Permit (5) illii CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2021-00116
Date Issued: 11/1/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S1016601500
Jurisdiction: Tigard
Site address: 12236 SW GARDEN PL
Project: Chimcare Subdivision: CROW PARK 217 Lot: 3
Project Description: Fire sprinkler permit-relocate 10 sprinkler heads to accommodate remodel.AFFIDAVIT SUMITTED.
Contractor: FIRE SYSTEMS WEST INC Owner: BKM PARK BC 252 LLC
600 SE MARITIME AVE#300 BY SLK GLOBAL SOLUTIONS AMERICA
VANCOUVER, WA 98661 2727 LBJ FREEWAY STE 806
DALLAS, TX 75234
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/30/2021 $145.24
12%State Surcharge-Building 09/30/2021 $17.43
Type of Use: COM Plan Review-Fire Life Safety-COM 09/30/2021 $58.10
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 09/30/2021 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0.1 Design Area:
K Factor:
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $221.27
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $6,082.00
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 t forth in OAR 52-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: ^ Permittee Signature: (c( C Gripl C""75G�
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 Applicatio ECEIVED eia
Fire Protection System SEP 201 �7 FOR OFFICE: l SF ONI.I
City of Tigard Received
Date/By:4 [/0/ PemutNo.F0320?/-0//, 6
13125 SW Hall Blvd.,Tigard,OR 9722(�ITY OF TIGARD Plan Review
Phone: 503.718.2439 Fax: 503.59 /� ! ' Other Permit:
��DIIN DIVISION DateBy:
t l+13 Inspection Line: 503.639.4175 Date ReadyBy:(/�Ct y(�j� tsl/�,. See Page 2 for
Internet: www.tigard-or.gov Notified eth 4'� 47(�'t 1c Supplemental Information
❑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
work indicated on this application.
❑1-and 2-family dwelling ElCommercial/industrial Valuation: $
ElAccessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other. Number of bathrooms:
JOB SITE LNFORMATION AND LOCATION Total number of floors:
Job site address: 12236 SW GARDEN PL BLDG 1 New dwelling area: square feet
City/State/ZIP: TIAGARD OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:CHIMCARE TI Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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
work indicated on this application.
FSW TO RELOCATE HEADS TO ACCOMMODATE REMODEL Valuation: $ 6082.00
Existing building area: square feet
New building area: square feet
': Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
® APPLICANT 0 CONTACT PERSON
NOTICE
Business name: FIRE SYSTEMS WEST All contractors and subcontractors are required to be
Contact name: BRANDON WHITTAKER licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 600 SE MARITIME AVE STE 300 jurisdiction in which work is being performed.If the
City/State/ZIP: VANCOUVER WA 98661 applicant is exempt from licensing,the following reasons
apply:
Phone:(360 )693-9906 Fax: :( )
E-mail:BRANDONW@FIRESYSTEMSWEST.COM
CONTRACTOR BUILDING PERMIT FEES*
Business name:
FIRE SYSTEMS WEST (Please refer to fee schedule)
600 SE MARITIME AVE STE 300 Permit fee:
Address:
City/State/ZIP: VANCOUVER WA 98661 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(360 )773-6185 Fax:( ) (Due upon application submittal.)
CCB Iie.:49732 Total permit fees:
�„, �a Amount received:
Authorized signature: LG7.'6A, L(//i
This permit application expires if a permit is not obtained
Print name: BRANDON WHITTAKER Date:9/14/2021 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I]\Building\Permits\FPS-PermiiApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
Describe.rwork to:be-doner
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
0 New system, Number of sprinkler heads: Number of alarm devices:
Addition or !'"`' -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: r ) -rt, a E c c,04-r e- 5 F'j2/1.4C[-e'le J ZO 4 o 0A-r 6-
Type=.of;�, ste�►;(Complete�l,;B,.Cxor.D a$ appXieabie)
Aa1 �oxxlnne cis!Spr nkler
Sprinkler Type a Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ((No
Hazard Group /bq•!a-r
Density
• Design Area
K Factor tit"
Sprinkler Project Valuation: $ ( 08,� O 4
, ..: r;>. ,:... ...:.. .. ...... .c.a.-,.^..fr•. ..,:, ;[':x�::.�,::;i:S: .._..-• r: t:-,::_!..�_,,:�:vi,':°r:i;:'aw�t;<i?:. ¢'..,t:. ...;!r+i3g:_` }�;d:y'�>[
T _ ;yl�W hY:i<yC:::�- �;k.°;'dt_?:a�i�,.•:�•'t-�.. .. y`':,: _.;:�, "o ,.'%iY.::;:Yy:":'•::., _
Hood Project Valuation: $
,.h 4 Sc;:: .xi:, i�iri_ ':rt'•o=^a b:+'_ .r.?,. �-ri:i
,r. �iL+r'a; i.3 ,�,,,u:,�t.^•,r. .�_... ,v..,� .i-?c'= •-:c:^,-,4.,taM.;-iGx �rri:•.:�..
