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Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 11111 q t; COMMUNITY DEVELOPMENT Permit #: FPS2011 -00134 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012 Parcel: 2S112AD00200 Jurisdiction: Tigard Site address: 6830 SW BONITA RD Project: Clowns Unlimited Subdivision: BONITA GARDENS Lot: 4 Project Description: Fire sprinkler system. Contractor: WESTERN STATES FIRE PROTECTION Owner: STEMS FAMILY HOLDINGS LLC 13896 FIR ST STE B BY JOHN E SMETZ OREGON CITY, OR 97045 PO BOX 560 AURORA, OR 97002 PHONE: 503 - 657 -5155 PHONE: FAX: 503 - 657 -5182 FEES Description Date Amount Specifics: Info Process /Archiving - Lg $2.00 (over 02/28/2012 $2.00 11x17) Type of Use: COM Info Process /Archiving - Sm $0.50 (up to 02/28/2012 $22.50 Class of Work: ALT Type of Const: VB 11x17) Occupancy Grp: S-1 Height: ft Permit Fee - COM 11/15/2011 $403.40 Stories: 1 12% State Surcharge - Building 02/28/2012 $48.41 Plan Review - Fire Life Safety - COM 11/15/2011 $161.36 Commercial Sprinkler System: Sprinkler Required: Yes Sprinkler Type: Wet Standpipe Required: Hazard: ORD2 Density: .6 Design Area: 2000 K Factor: 16.8 Commercial Fire Alarm System: Fire Alarm Required: Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $637.67 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $39,578.00 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 OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: lei 41 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 oiM.Y City of Tigard 6) Received �� r' Date /By: Received I / /) Permit No.: � j) u :� 131 SW Hall Blvd., Tigard, OR � . Plan Review II Phone: 503.718.2439 Fax: 503.5 60 \ tom' Date /By: ro/ • 'Z i • : er Permit: t - �(JS�t ( — Ui7 I Ilk I l c n I: D Inspection Line: 503.6394175 '1 G S�0 Date Ready /By: rt /��,, '77.7.67' kris: ® See Page 2 for Internet: www.tigard- or.gov O � ,, Notified /Method: 0...., I'3 hi Supplemental Information TYPE OF WO REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ D'molition 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: existing bld 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: 6830 SW Bonita Rd. New dwelling area: square feet City/State /ZIP: Tigard, OR 97224 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Clowns Unlimited 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: 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 DESCRIPTION OF WORK work indicated on this application. Pa ,fropGi r install new fire sprinkler system and approx. 25'-0 of underground fireline Valuation ..ix19 , it 9 � rd L Existing building area: square feet 'W r ] New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: lec q q , /NeLcq, ea Name: Type of construction: s �O /� v�u�� Address: Occupancy groups: City/State /ZIP: Existing: Phone: ( ) Fax: ( ) New: ® APPLICANT 0 CONTACT PERSON NOTICE 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, OR 97045 applicant is exempt from licensing, the following reasons apply: Phone: (503) 657 -5155 Fax: : (503) 657-5182 E -mail: darrell.fluit @wsfp.us CONTRACTOR BUILDING PERMIT FEES* (Please refer to fee schedule/ Business name: Western States Fire Protection Co. Permit fee: 459.82 Address: 13896 Fir Street, Suite B City /State /ZIP: Oregon City, OR 97045 State surcharge (12% of permit fee): 55.18 FLS plan review (40% of permit fee): 183.93 Phone: (503) 657 -5155 I Fax: (503) 657 -5182 (Due upon application.) CCB lic.: 104570 - - Total permit fees: -- 698:93 Authorized signature: Amount received: This permit application expires