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Permit (211) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT COMMUNITY DEVELOPMENT Permit#: FPS2016 00207 13125 SW Hall Blvd.,Ti Date Issued: 12/12/2016 T[ a1 1. and OR 97223 503.718.2439 9 Parcel: 1S136DD05300 Jurisdiction: Tigard Site address: 11850 SW 67TH AVE, STE#150 Project: American Family Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 9 Project Description: Fire alarm-Adding(3)notification devices and relocating(2)devices. Contractor: POINT MONITOR CORPORATION Owner: PNWP LLC#2 5863 LAKEVIEW BLVD STE 100 PNWP LLC LAKE OSWEGO, OR 97035 6600 SW 105TH AVE#175 BEAVERTON, OR 97008 PHONE: 503-627-0100 PHONE: FAX: 503-627-0110 FEES Description Date Amount Specifics: Permit Fee-COM 12/09/2016 $102.20 12%State Surcharge-Building 12/09/2016 $12.26 Type of Use: COM Plan Review-Fire Life Safety-COM 12/09/2016 $40.88 Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 12/09/2016 $3.00 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: Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $158.34 Valuations: Required Items and Reports(Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $2,500.00 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 or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: i/ 11.0 . Permittee Signature: Ata, .t, , • C.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. Buildin Permit A ' ' EivEl) Fire Protection SysteFOR O1.1r1(L t.SI O\L1 Cl of Tigard ,Aq�� (�q Received /�,.. `, g ga d.) 7 2 U I Date B : /Z©. / Permit No.: YJ�j��'�d aO/ iii . 13125 SW Hall Blvd.,Tigard, 7 6 _ Daten Review Q `� 06027 Phone: 503.718.2439 Fax: 503.598.1960 Date'B : Other Permit: At( T t< n is I) Inspection Line: 503.639.41TV OF I ,i Date Read;By: Jwris: ® See Page 2 for Internet: www.tigard-or.go 11 13t1► Notified/Method: Supplemental Information BUILDING DIVISION TYPE OF WORK -REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑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. ID1-and 2-family dwelling ®Commercial/industrial Valuation: $ IDAccessory building ❑Multi-family Number of bedrooms: ElMaster builder 0 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address:11850 SW 67th Ave. New dwelling area: square feet City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet Suite/bldg./apt.no.: Project name:American Family Insurance 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. Fire alarm notification devices Valuation: $$2,500.00 Existing building area: square feet New building area: square feet I] PROPERTY OWNER ta TENANT` Number of stories: Name:American Family Insurance Type of construction: Address:11850 SW 67th Ave. Occupancy groups: City/State/ZIP:Tigard,OR 97224 Existing: Phone:( ) Fax:( ) New: I APPLICANT 0 CONTACT PERSON NOTICE Business name:Point Monitor Corp. All contractors and subcontractors are required to be Contact name:Brooke Williams licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address:5863 Lakeview Blvd#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:bwilliams(a`pointmonitor.com CONTRACTOR BUILDING PERMIT FEES* Business name:Same as above (Please rojertofee schedule) Permit fee: Address: State surcharge(12%of permit fee): City/State/ZIP: Phone:( ) Fax: FLS plan review(40%of permit fee): ( ) (Due upon application submittal.) CCB lic.:135901 Total permit fees: Authorized signature: ° 2r.' Amount received: /5. 3� This permit application expires if a permit is not obtained Print name:Ben Breit Date:12/7/16 within 180 days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board. 1.Building Permits FPS-PermitApp 031016.dor 440.46131(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: O New system Number of sprinkler heads: Number of alarm devices: ® Addition or 0 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 0 11+ heads: Plan review required and 0 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 0 Wet 0 Dry Additional Standpipes Information: Sprinkler Supply Line 0 Yes 0 No Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B.) Type I Hood Fire Suppression System Hood Project Valuation: C.) Fire Mann 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: $ (:.\Users\bw•ilJams\i)csktop \fire permit-city of til,,ard.doc 2 ,� City of Tigard 1 '/ C0 RKEIVEP Permit No.: 5 7 13125 SW Hall Blvd.,Tigard,OR Phone: 503.718.2439 Fax: 503.598.1960 Date Received: /R-/1 lI 4' Inspection Line: 503.639.4175 t I 2016:',;.\i‘ Internet: www.tigard-or.gov DEL By: (/�. akee t,_l h '!CARD FIRE ALA►R11YIL `IR i , . E ,AAVIT FOR ALTERATIONS BivOR TENANT IMPROVEMENTS (MAXIMUM OF 5 DEVICES WITHOUT PLANS) Project Name: American Family Insurance Occupancy: Same Job Address: 11850 SW 67th Ave.,Tigard 97224 Suite: Contractor: Point Monitor Corp. Phone: 503-627-0100 Valuation of work: $2,500 Type of System: (check one) DRequired q •QNon-required (check one) ■•Automatic DManual •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(max 5) Number of Proposed Notification Appliances: To be Added(max 5) 13 /To be Relocated 0.5)A. I, Ben Breit 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. Signature: Date: 12/7/16 Print Name: Ben Breit 1:1Building\FormslFireAlarmAffidavit_071514.docx Page 1 of 1