Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
>: • COMMUNITY DEVELOPMENT Permit #: FPS2010 -00049
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2010
Parcel: 2S101 BC00900
Jurisdiction: Tigard
Site address: 12291 SW KNOLL DR
Subdivision: Lot: 0
Project: The Knoll at Tigard
Project Description: Fire sprinkler system for new 48 -unit apartment building.
Owner: FEES
THE KNOLL AT TIGARD Description Date Amount
PO BOX 23206
TIGARD, OR 97281 -3206 Permit Fee - MF 05/04/2010 $653.40
12% State Surcharge - Building 05/04/2010 $78.41
PHONE: 503 - 293 -4038 Plan Review - Fire Life Safety - MF 05/04/2010 $261.36
Contractor:
WESTERN STATES FIRE PROTECTION
13896 FIR ST STE B
OREGON CITY, OR 97045
PHONE: 503 - 657 -5155
FAX: 503 - 657 -5182
Type of Use: COM
Class of Work: NEW Type of Const: VB
Occupancy Grp: R -2 Height: ft
Stories: 4
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Yes Hazard: LT
Density: .10 Design Area: 1067
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $993.17
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 71000
Residential Square Footage: 0
Fire Alarm Valuation: 0
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 -0100. You may obtain a copy of the rules
or direct questions to O by calling 503.246.6699 or 1.8 . 0
Issued By: j Perm ittee Signature: L r l
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Foli OFFICE USE ONLY
City of Tigard RECEIVE', Received Date/B % r ��
I' 4 Permit No.: �iPSPp /�
RECEIVE 7
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ►
li
II Phone: 503.639.4171 Fax: 503.598.1960 Date /B : �` ailW 44 Other Permit:
TI G n R u Inspection Line: 503.639.4175 MAY 4 2010 Date Ready /By: 6f1 See Page 2 for
Internet: www.tigard or.gov Notified/Method: 0 1 INMEM Supplemental Information
CITY OF TIGARD w a w e e f
TYPE OF woIUILDING DIVISION REQUIRED DATA: 1- AND 2- FAMILY DWELLING
IN 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.
❑ 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $
❑ Accessory building ® Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 8485 SW Hunziker i' ( �� {�(Z New dwelling area: square feet
City/State/ZIP: Tigard, OR Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: The Knoll Apartments 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.
New NFPA 13 Wet and Dry Systems for new 4 -story apartment building. Valuation: $$71,000.00
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 ❑ CONTACT PERSON NOTICE
Business name: Western States Fire Protection All contractors and subcontractors are required to be
Contact name: Jared Hill licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 13896 Fir St. Suite B jurisdiction in which work is being performed. If the
City/ State/ZIP: Oregon City, OR 97045 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 657 -5155 Fax: : (503) 657 -5182
E -mail: Jared.Hill @wsfp.us
CONTRACTOR BUILDING PERMIT FEES*
Business name:
14IDC F (Please refer to fix ae t0 4 i° Permit fee: 14S3,
Address:
City/State /ZIP: State surcharge (12% of permit fee): 761, Y/
FLS plan review (40% ofpermit fee): /
Phone: ( ) Fax: ( ) (Due upon application.) "..0 , 3�0
CCB lic.: 104570 Total permit fees: 9 3 / 7
Authorized signature: / �
7/ Amount received: 19 . F 7
J ` This permit application expires if a permit is not obtained
Print name: Jared Hill Date: 5/4/10 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits \FPS- PermitApp.doc 10 /01/09 440- 4613T(11/02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ® New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration /A 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 778
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
® Wet ® Dry
Additional Standpipes
Information: Hazard Group Light
Density 0.10
Design Area Varies
K. Factor Varies
Sprinkler Project Valuation: $ 71,000
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: 1 $
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 $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): $ 71000
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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
http : / /www.tigard- or.gov /city_hall /departments /cd /docs /FPS - PermitApp.doc 10 /O1 /T
CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR A BOVEGROUND PIPING
PROCEDURE
Upon completion of work, inspection and tests shall be made by the contractors representative and witnessed by an owner's representative. All defects shall be corrected and system left in servic
before contractor's personnel finally leave the job.
A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative'
signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances.
