Permit (5) q CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
' ' COMMUNITY DEVELOPMENT Permit#: FPS2023-00109
TIGARD 13125 SW Hat Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9l27/2023
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 350
Project: RiskPoint Subdivision: Lot: 2
Project Description: Fire alarm permit: Modifying fire alarm circuit,(2)new strobes,and(4)horn strobes.
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 09/27/2023 $123.72
12%State Surcharge-Building 09/27/2023 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 09/25/2023 $49.49
Class of Work: ALT Type of Const: IIB Info Process/Archiving-Sm$0.50(up to 09/27/2023 $5.50
Occupancy Grp: B Height: 25 ft 11x17)
Stories: 1 Hourly Building Rate 09/27/2023 $180.00
Hourly Building 12%State Surcharge 09/27/2023 $21.60
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: Automatic
Pull Station Required: Yes Smoke Detectors Req: Yes
Battery Gales Provided: Yes Cut Sheets Required: Yes
Total $395.16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,302.40
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:
70-
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 SWof Tigard i) 3 Permit No.:
�CEIVED Date/Sy: Ci y J �`'�-
14 � 13125 Hall Blvd.,Tigard,OR Plan Review
I. Phone: 503.718.2439 Fax: 503.5 Date/By: Other Permit. fh.l
T I(i,1 K 17 Inspection Line: 503.639.4175 Date Ready/By: June: 12rSee rag e 2 for
Internet: www.tigard-or.gov SEP 1 3 2023 Notified/Method: /i- 13 c. Supplemental Information
TYPE OF v4OIE#OF TIGARD REQUIRED DATA:1-AND 2-FAMILY DWELLING _
E 1 LDING DIVt3ION Permit fees*are based on the value of the work performed.
El New construction emo rtlon
Indicate the value(rounded to the nearest dollar)of all
❑✓ Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
: CATEGORY OF CONSTRUCTION work indicated on this application.
ID1-and 2-family dwelling ✓❑Commercial/industrial Valuation: $
IDAccessory building ID Multi-familyNumber of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 15350 SW Sequoia Parkway #350 New dwelling area: square feet
City/State/ZIP: Portland, OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: RiskPoint - pcc241-350 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.
Modify fire alarm notification circuit as req per NFPA72 for new floor plan. Valuation: $ 4302.40
New equipment includes (2)strobes and(4) horn strobes. Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
APPLICANT [31 CONTACT PERSON NOTICE
Business name: Point Monitor Corporation All contractors and subcontractors are required to be
Contact name: Hannah Jensen licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 5863 Lakeview Blvd, Suite 100 jurisdiction in which work is being performed.If the
City/State/ZIP: Lake Oswego, OR 97035 applicant is exempt from licensing,the following reasons
apply:
Phone:(503 ) 627.0100 Fax: :( )
E-mail: hjensen@pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: Point Monitor Corporation (Please refer to fee schedule)
Permit fee:
Address: 5863 Lakeview Blvd, Suite 100 State surcharge(12%of permit fee):
City/State/ZIP: Lake Oswego, OR 97035 FLS plan review(40%of permit fee):
Phone:(503 ) 627.01 00 Fax:( ) (Due upon application submittal.)
CCB lic.: 135901 Total permit fees:
Authorized signature: r 1 Amount received:
l } This permit application expires if a permit is not obtained
Print name: Hannah Jensen Date: 09/12/2023 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\PPS-PermitApp0031016.doc 440-4613T(1 I/02/COM/WBB)
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:
El New system Number of sprinkler heads: JI 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:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line Cl 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: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
MI 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: $
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