Permit (3) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2023-00107
T f GA RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/7/2023
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 110
Project: Gary Law Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Fire sprinkler permit for Ti:Removing(2)heads and relocating(1)head.Affidavit submitted.
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES L P
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 09/07/2023 $56.47
12%State Surcharge-Building 09/07/2023 $6.78
Type of Use: COM Plan Review-Fire Life Safety-COM 09/07/2023 $22.59
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 09/07/2023 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $86.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $695.00
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: .f/] Oefilt Permutes 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 RECEIVED FOR OFFICE USE ONLY
City of Tigard Received
C� 2023 Date/By: r��„��I u�
• 13125SWHallBlvd.,Tigard,OR 972a1;.,:1 U Q IQ �� riSlA�� �flllr
Plan Review C. �V v
rri
Phone: 503.718.2439 Fax: 503.598.1960 Date By: V Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: /1 II r,i �'�r saris RI See Page 2 for
Internet: www.tigard-or.gov p I,, G Notified/Method: l•� I�IU/''fx`J
BUILUNG DIVISIONSupplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 0 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.
❑ I-and 2-family dwelling 0Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑ Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:12909 SW 68th Pkwy New dwelling area: square feet
City/State/ZIP:Tigard OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:110 Project name:Gary Law TI 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.
Plug 2 fire sprinkler heads and relo 1 for TI Valuation: $695
Main permit number BUP2023-00135 Existing building area: square feet
New building area: square feet
III PROPERTY OWNER 0 TENANT Number of stories:
Name:PACIFIC REALTY ASSOCIATES L P Type of construction:VB
Address:15350 SE SEQUOIA PKIATY#300 Occupancy groups:B
City/State/ZIP:PORTLAND, OR 97224 Existing:
Phone:( )503 624 6300 Fax: ( )
New:
Iii APPLICANT ❑ 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:
Phone:( )503.684.2928 Fax: :( )503.684.9657
E-mail:m.distifeno@wyattfire.corn
CONTRACTOR BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection (Please refer tefee schedule
Address:9095 SW Burnham Permit fee:
City/State/ZIP:Tigard, OR 97223 State surcharge(12%of permit fee):
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:
Authorized signature: -r ---- Amount received:
..,-.= ' This permit application expires if a permit is not obtained
Print name:Michael Distifeno Date:9/6/2023 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:,BuildinglPermitsTFPS-PermltApp_031016.doc 440-4613T(I I/02/COMIWEB)
11111 City of Tigard Permit No.: /PV1,013.06 161
13125 SW Hall Blvd.,Tigard,OR 97223 q
Phone: 503.718.2439 Fax; 503.598.1960 Date Received: I le 0,6 i/3
Inspection Line: 503.639.4175 .y1 _
11 G A a I) Internet: www.tigard-or.gov By: I` , ,� /i - (_ L, _/� f ICI
VI Vlti/ l.(A,JI of_1
FIRE SPRINKLER AFFIDAVIT FOR ALTERATEI`V�E®
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) SEP 6 2023
CITY OF TIGARD
BUILDING DIVISION
Project Name: Michael Distifeno Occupancy: B
Job Address: 12909 SW 68th Pkwy Tigard OR 97223 Type of Construction: VB
Suite: #110
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: 3 ,
Type: SSP-QR Hazard: Light Density: 0.1
I Wyatt Fire Protection Oregon Construction Contractors Board No. 64077
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits, beams,partitions, walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop (exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads(see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
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.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature: Date: 9/6/2023
Print Name: Michael Distifeno
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