Permit CITY TIGARD BUILDING PERMIT
PERMIT #: BUP2006 -00534
awl COMMUNITY DEVELOPMENT DATE ISSUED: 2/22/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S113AB -00300
SITE ADDRESS: 16083 SW UPPER BOONES FERRY RD ZONING: I -L
SUBDIVISION: FANNO CREEK PLACE LOT: JURISDICTION: TIG
PROJECT: FANNO CREEK PLACE
Project Description: Bldg. B Fire sprinklers.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2N sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
GARAGE: sf OCCU SEP. RATED:
STOR: HT: ft
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 11,284.00
Owner: Contractor:
OPUS NORTHWEST LLC DELTA FIRE INC
1500 SW FIRST AVE. STE 1100 14795 SW 72ND AVE
PORTLAND, OR 97201 PORTLAND, OR 97224
Phone: 503 - 916 -8963 Contact #: PRI 503 - 620 -4020
FAX 503 - 620 -1058
Reg #: LIC 64174
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 11/2/2006 $158.50
[TAX] 8% State Surcha 11/2/2006 $12.68
[FLS] FLS PIn Rv 11/2/2006 $63.40
Total $234.58
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 than 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 these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
� Permttee Signature: / '
Issued By: � � t'1 � i 9 I . �l
v /
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.
•
Fire PrGteckon System
/6 SW (Jeer baeleg 0 r(
Building Permit Applies ECEI VE - : - i oR orrICE USF ONLY - -
City of Tigard _NOV ''e`d/( py 0 Permit No. t . , D6 -e
13125 SW Hall Blvd., Tigard, OR 972 Plan V ,r �ooU Pian Revie
'� B Phone: 503.639 4171 Fax: 503.598.4d60.. OF TI Date/B Other Perini ' 1 /005) T. I G i# k D Inspection Line: 503.639.4175 �RO Date Ready/By- / ® . ee Page Z for
Internet: www tigard -or gov BU�LD�NG DIVISION Nonfied/Meihoc� ) _G / \ 1X .I Supplemental Information
S1) mlCt. WAN c) v l
s: •r. _ "n ft , �,,, =rs,: _. s'7;•va;r.a'nr..;. - t; .: v }mss � r t' � r 2; • '�:` A, ,,,., 7:,,4 ..roi.a,
N.:.:', krti +:t '•4 t.L� ,v��`7,�f�= ?9.�. �Fi4. �:p .H' x .. •`.Ib - .,aye' � , nt - a: t�n,�w � v,. c.••F ar��•• -•„r. , taus
t,,,,7`7 ~ •_ r ev - - i t ; ...' • '- „. a4 ° :TY WO � 'tli ' r: b S r E V '�'.. -Vg t `= Q .. ; LaAND :FAMIL:1t.DWELLING-
?" ,u -,, t ' : ' z pea 'A,A , RE UIRED DATt�: y
:,?x��.�'Y -� ?: i5� «�.4 ,�. �&. 1` ��. �.. � :r0.�_,uee- >r,is•_�:`✓1�_. �r:.- w�PM1a.'"i�..e ,4`._- Y�.ii'L'ti,.a�: _..A+' :.. �,��.:. ��:. n ,. .,. -w.... a v3... -
New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
i gLAdditionialteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
t- ? ,;; .: "; ;= ', " 'iM; - " ' g, f " z7 - -iaa, ,:o'v :�, work indicated on this a lication.
'" X± s ( c ' rA '4ri CAT EGUR F i 2.. u 4 - =- 4 •_ =•> pp
a �= .m:41e;:5?=5- <l <k F�a.,� - t,. ,�:fi%�".,n;.�;rL" .+-x r�...' t� ..=:% a.,,, r: r_ a.,. k->.:, cn...+ <CM:ir:�c:Y•, "•� "°:;yi%���
❑ I- and 2 -family dwelling [Commercial /industrial
Valuation: S
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
,, ,�. ..; - r• . �x- y..r,,x. °: - ,- ,.,�. ,t,•.; -., ">' ^.z` ="s:> ; , ti" � _
--- : ^fe �- 4F�`,': +J ,le._,",,,,,,,,,,,,"..,:., B l i F eORhiAT f.b eki ii 'i'•- � ' ' j'„ : ° [r•,•- i ' i; Total number of floors:
' ,-- ,- r, S; , . .,k r `:�?n;i } ws., s∎: d`.SfsA c�' :tn: ., -,2 •. rho-,., r ,n ,,`��:x;S ta;k�,, ,,,,,k-,.. r L " #i,:
Job site address ) (o Ux n � Y- ev y RoA New dwelling area: square feet
City /State/ZIP: rot 0 k 0 17 f Ll Garage /carport area: square feet
Suite/bldg./apt. no Project name: (none) C.tekv, + x� i 15 Covered porch area: square feet
Cross street/directi (none) _j9b site: Deck area: square feet
Other structure area: square feet
,.