if a permit is not obtained Print name: Darrell Fluit Date: 11 -11 -11 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 02/01/11 440 -4613T(I1 /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 ® 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: 177 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 Storage Density 0.60 Design Area 2,000 K. Factor 16.8 Sprinkler Project Valuation: $ 39,578 B.) Type I - Hood Fire Suppression System Hood Project Valuation: ' I $ 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): $ 39,578 Permit fee based on project valuation (see fee schedule): $ 459.82 Permit fee based on square footage (see D above): $ State Surcharge (12% of permit fee): $ 55.18 FLS Plan Review (40% of permit fee): $ 183.93 TOTAL: $ 698.93 Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal. C: \My Data \Drawings \152355 - Clowns Unlimited i1 \Cityy of Tigard permit applicatin.e a 02 /01/11 Western R F Fire Protection Co. NO 15 2 io� ,C'tue4 acrd CITY OF TtGF'D pt Itt ftNG DIVIStO" TRANSMITTAL FORM To: City of Tigard — Building Department DATE: November 11, 2011 13125 SW Hall Blvd SUBJECT: Clowns Unlimited Tigard, OR 97223 Fire sprinkler submittal ATTENTION: Plan examiner JOB NO.: LS2355 RI SHOP DRAWINGS NO. COPIES SHEET NO. DESCRIPTION ® FOR APPROVAL 3 FP -1 Clowns Unlimited — fire sprinkler drawings ❑ APPROVED 3 - Fire sprinkler material submittal ❑ APPROVED AS NOTED 3 - Hydraulic calculations — East Bldg, West Bldg, Office ❑ NOT APPROVED - RESUBMIT 3 - Seismic bracing calculations ® FOR YOUR USE 1 - City of Salem fire sprinkler permit application ▪ FOR DISTRIBUTION 1 - Cheque for plan review $18322 0 If you have any questions, please feel free to give us a call. Thanks, BY Darrell T. Fluit SIGNED Xe--/ 13896 Fir Street, Oregon City, Oregon 97045 (503) 657 -5155 FAX (503) 657 -5182 CCB #104570 ?mil CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR U NDERGROUND 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'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 Date 4 PROPERTY ADDRESS ACCEPTED BY APPROVING AUTHORITY('S) NAMES ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS El 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 APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS BEEN LEFT ON THE PREMISES? ® YES ❑ NO IF NO, EXPLAIN ® YES ❑ NO ® YES ❑ NO LOCATION SUPPLIES BUILDING: PIPE TYPES AND CLASS TYPE JOINT PIPE CONFORMS TO NFPA -24 STANDARD ® ❑ NO YES UNDERGROUND FITTINGS CONFORM TO NFPA -24 STANDARD ® ❑ NO YES PIPES IF NO, EXPLAIN AND JOINTS JOINTS NEEDING ANCHORAGE CLAMPED, STRAPPED, OR BLOCKED IN ® ❑ NO YES ACCORDANCE WITH NFPA -24 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. Flush at flows not less than 390 GPM (1476 Umin) for 4 -inch pipe, 880 GPM (3331 Umin) for 6 -inch pipe, 1560 GPM (5905 Umin) for 8 -inch pipe, 2440 GPM (9235 Umin) for 10 -inch pipe, and 3520 GPM (13323 Umin) for 12 -inch pipe. When supply cannot produce stipulated flow rates, obtain maximum available. HYDROSTATIC. Hydrostatic tests shall be made not less than 200 psi (13.8 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess of 150 psi TEST (10.3 bars) for two hours. DESCRIPTION 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 qts. Per hr. (1.89 Uh) per 100 joints irrespective 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 may be increased by 1 f. Oz per in. Valve diameter per hr. (30 mU25 mm/h) 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 oz per minute (150 mUmin) leakage is permitted for each hydrant. NEW UNDERGROUND PIPING FLUSHED