A,B &C above): $
Permit fee based on project valuation see fee schedule): $
Permit fee based onsquare footage see D above): $
State Surcharge 12% of permit fee): $
FLS Plan Review 40% of permit fee): $
TOTAL: $
l:ABuilding\Pcrmits\FPS_I'erm tApp_031016.doc 2
EL
City of Tigard ° EC IV Pennit No.:
T
13125 SW Hall Blvd.,Tigard,OR 97223Phone: 503.718.2439 Fax: 503.598.1960 " Date Received:
Inspection Line: 503.639.4175 offy ()F 11GARD Internet: www.tigard-or.gov BUIL'OING DIVi5I0N By.
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF S DEVICES WITHOUT PLANS)
Project Name: Mintun Media - PPC082-190 Occupancy:
Job Address: 12909 SW 68th Parkway Suite: 190
Contractor: Point Monitor Corporation Phone: 503.627.0100
Valuation of work: $3632.00
Type of System: (check one) ❑I Required ❑Non-required
(check one) ❑Automatic ❑Manual ❑E 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(m.5) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added wax 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added tmax 5) 3 /To be Relocated(max 5)
1 Point Monitor Corporation 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 co i, ent with a c the sketch attached shall be available for 11 iinspe tions.
Signature. Date:
Print Name: Sharon Erickson
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