Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
'PIs COMMUNITY DEVELOPMENT Permit#: FPS2022-00151
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/10/2022
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 290
Project: Thenell Law Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: Fire alarm permit:Adding(1)and relocating (1)notification appliance.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 11/10/2022 $91.44
12%State Surcharge-Building 11/10/2022 $10.97
Type of Use: COM Plan Review-Fire Life Safety-COM 11/10/2022 $36.58
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 11/10/2022 $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 Reg:
Battery Calcs Provided: Cut Sheets Required:
Total $139.49
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,946.00
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
n
Issued By: •
4��/ems --7 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 Application
Fire Protection System FOR OFFICE USE ONLY
Received _
City of Tigard V! DateB : Permit No.:
13125 SW Hall Blvd.,Tigard,OR 972 E , M �D Y /) I���� '�" �`�'s -?}3 - i>>!
g Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: N# Other Permit:® ' P q _ ;v�L
I I.;A 12 n Inspection Line: 503.639.4175 NOV1. 0 ?O�f Date Ready/By: �t ( y hats. e? age Information
CJ�n
Internet: www.tigard-or.gov Notified/Method: Ii nti}` e Supplemental Information
t��CtTY OF TIGARD lt2 r,,,( ,�!-,a.r>.r
TYPE OF WURKDING DIVISION .... ---- REQUIRED DATA: 1-AND 2-FAMILY DWELLING
El New construction El Demolit n Permit fees*are based on the value of the work performed.
ii Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Others equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION \\\\t\\\ work indicated on this application.
❑ I-and 2-family dwelling ❑Commercial/industrial Valuation: $
ElAccessory building El Multi-familyNumber of bedrooms:
❑Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12c((Jy SA") ., .+1,\ Pic-�/( New dwelling area: square feet
City/State/ZIP: Tp4 /O K. / Garage/carport area: square feet
"
Suite/bldg./apt.no.: Project name: v*L I UN) p g2. 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application. „
/ '- Valuation:t gy6ror j4A/1 /i^, U) ,d ttily 9'il-, q.4,��� ,�(1I.vy, ,�,„6.. / 0>c‹.....4-h.6...c
/ Existing building area: squire feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: .i
._ i v LOrpr}"=AlVv-A All contractors and subcontractors are required to be
Contact name: S yard x Erd-sQ.1 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: - gc I3A'^jjuj e .j a jurisdiction in which work is being performed.If the
City/State/ZIP: �'ial t7Ct.QC+O/OR_ CI7°35 applicant is exempt from licensing,the following reasons
�l apply:
Phone:(SO) C222 —0100 rF-�ax::( )
E-mail:ef:C Zsg_k�Qti'1..1'i"'1e,t1/"K7 .Cc'M
CONTRACTOR BUILDING PERMIT FEES*
Business name: � "�, " (Please refer to fee schedule
o,4 u, 43 C.6!1!L Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: l 3.14 I Total permit fees:
�/ Amount received:
Authorized signature:9W� % "
This permit application expires if a permit is not obtained
Print name: I cal-L ,S ilk I j)/0 72,1-„, within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
IAHuilding\Permits,FPS-PermitApp_031016.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: 5— 1-1t
❑ Addition or ❑ 1-10 heads: Affidavit required and devices: Affidavit required and
Alteration (3) copies of sketch showinarea (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: $
.) 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:ABuildup\Permits\FPS_PermitApp_031016.doc 2
City of Tigard Permit No.: j f S ?0 7'2—00 01
III • 13125 SW Hall Blvd.,Tigard,OR 97223®' Phone: 503.718.2439 Fax: 503.598.1960 Date Received: I t
1/(i l/ -
Inspection Line: 503.639.4175
TIGARD Internet: www.tigard-or.gov By: _CA of J t A✓it
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Thenell Law - PPC082-290 Occupancy:
Job Address: 12909 SW 68th Pkwy Suite: 290
Contractor: Point Monitor Corporation Phone: 503.627.0100
EGEI1lED
Valuation of work: $ 1,946.00
NOV l 4 ZO?.r
Type of System: (check one) *Required Non-re uiredCITY O TIGARG
Yh Y n q BUILDING DIVISION
(check one) ElAutomatic ['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 cmax 5)
Number of Proposed Notification Appliances: To be Added(max 5) 1 /To be Relocated o 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.
Sharon Erickson ""`" °y5° i1=- 11/10/2022
Signature: -0; �.w<��PbmMa.,n. N_��.E„.=,.
Date:
Print Name: Sharon Erickson
1`_\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1
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A-2;;"SCALE 1/8" = 1'-0"
SPACE FOR:
THENELL LAW
PACIFIC PARKWAY CENTER
12909 SW 68TH PKWY.#290
PORTLAND,OR 97223