r+5,� --� ,11 ,,, t...r, r - r .tip. , ;,N.ac, ' • wJr.,,. ,Z:..
R K 99 ED: DA TA c `' C U M M R CIeAU E:H CKL:IST- :aA •,
+ tv ,ch;; - wv xtq�v� .r:. -•:. - <. US s C
a;- .�. E .- v.: •-� >
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
tx,:y,, a �.,;,F xa� }- r,,l.w tV xy �, - -,� ��., h ��µ
-K ','. ,- �` �Pr , ~' ' a .04% work indicated on this application.
F : )' y ; �` .� ei , ,, 1 DESCRIPT k. -,42N,',-.4, WORK ^ =' °` � n 0 , , ,,', ;. + ? w PP
C�•S`j +J .. A' "4 1N- '�d'S.�. � ''�v l4 =' -� -2C� m , w n. ,. w• �k '�v`i N +���,M. ±G ':�rn,S�NS r sJd:
Valuation: S // _7.:11
Existing building are . 3�4 square feet
New building area: 77 square feet
�., ",� i ° -- ` rsnx:.� ...-� :3 �r -u, •u y��atii�y ' - r �,s.�;*��, °oaf.., .... -, , t = -• , ;�v r`�t�� :; -5`
Number of stories:
,' .# ` ®' PROPERTY OWNER :. i� ' = - 21:1 • y�N r'4 i k ` :- '>A �• *'
„� tc�S'�a . ... , .., - .. ,v_i•. .,��s r:���'I9:r -�:�'� �v i aT E N�: 4N TYi «;�': <`'�;•�= eT�_� -"_,,`
Name: Type of construction: 02 a
Address Occupancy groups:
City /State /ZIP Existing:
Phone. ( ) Fax. ( ) New -
y "F >,;f;.i-r+ .yF.4,k .. �� „f..,ms•,^,,,..y,��,�r",; n „r<-• asa ;,'� �RT.:k- �,x�..,�•�.��3R Oyu;,:•,, F,4'C- , �;..r � - +r
i > fi s ')-Mi `PPLI fi. t# ^�3..� '� ,,^.', .aaa;I, . r, ,a , .d'? � t.r = , c:t e , p:,,,w4- y i ;, t; i.v,;p =:r ; u;a-,..y , ,,
-r .`:.� ” :,, , t .�`. -;, . ,,� , ,,, ,i c Ln Y CO{,TACT'r _; +;, , s - r 4 F,k . s , 5 a rI. ��' 3 `
�, _ 'd$v±s _ _- - , ._ ,�,, ��K� �4n 4it' �-.- U o � ,; ��;�f;tNO TICE w�s�'.�?��� � :?va �r ",�s >t�%s�ay
Business name b el k, 'r., r p j y - c All contractors and subcontractors are required to be
Contact name. AA'ir V ( C j- p f•,` licensed with the Oregon Construction Contractors Board
� "` v under ORS 701 and may be required to be licensed in the
Address: I ti7 �c)6 7 �, jurisdiction in which work is being performed. If the
i f //'' applicant is exempt from licensing, the fo owing reasons
City /State /ZIP
- �OS�1un �7 N apply: /5 -
Phone - 63 ) (D� L
( � /Q 3-o Fax:. (50 COc - 1 0 K
7" /a.0
E -mail.
