Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11
'PII COMMUNITY DEVELOPMENT Permit#: FPS2023-00083
Date Issued: 7/19/2023
T f G A R T.) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S113AB01201
Jurisdiction: Tigard
Site address: 16250 SW UPPER BOONES FERRY RD
Project: NW Regenerative Subdivision: None Lot: None
Project Description: Fire sprinkler:Adding(3),relocating(14),and plugging(1)sprinkler head for TI.
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 07/18/2023 $102.20
12%State Surcharge-Building 07/18/2023 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 07/18/2023 $40.88
Class of Work: ALT Type of Const: VA Info Process/Archiving-Sm$0.50(up to 07/18/2023 $7.00
Occupancy Grp: B Height: 25 ft 11x17)
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: 0.1 Design Area: 1500
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 $162.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,791.00
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 copy of the rules
Issued By: ///72:-tr—e_ 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 RECEIVE �" /�-q FOyRn�OFFICE USE ONLYy�/� r� /�Q
City of Tigard Date/B: b IiSI KJ ,3' r, 1ii.1'O05O3
y Permit No.:
r 13125 SW Hall Blvd.,Tigard,OR 97223 Pan Review
11 Phone: 503.718.2439 Fax: 503.598.1960 JUN 1 5 2023 Date/By: ) Other Permit:
'TIGARD Inspection Line: 503.639.4175 Date Ready/By: Jwis: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: k 13 a3 I Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
O 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 CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling ❑i Commercial/industrial
ElAccessory building ❑Multi-family Number of bedrooms:
['Master builder ['Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:16250 SW Upper Boones Ferry Rd New dwelling area: square feet
City/State/ZIP:Portand OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:NW Regenerative 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 relo fire safety heads for tenant improvement Valuation: $2791
Existing building area: 4090 square feet
New building area: 4090 square feet
II PROPERTY OWNER 0 TENANT Number of stories:1
Name:Pactrust Type of construction:VB
Address:15350 SW Sequoia Pkw#300 Occupancy groups:B
City/State/ZIP:Portland OR 97224 Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Michael Distifeno 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:
y:
Phone:( )503.684.2928 Fax::( )503.684.9657
E-mail:m.distifeno@wyattfire.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection (Please refer tafee schedule,
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 upon application submittal.)
CCB lie.:64077 Total permit fees:
Amount received:
Authorized signature:
y j This permit application expires if a permit is not obtained
Print name:Michael Distifeno Date:6/15/2023 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I.,nulding\Perinits'FPS-PermitApp_031016.doc 440-4613T(I 1/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:Add and relo heads for TI
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 18 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: Plugging one head, 14 relos, 3 new
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 i( 4
Density _ I •
Design Area ✓
K. Factor 5.-;
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: $
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