ACCORDING TO NFPA -24 STANDARD ® ❑ NO YES BY (COMPANY) IF NO, EXPLAIN HO FLUSHING FLOW WAS OBTAINED THROUGH WHAT TYPE OPENING FLUSHING UBLIC WATER ❑ TANK OR RESERVOIR ❑ FIRE PUMP ❑ HYDRANT BUTT OPEN PIPE TESTS LEAD -INS FLUSHED ACCORDING TO NFPA -24 STANDARD ® ❑ NO YES BY (COMPANY) IF NO, EXPLAIN HO FLUSHING WAS OBTAINED THROUGH WHAT TYPE OPENING UBLIC WATER ❑ TANK OR RESERVOIR ❑ FIRE PUMP ❑ Y CONN. TO FLANGE & SPIGOT OPEN PIPE l (OVER) • ALL NEW UNDERGROUND PIPING HYDROSTATICALLY TESTED AT JOINTS COVERED HYDROSTATIC TEST] PSI FOR HOURS ❑ YES fir NO TOTAL AMOUNT OF LEAKAGE MEASURED LEAKAGE 0 GALS. HOURS TEST ALLOWABLE LEAKAGE (, GALS. HOURS HYDRANTS NUMBER IN ALLED TYPE AND MAKE ALL OPERATE ATISFACTORILY ❑YES 0 N WATER CONTROL VALVES LEFT WIDE OPEN ,B YES ❑ NO CONTROL IF NO, STATE REASON VALVES HOSE THREADS OF FIRE DEPARTMENT CONNECTIONS AND HYDRANTS INTERCHANGEABLE WITH THOSE OF FIRE DEPARTMENT ANSWERING ALARM ❑ YES ❑ NO DATE LEFT IN SERVICE �t - 12 - 1 2 REMARKS NAME OF INSTALLING CONTRACTOR: 1115 Western States Fire Protection Company TESTS WITNESSED BY FOR PROPERTY O R (SIGNE TITLE DATE SIGNATURES I FOR INSTALLING C CTOR ( IG ED) TITLE / DATE +^- S • >'yp - YG rt° J-..O^+ I /2 — /17 FOR LOCAL FIRE ; • L (SIG y!). TITLE TE 152 . `ic'i��'( 1 c [-t I BALI 7 - /,,N - f Z FOR RESPONSIBLE MANAGING MPLOYEE TITLE DATE I Jeff Murphy (Project Manager) I ADDITIONAL EXPLANATION AND NOTES (BACK) FZC o0 f3 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 owners 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'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 Date CLOWNS UNLIMITED PROPERTY ADDRESS 6830 SW BONITA RD. TIGARD, OREGON 97224 ACCEPTED BY APPROVING AUTHORITY('S) NAMES CITY OF TIGARD ADDRESS 13125 SW HALL BLVD. TIGARD. OREGON 97223 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS • O 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 O YES ❑ NO 3. NFPA 13A ® YES ❑ NO LOCATION SUPPLIES BUILDING: WET SYSTEM OF SYSTEM YEAR OF ORIFICE TEMPERATURE MAKE MODEL MANUFACTURE SIZE QUANTITY RATING RELIABLE F1FR56 RECESSED PENDENT 2011 Y2" 5 155 °F RELIABLE F1FR56 UPRIGHT 2011 %:" 2 155 °F SPRINKLERS RELIABLE J168 UPRIGHT 2011 0.64" 152 286 °F RELIABLE F1FR56 HORIZONTAL SIDEWALL 2011 %:" 10 155 °F RELIABLE F1FR EC -9 HORIZONTAL SIDEWALL 2011 17/32" 8 155 °F PIPE AND Type of Pipe: SCHEDULE -10/40 STEEL PIPE FITTINGS Type of Fittings: CI and GROOVED FITTINGS MAXIMUM TIME TO OPERATE ALARM DEVICE THRU TEST CONNECTION ALARM VALVE TYPE MAKE MODEL MIN. SEC. OR FLOW FLOW INDICATOR SYSTEM SENSOR WFD60 INDICATOR DRY VALVE Q.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 & 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 (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 HYDRAULICALLY TESTED AT 200 PSI FOR _2_ 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 OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? TESTS ❑ YES ❑ NO DRAIN READING OF GAGE LOCATED NEAR WATER SUPPLY TEST RESIDUAL PRESSURE WITH VALVE IN TEST 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 ❑ 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? 0 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 0 YES ❑ NO DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME OF SPRINKLER CONTRACTOR: 1 6 Western States Fire Protection Company TESTS WITNESSED BY FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES I I FOR SPRINKLER CONTRACTOR TITLE DATE a � t tr I 3/ /7 FOR LOCAL FIRE MARSHAL (SIGNE TITLE DATE I I FOR RESPONSIBLE MANAGING EMPLOYEE (SIGNED) TITLE DATE I I ADDITIONAL EXPLANATION AND NOTES (BACK) i r