PL (93. "O
_ :'K &u •, S,iSu` •. _ , %.�” s'e�;:�u'7,� "�a :"^".` -: r, +- •tw��•,`:c<v_ $G� - > - .t:sL-- -us =�• ! t ' c q. ' � ' `' ' °r �"� .�t.i�' -:r - i
'^.f _
Sri �"� q. "' , 4" , -_ ! s CONTR cTOR` ym "� �' ,r,' '` sfi = � r . - t ..
T-;.. o:'•�. €,'w_ - ...,,,, -�i r. r � ,,,, r, � r : ;, ,? . :r' • r" ' �;;;'A. , 1, :F "" � i6 G FEES!; = " ,, , r •.t' i `
��c �:•,h�u7ti..., .� . _ „� _., . - . sv=s.+r.; �, �_ .- a�.�d��,,,t.4.fa��aaui�:+ _4� E�t ' � �,:�;, UIl;D PERMIT `'�1 x
.�,c � =� r3 " k';i,S•;;(Pfease`iejer ro` je e.'se/ied u le1 `� � � ,`�:�:: ���.i�'� _ ".�;
Bus mess name: v Y e - ` c _
Address- 1 LA-701. nC� A e o Permit fee
City /State /ZIP: ' Vol . 1l Ct� i ®01 C.f 9 u State surcharge (8 /o of permit fee)
C FLS plan review (40% of permit fee).
Phone (50 (g _00 Fax (5 3) � ( l oss (Due upon application.)
CCB lic. (p - 7t- O C' I Total permit fees
Amount received: i 7 4 .
Authorized signature ni � - n �� permit pp p permit d+0
X X This rmit a lication expires if a ermit is not obtained
Print name. Ne ld 1 o r lot (4l) c �� Date I i / d r within 180 days after it has been accepted as complete.
( • Fee methodology set by Tn- County Building Industry
Service Board
I \ Btu dding \Permits \ FPS-Penn aApp doe 03/23/06 440- 4613T( I I /02 /COMVWEB)
_ - t i. �- _ ' � ,• t
• 1 - a - � , • .
. ,
°' t i
City of :Tigard: Fire Protection Permit Checklist . ' •
Page 2 - Supplemental Information '
F,' - _,z 9;ALa✓ ire... ' P, �p36.•Y` Y'-Lti. -t tr Y•• ar'6 Y xr,• si> z ? r rb pt . `.wF, w` .?' . ilk
Describe work„to betdone.ri rs =.. : s • � = 1 4 - z . -, _ X1.4.
1.) ❑ New 2.) Modification to sprinkler heads only
. El„ Addition 1 -10 heads: No plan review required.
Alteration 11+ heads: Plan review required.
0 Repair
Number of sprinkler heads:
Additional description of work:
'c+- >5.'A� " r a a.r 7; • x r . ... --y . 'a •.++,. r' -=.Ce, . • K +,er . ,a , �, 'a. ,.�. .,,.. , ',
Typeof ( app ,i.� .<
m —
d� • �r ! r' Cr ,y; " "FQ � ,,. ,� t '°f,�' i �` •Jc. .�, .,, rt'' 4'* .`�' =E5 "s aZ
st Y 1, ,J ii ,' 4 '+' p t- tea.. ' , , A"4 7 r , (
A) ° S p • rin k le r s r �v j k t =`'' 2
P:0,31. ' F ri,- ,We`;.Wi24 . .,r", ?.. i''sh4 ;,irAtatik> -,,i F? - , trt V,44ei'i,•taa'atla '. -ArF x�• , li ' �} .i,a, c ., .'7.•, � •� ;;;;
- Wet . ■ „ ❑ Dry f ' - t '
Additional Standpipes - LO , '
Information: Ha zard Group ' ' '
p . ,Lsl �`� .. ' ;
