Permit ,� CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
v
` COMMUNITY DEVELOPMENT Permit #: FPS2009-00091
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 10/27/2009
Parcel: 2S101 AC00400
Jurisdiction: Tigard
Site address: 7095 SW GONZAGA ST
Subdivision: NATIONAL SAFETY BUILDING Lot: 0
Project: National Safety Building
Project Description: Install fire sprinklers.
Owner: FEES
NATIONAL SAFETY COMPANY Description Date Amount
17010 SW WEIR RD
BEAVERTON, OR 97007 Permit Fee - COM 10/27/2009 $219.80
12% State Surcharge - Building 10/27/2009 $26.38
PHONE: Plan Review - Fire Life Safety - COM 10/27/2009 $87.92
Contractor:
VANPORT FIRE SPRINKLERS INC.
6101 NE 127TH AVE.
VANCOUVER, WA 98682
PHONE: 503 - 241 -2311
FAX:
Type of Use: COM
Class of Work: NEW Type of Const: VB
Occupancy Grp: B Height: ft
Stories: 2
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type:
Standpipe Required: No Hazard:
Density: .10 Design Area: 989
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 $334.10
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 23500
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 of er
applicable law wolf'" rk wifl-b done in accordance with approved plans. This permit will expire if work is not started within 18: days of
issuance r if work is suspend�fgr more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted •y the Oregon
Utility otification Center. Those rul - - se •rth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You ma obtain a opy of the rules
or d' ect questions to OUNC • ailing .03 '46.6.99 or 1.800.332.2344.
I sued By: Jr,
/ Permittee Signature: li,
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 REC FIVE: A ' eceived
FOR OFFICE USE ONLY
City of Tigard O C T �`� Date /B Permit No.: Fp�2 %A i, I
il l 13125 SW Hall Blvd., Tigard, OR 97223 V� 2��9 Plan Review Other Permit. �• .0 00
, Phone: 503.639.4171 Fax: 503.598.1960 CI Date /B • � ,t�\
Inspection Line: 503.639.4175 of /s l Date Ready /By: ® See Page 2 for
'TIGARD p B UILDING
'V Notified /Method , r � ' O 1 _ � . Supplemental Information
$.. .aa�: - ,.;'�'�z"�w`"•r':K.- a -��? °may - -' �.i�- - `a:a3;e, ^�r`„�,A a�4..�'., �^`�x":.� .a;�:s�?�,,;!�.s�: � rns�. �� '
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sr r- WORK i k > , ._:. ,.- - N •, REQUIR'EDrDATA' 1 AN - FAMILY DW =E, . .
9i A � ,�T,YPE =�OF��4'- � � �,��� -,�,. -mss �....a'� e,��:r„�¢k. v. ��.'
6'$�'*','.� �ri;R��r. ` �ssL ;�:.�,��✓,:�W } .x4 �• >..> a.�, ^.:x.m; ,:kx nx�- �3u au.:.., F�,.�x;n.t.:�.<t,�k +t= : z::,�±�;��x. .��.�a��.�tc�t�:. �tix�_:k
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
w
,,.;,. . ed ;r • .; ttt -.: : sit,y-.r�� -�,a_w> r"j s •rv7M work indicated on this application.
;w ;. a' ;, :Y 'v; " .: � 4 :.-, ,... C ArTEGORY %- rd .CONSTRUCT ION �= - A 7 Y OM.e/ Ii!). ,r�tx
': r:4`�'3`F.;:t'?E;'`i:` '- 7i=".s x; p°'' ii!.'°, F• j ,^: v;, �rc. T: kr�°; e�': � �i�= svFx 'i.:Y5.7ifit ?�g ,•1 r."+'v�`;',<. ; e,.�
`'�' Valuation: $
❑ 1- and 2- family dwelling€ommercial /industrial
Number of bedrooms:
❑ Accessory building ❑ Multi- family
❑ Master builder ❑ Other: Number of bathrooms:
- .t „, ..: . >- �_:�sr,P v. >x r:x Total number of floors:
r I � JOB,'3S1 4R RMA'FIOI. -AND LOCASI , tla
's nt s'F,..t�s..�.danraF_'� '.���i'sa�+s.- �a�':,�';, �ry +:r;.,:° vgk,rw -._vz �u3r.�,vant��'�C.;�.. ..= :�4Ea�".��r,.T.; .fir... w. s F ..mss -f.._
Job site address: New dwelling area: square feet
70 q c— S w G a N ZA (>---
City /State /Z1P: -t-- ,Y n Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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iteet RED<DATFA GOM1 IE VSE'GHEG�KL"`)(ST ,��
ki<. ts:: -;� •.:m.az:�r nd,, . -.. i�v �.•c ,.r...,e,• r- x, , ,ri;._i? . 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
41 Y'g - ^roc ; .» +.t :a;E�tt �.a oV ' tt-c +�'° °',: ^: r '� °Y, . 4 �. .... Ne ., � .; ' �;�1 ,k
#��_� { T I `�� yv�,u �, ,..:� ` ����',} work indicated on this application.