- ,_`ti.:. .1. .af• Vim' .1.. .`..�•'7'... ,.1.L��,:,:
:,.,.... ., )-.1., .. i.._r:•`".:•:,. _::•.+.!-^Y'^..,,�.: 4 ._ ,.::.: ;.:.:_'���vi Y7: '.i?,'}'- ::�:<'r�� .nC,:.q,.. •=l�ia�' x:?:_!,y.�:.i. �}'yx�e-•i .t',:
... -.,: :,_vro :•rr..4-a...,."•y:. .a,F....4:'h?:,::-..i.c.:�vv`<j�°:Y.-`<.-wa;....nK:.»_',y:�:''S^.....ii.�.,..t:, ,^ 1 ,���.,tta'�"�-.+.c �:h....3:... •,!•.t•}:_:",�',Y•+.•�:,,,<-''nf_:r'...:.<:s�
�. _ �. _:7,+;;'t�::�',. .'1{\.r ar'�.a,.J-:` �,s. '�"'��4i;iw. 'N:'f'?Y• .:1:�k`.•��**•• <'M��^,c. 4•.. .•a-.y.. .w zvr.
��p `}.<.:•�:' .x. i3:,, ':T-}-a,-.a:�; 1 .k'3+[.r :a. ,.l:V:+ree,v..
v. ...:•!!...t.._,i�—"[tj-- � .::_�'.a...:_.. .....*:=5.i.,.. :`i�x"_ ���:.'..'.,:r..._ ..., '.'N.'�..r •!,r`i 't, .:13:
.ti
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
:?eii�'id2Y,_. i-•3"�fa:' - +•Gi}:
.K':. e.),. :J:a;• ,!,,. .Ua r.y.:. -:l"";:=:J,.r1. - ' '= ,;.'i.`•' w:j'.a•r,- ,`q`+
_.y-.. k.�•c-:tx::,,3:ua�'
•
ti "' .W... r"�;'`r:`Y':';8..�.,li,',,.'sa•:r:;;�',•>cY.:;'1a a6;:;.. '�:ix;`.:<>_ tv�;+?:a,a ..'P„r'fs:Y>
,;, :Re i etitlal:S
a: .:�-:, '...,....T•�,-'-':-�:.- ::p.:.�.�rx�:-:,s':.-?x:.::.•.s:t:,K:r_..t•':rt....+.-r•.'+��� ,.:: .,..:�i..... � .. ::,^iw,>.'s - e�-:�''"'�:,�%,r�.���'.:�@a:,<S•,e.,Mzs a x.-v[<::?t�'�a�y�?',"';rtz"-",shy.','+.''` ...', t..c-, :,+,z x• _r" �c--!,ri+:,..::.
.1
Square Footage: Permit Fee: � e s, s'{�\y'c 1 {\ ��', ��rx� �><•��.�,� ;,k�n�.iM`•�`�:•�
0 to 2,000 $198.75
2,001 to 3,600 $246.45 '"
3,601 to 7,200 $310.05
:1.i% `r?;i_,-.: :rA^.:>..S','S:i�Sy..c�-"•.att�,F tj`.,,C'�i :.?»;ti,,a,.. Ti4'^'-0p-S'�'>
7,201 and greater $404.39 -';:;��•.a-. .�..5..';. ti =�i�.���.v:-.. ..,..<.z�....._,-...t:z-,='- .
Sprinkler Project Square Footage: sq.ft.
•
pxxa
Project valuation subtotal(see A,B&C above): $ [p 0,9d,, 0 0
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: $
I:\Building\Pe tnits\FPS PcnnkApp_031016.doc 2
RECEIVED
City of Tigard 1 2��� Permit No.: FPS2O2f-�OQ//�'�.
111 • 13125 SW Hall Blvd.,Tigard,OR 97223 SEP
s Phone: 503.718.2439 Fax: 503.598.1960 Date Received: �5/202/
' /'T�((,f
T I G A h l� Inspection Line: 503.639.4175 ,, Y OF TIGARD f+ 1j �
Internet: www.tigard-or.gov
11I*DING DIVISION By: r/fI •
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS err.
ICE-
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) «'V
Project Name: chimcare Occupancy: light
Job Address: 12236 sw garden pl bldg 1 Type of Construction: I I-B
Suite:
Contractor: FIRE SYSTEMS WEST Phone: 360-693-9906
Number of Proposed or Altered Heads: 10
Type: wet Hazard: light Density: •10
1 FIRE SYSTEMS WEST Oregon Construction Contractors Board No. 49732
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 ofNFPA 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 ofNFPA 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: oteeeotaF76?) Date: 9/21/21
Print Name: BRANDON WHITTAKER
I:\Building\Forms\FireSprinklerAtfidavit 071514.docx Page 1 of 1