PROPERTY NAME Date
PROPERTY ADDRESS •
122q „I' L J knee i L --- !Z_
ACCEPTED BY APPROVING AUTHORITY('S) NAMES
ADDRESS
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ® YES ❑ NO
EQUIPMENT USED IS APPROVED ® YES ❑ NO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ® YES ❑ NO
OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES:
1. SYSTEM COMPONENTS INSTRUCTIONS ® YES ❑ NO
2. CARE AND MAINTENANCE INSTRUCTIONS ® YES ❑ NO
3. NFPA 13A ® YES ❑ NO
LOCATION SUPPLIES BUILDING:
OF SYSTEM
YEAR OF ORIFICE TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QUANTITY RATING
%fie rttR 201 t' %z o` 21
SPRINKLERS
PIPE AND Type of Pipe: 5 CCc t —5t''( —564 (((? ° S VI e c (
FITTINGS Type of Fittings: jafthasirsiu ocitee/ — Cc-5 t—
MAXIMUM TIME TO OPERATE
ALARM DEVICE THRU TEST CONNECTION
ALARM VALVE TYPE MAKE MODEL MIN. SEC.
OR FLOW INDICATOR (J r� ' lo 5 s drr.. 4e,.svr S K)
DRY VALVE Q.O.D.
nn MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
Reieoble 0 676/5
/5
TIME TO TRIP TRIP POINT TIME WATER ALARM
THRU TEST WATER PRESSURE AIR PRESSURE AIR REACHED OPERATED
CONNECTION' PRESSURE TEST OUTLET' PROPERLY
DRY PIPE MIN. I SEC. PSI PSI PSI MIN. SEC. YES NO
OPERATING Without � ^ i •y 1 b i l b Pal ❑
TEST Q.O.D. q / aL °! h
�.D ❑ ❑
IF NO, EXPLAIN:
*MEASURED FROM TIME INSPECTOR'S TEST CONNECTION OPENED. (OVER)
•
• OPERATION
❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC
PIPING SUPERVISED ❑ YES ❑ NO I DETECTING MEDIA SUPERVISED ❑ YES ❑ NO
DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE CONTROL STATIONS ❑ YES ❑ NO
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO, EXPLAIN
DELUGE &
PREACTION ❑ YES ❑ NO
VALVES
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE VALVE MAXIMUM TIME TO
MAKE MODEL SUPERVISION LOSS ALARM? RELEASE? OPERATE RELEASE
YES NO YES NO MIN. SEC.
❑ ❑ ❑ ❑
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static pressure In excess of 150 psi (10.2 bars) for two hours.
TEST Differential dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped.
DESCRIPTION
PNEUMATIC: Establish 40 psi (27 bars) air pressure and measure drop which shall not exceed 1 -12 psi (0.1 bars) in 24 hours. Test pressure tanks at normal water level and air pressure and
measure air pressure drop which shall not exceed 1-1/2 psi (0.1 bars) in 24 hours.
ALL PIPING PNEUMATICALLY TESTED AT- 4Q PSI FOR _24_ HRS. IF NO, STATE REASON:
DRY PIPING PNEUMATICALLY TESTED ❑ YES ❑ NO
EQUIPMENT OPERATES PROPERLY ❑ YES ❑ NO
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR 1
OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS?
TESTS ®'YES ❑ NO
DRAIN I READING OF GAGE LOCATED NEAR WATER SUPPLY TEST RESIDUAL PRESSURE WITH VALVE IN TEST 1
TEST CONNECTION: PSI CONNECTION OPEN WIDE PSI
UNDERGROUND MAIN AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING
OTHER EXPLAIN
VERIFIED BY COPY OF THE U FORM NO. 85B IVES ❑ NO
FLUSHED BY INSTALLER OF UNDER-
GROUND SPRINKLER PIPING pi/ES ❑ NO
BLANK NUMBER USED LOCATIONS: NUMBER REMOVED
TESTING /T1
GASKETS (/
WELDED PIPING ® YES ❑ NO 1
IF YES...
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? ® YES ❑ NO
•
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN I
WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? ® YES ❑ NO
DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED
QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS
IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT
THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? ® YES ❑ NO
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
(DISCS) CUTOUTS (DISCS) ARE RETRIEVED? ® YES ❑ NO
HYDRAULIC NAME PLATE PROVIDED IF NO, EXPLAIN:
DATA
NAMEPLATE ® YES ❑ NO
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
REMARKS
NAME OF SPRINKLER CONTRACTOR 4 Western States Fire Protection Company
TESTS WITNESSED BY
FOR PROPS OWNER (SIGNED) TITLE DATE
SIGNATURES I I
FOR SP LER CONTRACTOR (SIGNED) TITLE DATE
FOR 6 FIRE MARSHAL (SI r' TITLE DATE •
1 j !. , ./ �/n � i / '.i r,� �S„' " � r f /I ,..T - l/
FO YE / i �' S TITLE 11 /),�J6>f,r �/Z 1 D f A-/r
ADDITIONAL EXPLANATION AND NOTES (BACK)