r*r `= -' ,ma .:;. t DESCRIP, _ O1V � OF.�,W,ORK. ` W - ` ,. i,.• ', .ttk h ;
.".�.'_asx - „�'� s Fr � �a�4"+3v'�iv�, ° N _�s.;a�l`x.. ,,:� nc.:t.'w Y'�P ���s ��'�- ��z.;+s,'�a. -� .+'Lu
Valuation: $ Z 3 ) f ,---
Tri `fir (-1..._ F.;`/ tc sr r n i ti I c Lye( S yf /�I
Existing building area: square feet
New building area: i 1 r t) square feet
t sr r:�vh ;a. z sr�r "Y 7r.•° w� $; Number of stories: ^ .
V f. RO ERy r OWNER ` . s ®TEN 0
s�.: �: e- u• g�. �a<;§ TM; r: ^' �i- ?�t:$t3'J�?�z�fi±��H; }� :�5� kh.R,� �.� - . ° w'A:•a `i�,,.: � - � � a �hF'�" �4s+: ' +� � 1
r Type of construction:
Name: iv-O % Z- - 5 %� / %C 1`�/ C-0 T--1- , (z/d -I`1(.
Address: 17 0 10 S p W elk," p V Occupancy groups:
City /State /ZIP: D E Z-. y tre -rzhw 0.1 G ? 0 -) 7 Existing:
Phone: ( 503) FY( 2-../t b Fax: ( ) New: l�
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P57-`;.414M, s � � - .. <,� w ,• �� ?'C`� d� ,i ce' � �'' .` �'
—
, ® PPLICA ? pry ' V e } ', .CONTACT ,PERSON r k .. ' = laCE t- � ` a
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Business name: S 0 0 N FA.--0 44 ic/ All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: under ORS 701 and may be required to be licensed in the
Address: ( jurisdiction in which work is being performed. if the
applicant is exempt from licensing, the following reasons
City /State /ZIP: apply:
Phone: ( ) Fax::( )
E -mail:
:. ., 5 . -,. „e'i° N= , ._ : :•; $ce^e - u: +xatwfa b:3ti -^' 3'sa.!W -°. �z a2;'. .' ., 9 a ,��y�tiao- °n - - - - _- 'Net >t , L
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.a 5.t = tCOIVTRACO �:, 4: =.t �� ti . t Sr r ;. BIII D Y .. k "�
4� " '�� ,� ,1A�.r: "( P lease ;rejer�toJeerscliedri
Business name: C/4)-/-'1 I^ 5'P" r- k- te-r1 1C_ Permit fee:
Address: G.(0 ( i n, (2- (L7 P1 40e. State surcharge (12% of permit fee):
City /State /ZIP: ra "t-C-A, tA, Pr 9 6 ° FLS plan review (40% of permit fee):
Phone: (s) ) z" ( L-3 ( I Fax: ( ) (Due upon application.)
CCB lie.: ( 7 1, C6 -�. k Total permit fees:
1 V4471
Amount received: g(.�. I 0
Authorized signature:
This permit application expires if a permit is not obtained
Date: — —0 within 180 days after it has been accepted as complete.
Print name:
a S.- I'I (1 * Fee methodology set by Tri- County Building Industry
Service Board.
