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Permit
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT z 2 ' COMMUNITY DEVELOPMENT Permit #: FPS2010 -00171 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/09/2011 Parcel: 1S 135CA90125 Jurisdiction: Tigard Site address: 11046 SW GREENBURG RD 125 Project: Ash Creek Condominiums Subdivision: ASH CREEK CONDOMINIUMS Lot: 0 Project Description: Fire sprinkler system in building addressed as 11046 & 11048 SW Greenburg Rd Contractor: WESTERN STATES FIRE PROTECTION Owner: PHIL- ALEXANDER, LORRAINE 13896 FIR ST STE B 11046 SW GREENBURG RD #125 OREGON CITY, OR 97045 TIGARD, OR 97223 PHONE: 503 - 657 -5155 PHONE: FAX: 503 -657 -5182 FEES Description Date Amount Specifics: Permit Fee - MF 02/09/2011 $395.34 12% State Surcharge - Building 02/09/2011 $47.44 Type of Use: ME Plan Review - Fire Life Safety - MF 12/29/2010 $158.14 Class of Work: ALT Type of Const: VB Occupancy Grp: R -2 Height: ft Stories: 3 Commercial Sprinkler System: Sprinkler Required: Yes Sprinkler Type: Wet Standpipe Required: No Hazard: Density: 0 Design Area: 0 K Factor: 4.3 Commercial Fire Alarm System: Fire Alarm Required: Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $600.92 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $31,600.00 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, o if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility tification - • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or dir ct questions to OU by ing 503.232.1987 or 1.800.332.2344. /� Iss d By: e / / / ■ Permittee Si. ature: \ ) _ // 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 FOR OFFICE USE ONLY Received a .� _stn % City of Tigard Date /B : �' �7 PermitNo.:,i /a¢w—w�'7 III • 13125 SW Hall Blvd., Tigard, OR 97223 DEC 2 9 2010 Plan Revie � /1 n q / 1 Other Permit: (JlC roC© d Phone: 503.639.4171 Fax: 503.598.19 Date /By: l T 1 GARD Inspection Line: 503.639.4175 Date Read /B : furs: 61 See Page 2 for Internet: www.tigard- or.gov CITY OF TIGARD Notified Method: t`� n Supplemental Information BUILDING DIVISIO . „ l0gr -n - TYPE 0 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 work indicated on this application. ❑ 1 - and 2- family dwelling El Commercial /industrial Valuation: $ ❑ Accessory building ® Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: Total number of floors: Job site address: 11046 SW Greenburg Rd. New dwelling area: square feet City/State /ZIP: Tigard, Oregon Garage /carport area: square feet Suite/bldg. /apt. no.: I Project name: Ash Creek Condominiums Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet Subdivision: I 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 N ° work indicated on this application ngvq` 13Rfire sprinkler system Valuation: Existing building area: square feet New building area: square feet 5 r7 r € r t Number of stories: Name: Type of construction: Address: Occupancy groups: City/State /ZIP: Existing: g Phone: ( ) Fax: ( ) New: Business name: Western States Fire Protection Co. All contractors and subcontractors are required to be Contact name: Darrell Fluit licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 13896 Fir Street, Suite B jurisdiction in which work is being performed. If the City/State /ZIP: Oregon City, Oregon 97045 171 �'� �r3 applicant is exempt from licensing, the following reasons , `� `C apply: Phone: (503) 657 -5155 I Fax: : (503) 657 -5182 E - mail: darrell.fluit @wsfp.us Business name: Western States Fire Protection Co. nQ � 3 Permit fee: s j Address: 13896 Fir Street, Suite B 1 City/State /ZIP: Oregon City, Oregon 97045 State surcharge (12% of permit fee): y? . e FLS plan review (40% of permit fee): y �tL Phone: (503) 657 -5155 Fax: (503) 657 -5182 (Due upon application CCB lic.: 104570 Total permit fees: Authorized signature. Amount received: This per mit app lication expires if a permit not obtained Print name: Darrell Fluit Date: 12 - - within 180 days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board. 440- 4613T(11 /02/COM/WEB) I:\ Building\PermitaPS- PermitApp.doc 10/01/09 City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Describe work to be done: 1.) ® New 2.) Modification to sprinkler heads only: El Addition ❑ 1 -10 heads: No plan review required. El Alteration ® 11+ heads: Plan review required. El Repair Number of sprinkler heads: 272 Additional description of work: Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler ® \Vet ❑ Dry Additional Standpipes Information: Hazard Group Residential R Density 0.10 Design Area K. Factor 4.3 Sprinkler Project Valuation: $ 71,950 B.) Type I - Hood Fire Suppression System Hood Project Valuation: $ C.) Fire Alarm Submittal shall Battery Calculations ❑ Yes include: Individual Component El 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): $ 71,950 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. C: \My Data \ Drawings \LS1848 - Ash Creek Condos TI \City of Tigard permit applicatiot doc 10/01/09 Fer o f o _001 CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR A BOVEGROUND 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 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 O4 l .f r'P k_ ^ ! 9 —C4 to I Ic 4 / cZA.3 6"r ("2tbU ACCEPTED BY APPROVING AUTHORITY('S) NAME ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ® YES ❑ NO EQUIPMENT USED IS APPROVED El YES ❑ NO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION El 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 El YES ❑ NO LOCATION SUPPLIES BUILDING: OF SYSTEM YEAR OF ORIFICE TEMPERATURE MAKE MODEL MANUFACTURE SIZE QUANTITY RATING SPRINKLERS PIPE AND Type of Pipe: FITTINGS Type of Fittings: MAXIMUM TIME TO OPERATE ALARM DEVICE THRU TEST CONNECTION ALARM VALVE TYPE MAKE MODEL MIN. SEC. OR FLOW INDICATOR DRY VALVE O.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. 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. SEC. PSI PSI PSI MIN. SEC. YES NO OPERATING Without ❑ ❑ TEST Q.O,D. With ❑ Q.O.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 & ❑ YES ❑ NO PREACTION 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.. 1 ❑ ❑ ❑ ❑ ---"1/4 DROSTATIC: 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 Di rental dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. DESCRIPTION EUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop which shall not exceed 1 -1/2 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 40 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 SIUCATE, BRINE, OR, 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 r RESIDUAL PRESSURE WITH VALVE IN TEST TEST CONNECTION: PSI I 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 ❑ YES ❑ NO FLUSHED BY INSTALLER OF UNDER- GROUND SPRINKLER PIPING ❑ YES ❑ NO BLANK NUMBER USED LOCATIONS: NUMBER REMOVED TESTING ' GASKETS WELDED PIPING ® YES ❑ NO 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 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? IS 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: 16 Western States Fire Protection Company TESTS WITNESSED BY FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES FOR SPRINKLER CONTRACTOR TITLE I DAB -- / C ) —/' FOR LOCAL FIRE MARSHAL (SIGNE ' TO IITLE ' I ti C PU�A DATE � r�� FOR RESPONSIBLE MANAGING EM IGNE) I TITLE � t ATE • ODITIONAL EXPLANATION AN D S � 1, - , 9 r i I � pq ,y _ io -- / p _ /' (BACK)