Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2022-00137
Date Issued: 10/27/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 250
Project: Tru Independence Subdivision: Lot: 2
Project Description: Fire alarm permit for TI:Adding(1)and relocating(1)notification appliance. Affidavit submitted.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/27/2022 $102.20
12%State Surcharge-Building 10/27/2022 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 10/27/2022 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 10/27/2022 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: No Sprinkler Type:
Standpipe Required: No 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 $155.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,190.00
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: l `I ermittee Signature: /
Call 03.639.4175 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 FOR OFFICE USE ONLY
City of Tigard Et Received
16 fin/u �- Permit No.:re) 1
13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review ether Permit:°� C Phone: 503.718.2439 Fax: 503.598.15 �C�IV Dace/Rev ivon, j
T I G A IL D Inspection Line: 503.639.4175 Date Ready/By: 1mis: See Page 2 for
Internet: www.tigard-or.gov �,,�O C T 2 i n ' Notified/Method: 14/37/jj. /) y 7-(,y I ®Supplemental Information
'FY PE OF WORK" 1,*t 'I' REQUIRED DATA:I-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
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CON P t < work indicated on this application.
Valuation: $
0 1-and 2-family dwelling 0 Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
D Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND lame Total number of floors:
Job site address: j.53 .Slry .jt__ �,� pale .va%,2r New dwelling area: square feet
City/State/ZIP: 't VtQ OP, Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 'y 1 vyie,p?f J„ovIce_ Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
IVIEQIJIRED 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.
q A' Valuation: $ �[d„
l /M WrZ r ;alk (T1'Q.ACe- CI-a(-
2C� i
I /Vt'3 :f'_ L G,` pp a-iCcs re e t Existing building area: square feet
1 3 OoQ 1 v 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 ❑ CONTACT PERSON NOTICE
Business name: P8i,+ Cop,�;C r 1 Al]contractors and subcontractors are required to be
Contact name: � jb Cri I' licensed with the Oregon Construction Contractors Board
pp�� ' A ��I•-pp under ORS 701 and may be required to be licensed in the
Address: 50 Ca3 L-Ce1Ce VIt'+ti/ t 1 L&t, jurisdiction in which work is being performed.If the
r,, C72 applicantis exempt from licensing,the following reasons
City/State/ZIP: (L '7 3 loxke, c+
v apply:
Phone:(g yam) (3 ll 2, 7.-01 Fax:: ( )
E-mail:Sl'r'�-IVO AF` 71'Cfw' rh... ('-i 1
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule).
Business name: Pd "� Mr je , r
�tr Y Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: a
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: 1 3 SCt Q` Total permit fees:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
l34 L kk , ;1 9`�1'.1 �je$, t�//7 fr-r 9. within 180 days after it has been accepted as complete.
Print name: Kj rn �/ 1Js-Date: ( vL�'
y9 f" * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pcemies'FPS-PermitApp_031016.doc 4404613T(i l/02/COM/WEB)
City of Tigard Permit No.: /185 2Yl}i. a)131
13125 SW Hall Blvd.,Tigard,OR 97223
I Phone: 503.718.2439 Fax: 503.598.1960IN
Date Received: 14 2- /?J
Inspectionerne: wLw.t 503-or.gov %�
TIGAIi]) Internet: www.tigard-or.gov By: � f
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTEIREICAAVED
OR TENANT IMPROVEMENTS OCT 2 7 2022
(MAXIMUM OF 5 DEVICES WITHOUT PLANS) CITY OF TIGARLI
BUILDINU DIVISION
Project Name: Tru Independence PCC241-250 Occupancy:
Job Address: 15350 SW Sequoia Parkway Suite: 250
Contractor: Point Monitor Corporation Phone: 503.627.0100
Valuation of work: $2,190.00
Type of System: (check one) ['Required ❑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 s) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(max s) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) 1 /To be Relocated (max 5) 1
I Sharon Erickson 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 of this document with a copy of the sketch attached shall be available for all inspections.
'WPM wood by Encxe°n
Sharon Erickson ° °-asE 'n°°�° ---° °°°^°°w-s^�°°E 10/25/2022
Signature: o�.zou.+oxs�zeu.aaoroo Date:
Print Name: Sharon Erickson
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