1:\Building\ermits \ FPS-Permit App.doc 10/01/09 440- 4613T(I1 /02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
;Descnt e= .opal a done z , °., - - AA _ : . ,..n.; ~ -M4: : ", k 5 a ,,,,.. f :: 135,i ..ul
1.) El New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required. •
❑ Repair
Number of sprinkler heads:
Additional description of work:
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❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
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' �i '� tk9 ' e i i = '1 te r I,' ` t r ' r1a v t t
B) i,,,,, d F re S uppre s sio n S -0 '
Hood Project Valuation: $
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���'`��', . r�.. ��'�n• ,. .� i � ��� xM.3 .. �� � '� w � .n u`� � `w � z �•�;< qt,
'"= 'W '. 3 u " ;a ; t`. ,PV V ` "' i e: fit` >,' ,z . ^: „_ - - , s ;, :..«
r ;4 Flre w Alarm � � a , tr ' Pr 1 � F r t e k; z =a �
��'r -�p;�, kzi�` ^ ?§r..','tkt: *� ' fir'" z+ _�:`:xs�,dr.`.�':�£a�;�'��s �;..
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
s, " " a "sa' , . r ^ , i `, � , , _ .: rA a °''�65, t , . ? ° ' °:� - xi
.fr�`.` #'�� �'��� ���``r r�rF , ��,i
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+��,.� 3 - ;.
R'esidentia sSprinkler (StAn'da onelS. steirirW! ` 9
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�� tS;�'�1`��;a�M'? hx. � � °,..y.r, -z;�.w -
WORM :,1r' Z P, = rrY.
Square Footage: Permit Fee: , " '; R `: ,414":v ,
0 to 2,000 $198.75 r te
n a
2,001 to 3,600 $246.45,
3,601 to 7,200 $310.05 5.4k. .
fz
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
g:�+•.r 'A,75 eta '. ".'tr'^; „ $ ,7 aa
:a.+ .��:t ,. xsto-a� ^aek _ -
;
.n z� "�t� ri x zi�firw . v, `+�. ^ri �' "�
,. I t c' , y, v Fire Prgtection.Perm tr ;Fee, , , , O _ df:..�_ ,h t tr. ai `.,
a' �ri- � ,u,:�n,.r`�„!,a�.i;�ar..�.4 - _ �,`'�.5.,.,.�" *w,.._�. .� -..,. t,�,,,, -�n �"`� Y 1+""i x � &'r_Cu_ -fit
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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
1: \ Building \ Permits \Permit Forms 10 -01 -09 \FPS- PermitApp.doc 10/01/09 2
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FORE SPRONKEERS, IINCS
6101 NE 127TH Ave. Suite 200
Vancouver, WA. 98682
Phone (360) 256 -9838 Fax (360) 256.5886
www.te- vp.com
September 15, 2010
City of Tigard Building Department
13125 SW Hall Blvd.,
Tigard, OR. 97223
Phone (503) 639
Attn: Mark VanDomelen (markv@tigard -or.o )
Building Official of City of Tigard
RE: Willamette Dental @ 7105 SW Gonzaga Street, Tigard OR.
Project # 09CS -006
Testing and Flushing Underground Fire Line
Per NFPA 13 we tested and flushed 4" underground fire line into the above building
location see attach Contractor's Material and Test Certificate for Underground Piping.
During the flushing of the 4" underground fire line we did remove some rock in the line,
was witness by Tualatin Valley Water District and John Skourts (owner). We connect
the automatic fire sprinkler system to 4" underground fire line after test and flush was
complete. The work was done on April 2, 2ot.0: .
5- a saJ r Tv")
al ,„,,, / , 5 C ott 1.
Steve Wilson ,i ‘s 0 of -fs - /o •
Vanport Fire Sprinklers, Inc.
,Q,,,soG
Phone (36o) 256 -9838 FIL Fs
Email: ste\'ew a. tc- Vp.cOm pN 144.- W Ar4s1. Ax+ D
(NS ^fNbss L D Fwmc►i.r - '
IAA ✓%
•
Contractor's Material and Test Certificate for Underground Piping •
PROCEDURE •
Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's
representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job.
A oertificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and
contractor. it is understood the owners representative's 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 1, , 1;\ t e- � N 1 1 `Date 2
Property address O S' S i.A'O NZPcbt Pr , — kg-0 `DV-
Accepted by approving authorities {names)
Address
Plans ,�
Installation conforms to accepted plans �J Yes Li No
Equipment used is approved Yes f` No
1 If no, state deviations
Has person in charge of fire equipment been instructed as to location of i -t !-=� No
control valves and care and maintenance of this new equipment?
If no, explain
Instructions Have copies of appropriate instructions and care and maintenance IYes El No
charts been left on premises?
If no, explain
Location Supplies buildings
Pipe types and class i Type joint O t / r _
�� G�rss s2 l —
Pipe conforms to A1 /3 standard Yes EJ No
Underground I Fittings conform to _,L/.3__ standard -W/as No
pipes and joints ! It no, explain
Joints needed anchorage clamped, strapped, or brooked in -es L, No
accordance with NrP4 13 standard
If no, explain
Flushing; Flow the required rate until water is clear as indicated by no collection of foreign material in burlap bags at
outlets such as hydrants and blow -offs. f=lush at flows not less than 390 gpm (1476 Umin) for 4 -in. pipe, 880 gpm (3331
Umin) for 6 -in. pipe, 1560 gpm (5905 Umin) for B -in. pipe, 2440 gpm (9235 Umin) for 10 -in. pipe, and 3520 gpm (13,323
Umin) for 12 -in. pipe. When supply cannot produce stipulated flow rates, obtain maximum available.
Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.8 bar) for 2 hours or 50 psi (2.4 bar) above
Test i static pressure In excess of 150 psi (10.3 bar) for 2 hours.
description i Leakage: New pipe laid with rubber gasketed joints shall, if the workmanship is satisfactory, have little or no leakage at
• the joints. The amount of leakage at the joints shall not exceed 2 quarts per hour (1.89 Uhr) per 100 joints irrespective
t of pipe diameter. The leakage shall be distributed over all joints. If such leakage occurs at a few joints, the installation
shall be considered unsatisfactory and necessary repairs made. The amount of allowable leakage specified above can
be increased by 1 fluid ounce per inch valve diameter per hr. (30 mL/25 mm/hr) for each metal seated valve isolating the
test section. If dry barrel hydrants are tested with the main valve open so the hydrants are under pressure, an additional
5 ounces per minute (150 mt./min) leakage is permitted tor each hydrant.
! New underground piping flushed according to j/Yes C No
1 Ai FP4. % 3 standard by (company)
If no, explain
i Howilushing flow was obtained Through what type opening
Flushing Public water t7 Tank or reservoir 17.7.1 Fire pump ; L; Hydrant butt n Open pipe
tests --- - _
Lead -ins flushed according to ...._./ —l_. standard by (company) L; No
If no, explain
I HovyAtushing flow was obtained ! Through what type openi
water r- t Tank or reservoir Fire pump ` 0 Y connection to flange _I 't pen pipe
and spigot
Reprinted with permission from NFPA 13, Installation of Sprinkler Systems, Copyright@ 2002, National Fire Protection Association, Quincy, MA 02269.This reprinted material
la not the complete and official postion of the National Fire Protection Association, on the referenced subject which Is represented only by the standard In its entirety.
American Fire Sprinkler Association AFSA Form #AF064
9896 Skillman Street. Suite 300, Dallas, Texas 75243
•
All new underground piping hydrostatically tested at Joints covered
Hydrostatic
test ZOO . psi for ._..._ 7! .._ hours Yes rNo
Total amount of leakage measured
Leakage — gallons hours
test r
Allowable leakage
gallons — .. - hours
jJ bit Number installed 4 Type and make 1 All operate satisfactorily
Hydrants Q Yes (. ] No
Water control valves left wide open Yes [) No
Control If no, state reason
valves
Hose threads of fire department connections and hydrants interchangeable with L Yes IT No
those of lire department answering alarm
Date left in service 4 / / / O
Remarks
Name of installing contractor
SAN porl ru Sp ��,�!� -(mss
•
Signatures _.._ Tests witnessed by
For property owner (signed) Title Date
For install cont ctor (signs Title Date
Additional explanation and notes
Contractor's Material and Test Certificate for Underground Piping