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HomeMy WebLinkAboutPermit (4) Building Permit Application Fire Protection System FOR OFFICE USE ONLY it City of Tigard Received %�� '� DateB _ III 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review / rilIPIEVERIMIE 2` Phone: 503.718.2439 Fax: 503.598.1960 Date/8 : I�—.G ' L T[C;A R Lt Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for Internet: www.tigard-or.gov - " Notified/Method: Supplemental Information 6 TYPE OF 'WO 1i ' ' ,,r,1 'q : "" ,,, �I 1 ar y l iY'LF.R ., bATA: r�D 2)LtAM -DWEI.1,IN -,All 0 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 0 equipment,materials,labor,overhead,and the profit for the ''' ' CATE-6dAY 3T COI+i TkUCTJ844 : ,1 work indicated on this application. El1-and 2-family dwelling Commercial/industrial Valuation: $ El Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: 5-1ai J R �� Total number of floors: '`'rI , � T 1" ,, ll R TIUN Al D 111LF( I 't Job site address: 1' "tj l ' ) --)t , -V mo, j4+ 4. New dwelling area: square feet City/State/ZIP: . V(,s „ % 0(2-- "`j -I j- Garage/carport area: square feet Suite/bldg./apt.no.: Project name: 1(1 1 Qg)` Covered porch area: square feet Cross street/directions to job site: �`,?�J/�• Deck area: square feet GL. \I; TJ U_ is,�` -,e., + Other structure area: square feet REQUIRED D T'A:cOMMERcIAL- SE CH C I 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 i i D SC ,'TION Ilk' WORK'i 4 i '; work indicated on this application. C\G A. 0( . l...ck.A • 0C-C.jA.�Q� Valuation: $ 1 21 12 i 0° �z, c- 4,� „o„vo 1. Existing building area: square feet r4?A.) I �G�Q Q(1�( L(�UL1L9 New building area: square feet ❑ 'if OPl R"TY WNER „ � ' _ i' „ Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone:( ) Fax:( ) New: i'� ,i� 0 A3' L1A �(E ,'NT inn, CONTACT" R ON y FI' ! re ,- i' NOTYCR Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed.If the City/State/ZIP: applicant is exempt from licensing,the following reasons apply: Phone:( ) Fax: :( ) E-mail: Business name: " � / ,c iif,',01'easerefertofe schedule �� � �. Permit fee: Address: (o 3 t7 '�.i9 A, , � If I State surcharge(12%of permit fee): City/State/ZIP: J_J (')�� , � 0 a Qt-7 0 3 FLS plan review(40%of permit fee): Phone: 3 (o 21 .a ©\O D Fax:(533 i I 0 —0.21-7_ (Due upon application submittal.) CCB lie.: I ',?J 15 9© 1 Total permit fees: Amount received: Authorized signature: ; This permit application expires if a permit is not obtained Print name: 0_,,, . -V I i7✓�./ Date: (,! I_1 j')Co i C 2,3 within 18ii days after it has been accepted as complete. � * Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(1 1/02/COM/WEB) CityTi of Tigard Permit No.: 5 74 a 13125 SW Hall Blvd.,Tigard,OR 97223 I - Phone: 503.718.2439 Fax: 503.598.1960 Date Received: Inspection Line: 503.639.4175 ,,/ TIGARD Internet: www.tigard-or.gov By: z FIRE ALARM S''VSTEM AFFIDAVIT FOR ALTERATIONS OR TENANT IMPROVEMENTS (MAXIMUM OF 5 DEVICES WITHOUT PLANS) Project Name: Cake Hoopla Occupancy: Job Address: 7173 SW Dartmouth St. Tigard, OR 97223 Suite: Contractor: Point Monitor Corporation Phone: 503-627-0100 Valuation of work: $4,212.60 Type of System: (check one) ❑�Required nNon-required (check one) ❑Automatic [Manual ■❑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) 4 /To be Relocated(max 5) I, Cindy Szklarz 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: 06/15/2023 Print Name: Cindy Szklarz I:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1