Permit (5) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
° COMMUNITY DEVELOPMENT Permit#: FPS2022-00010
Date Issued: 4/26/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126CC00200
Jurisdiction: Tigard
Site address: 10065 SW CASCADE AVE
Project: Tesla Subdivision: None Lot: None
Project Description: Fire alarm permit-replacing(4)fire devices located w/n riser room
Contractor: WATER METRICS CO WEST Owner: 10065 SWC LLC
16120 SW 72ND AVE BY ALSTON & BIRD LLP
PORTLAND, OR 97224 BANK OF AMERICA PLAZA
101 SOUTH TRYON ST STE 4000
CHARLOTTE, NC 28280
PHONE: 503-603-9988 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/31/2022 $177.52
12%State Surcharge-Building 01/31/2022 $21.30
Type of Use: COM Plan Review-Fire Life Safety-COM 01/31/2022 $71.01
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 01/31/2022 $0.50
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 $270.33
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
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 AR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Permittee Signature:
6/1-
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 OFFICE OFFI( l SIC MIA City of Tigard Rc ci�cJ '�22_a20/10
Ili 4 D/!3 �> e Permit N„
13125 SW I lall Blvd.,Tigard,OR 97223 JAN13 } 2 Date Itc:Plan Rcsiew 4/� (hhcrPennrt BuP�� S
• Phone: 503.7182439 Fax: 503.598.1960 Dateiiy;
i 11,n H I) Inspection Line: 503.639.4175 CiT OF11(+ARD Date Realyiliy; I LSO eit Jura I 0 tiro Pate 2(or
Internet: www.tigard-or.govBUILDN r+ r �r�I wIN Notil'rcJr\lcth Supplemental Information
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
❑New construction 0 Demolition Permit fees•arc based on the value of the work perfiunned.
Indicate the value(rounded to the nearest dollar)of all
y.Addition/alteration/replacement 0 Other: equipment.materials,labor.overhead.and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: S
❑ I-and 2-family dwelling Conuncrcial/industrial
0 Accessory building Multi-I:antilr Number of bedrooms:
Master builderNumber of bathrooms:
00 Other:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: IV V J- (I YV Cif,rel 1/f New dwelling area: square feet
City/State/ZIP: #1 ')V /, Ina_ ]- "t- 1L_-3 r , v Garage/carport area: square feet
Suite/bldg./apt.no.: V Project name: Covered porch area: square feet
Crosso street/directions to job site: SVICE/,{v((A Ayet-Ye 1- Deck area: square feet
SWy de 0(1I S Fe Y tc le-fad 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.
N Valuation: $ 1 16 r4*
615
Il vi u" vv 1 rn Existing building area: square feet
Ness'building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: -p(4 f 1 12 i WI I 0 Type of construction:
Address: I ft V (` (S 'w 1,re. Jh/,v Occupancy groups:
City/State/ZIP:7 Avd t 0 7,1,- Existing:
Phone:( ) 1 Fax:( ) New:
APPLICANT 0 CONTACT PERSON
NOTICE
Business name: Vv44'(`/ vo� N• (4). vve J J All contractors and subcontractors are required to be
Contact name: pii / w "}-}' €'- !err " v licensed with the Oregon Construction Contractors Board
c,^'V + ' under ORS 701 and may be required to be licensed in the .
Address: V lr V V/4 itilli/ jurisdiction in which work is being performed.If the
City/State/ZIP: Z applicant is exempt front licensing.the following reasons
apply:
Phone:(cm) 11F d • Qfw0,�b/,,,% fax:�:(�r�� 1
1=-mail:p �(, 1gH1 y I r U 'I► I L,f- W / Y
v-� CONTRACTOR BUILDING PERMIT FEES*
Businessname: L �/�/FJ (
(Please refer to fee schedule)
Y� 0-� Permit li:c:
Address:
1 U r fiL, State surcharge(12%of permit Ice):
CitylSlatr/1.IP: 7 G74 FI.S plan review(40%of permit fee):
Phone:(6173 ) V D; • 94 m his ( ) (Date upon application submittal)
CCB lie.: 124n a i; Total permit fees:
•J ei ides r Amount received:
Authorized signature: O
This permit application espires ifs permit is not obtained
Print name: Mfr.(K. lee e rn Ay? Date: JO.It. 14,7/� within 180 days after it h»s been accepted as complete.
�'4 (� • fee methodology set by Tri-County Building Industry
Service Board
I tnuildmg orrots`FPS-PmmitApp 03101641oc 440.4613T(I If02'CO5tWEBt
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:
❑ New system Number of sprinkler heads: Number of alarm devices:
111 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 0 6+devices: Plan review required and
(3) sets of plans. (3)sets of plans.
Additional description of work: rep 0 n1 l► fire j/]a 1,cz Jt,id I k n17 7.
Type of System (Complete A,B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ 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:
0 to 2,000 S198.75
2,001 to 3,600 S246.45
3,601 to 7,200 S310.05
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): $
PIS Plan Review(40%of permit fee): $
TOTAL: $
1:\1luiklin}1\Prrmits\Fly PermitApr 03101G.doc 2
RE EW D
City of Tigard Permit No.: FPS2022—WO/10
,111 • 13125 SW llall Blvd.,Tigard,OR 97223 JAN 13 M22 /( /2�
Phone: 503.718.2439 Fax: 503.598 1960 Date Received:
inspection Line 503 639.4175
TIGARD �t�� (II tlta�RD /1�TV OF
Internet: u .tigard-or BU!UiLCLCiNG DIMS;:,ii�la} (J 17 ti� �
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) CO
Project Name: to $ I�' Uf 1) e p fi Ye PZ Y I c� up i cy:
Job Address: I f 0 W C G1fC'GvV we Nail r U Y"Type of Construction: If i lc vtita1i n
Suite: 417i23 :Q� IS trlig $• yd
Contractor: Welk V 1 n t fy i CS CO. Wei L Phone: f03. led 3 • 9 Gf e
Number of Proposed or Altered Heads: DAM
Type: Hazard: Density:
1, fi1tyi&it �Q'f V net f) Oregon Construction Contractors Board No. J7''S.- 163
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: tip 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 co this document wit a copy of the sketch attached shall be available for all inspections.
Signature: 71)WAMQ— Date: 10 • I ' vU7/
l
Print Name: Tatiq.ael, M H Pft,r►i
I1Building1Fonns\FireSprinklerAtlidavit_071514.docx face I of 1