Density 1'O •
Design Area a0& Sc 1✓-r
K. Factor •( • .
, Sprinkler Project Valuation: $ 1\ 'Q,15(-4 •
.,. ,� v L k � 7:;.N i` +ht� F,. \, ;'�•A;;fi' + ,4:.u1'>T.'.b:a9 ?�{` :r:P u•;- j S„J. 9 ,!' i 1• �:Y9:•y ��,y+;u„ ,•'{r ;L ":r�,'v�,.. w, y �WW1
B) e : Type : - �Fire >Suppression`_System . AM" .' `•�." ... ;;�rgff4. ti"" {3';F i
. Hood Project' Valuation: ' ' $ , /J
�� ±:�, _ :-�. „,�; . :t�: . ?,, 1= ,..,'�- s- ;;�,,r ,aK ,,,�� ; �� +�,.,.rij, str;•`s �s �� -nh 4g }•, ;, ,.�,: ' n„R « � -(,, �..�
f, {a n - -fk' ie • • ,�.� ,4 r' ie ym- F :1 -it v., a p. vM S `� t. ' V', t -
5 . ,`+' w `7 ” ",, .1(.. -•�. s;` v. F u+ 'E + `,. r :I ,, ;+9 ' ,k` qr ,` �,:, •�r1 „,', 4 S,' y ..„,,,, r.,, ,.,
l•�h` !� �, M1 r, �+t•, � �`is;,r � - ,. ?' + � I •ay J �`. ^ �t;; 'a�S'�. -, 'i ,�' ` ?�. C „� � �'' b' "'s,�"�', -. _.
• � r ,�,, ` w. � �. 1a; ,s, �7' :.� ='zM°' {z4 �� c", ,l" '� ti a �1. � ,� c �$, F "r� Z r. 'i4 v _' .ryF r'; . •,, M�
�. . ; �s. �kw �, x'' :rr:� -1. .� �, at �-.,, � ;.: , ••. - � �',r >p .r• a ^n��-•� �� -, r� �, �
J 'Fire Alarms ct ` � ( ; � t to, ':w.;i a `ie ty.•,`(.' ' ;' ; +• +. ,tYs-,� 4, ; -N` wN C 4 • r �..tr` F _ 4, ' u
,u .r , ' ,.. `,� 'j .4 ".», rcra., , �`4':` ,E `a_ ,p;.y„4,- *i � y '" , 3' ,t "° `�6r y.,' a,..�
a'� �tr *, '� �.'�":•: 'fi 'a ' ��++ "'-� 2,av��. �,f _r'i`.' „��'�`.M k;e s. �yTS g nn4�,:_ a. ts” 5si'. C�sE�.' i. n—« �e• i;.`* �_;:?' ?`'',;ti i. '#L'�',{.- •�r1,fi +41w$ca„.'.rfir.
' i,.'Y'f', rfc5 :ru'4FG '°�i•,` Ei4T�.�A2weu��N?n L��i�� i"
Submittal ihall Battery Calculations ' I Yes •
include:. Individual Component ' ❑ Yes •
Cut Sheets .
• 'Fire Alarm Project Valuation: $ N Pc
�F: �'A.t�,r' ; ri, ;3 z �t, ;- ;r '.z. A(?' ezt xr :
":.r , ,s t :,; c v ,,,, : 7. �-5,,- o$ .( :�. ai ia" r e :;,. ,
, -4=t .
s
s� � f• , •ti, :,,•t'Si •L,_• �,, ,A r � v'{Y. " r?•?�, �^'4 t ar„,,• SQ , I.:�° r f •. : , ? -- , - ?.. yt ,-
`r;�i�•3c�, ,.:3,_+,�3zF :� r�r ,tr��"�, �•;4 x �.�4 :c���3,�y�;' '� S .wl•. >, a ar,r��`; a- " . , : fi y ,
1 ,.. e4R esi d' entia lr t S r in kl 'er' (( S tand '.Alon e_ , p ' • ; ' 4'`, =.g xly -'• " ` ° ,
, .;P. , - \ ' SyStem.,,,,, ? r a „ r , , ,, , .,,.4;r`?.' .. -,,,,, ,,:c. ,,,�^ "'
• "';: r,.r ^.At�.kF _ a�tri Wit... � r t2• �•,a.rr�;as4_ _ .''�2- . _.....t c�r.,,r.';;?� fir: v<3rs; .. �?!t.:s� ��d � - a , � "f.`�s „' �'',
' Square `Footage: , e _; -, r k •,�r k. ^y's;v;:"t>: -% 10.�a�: v� ' , . it' - ,a
• P e r mit Fee: �.�,` - � � ; �` -�,. �" ; ��
, O -to 2000; .. , . $18750 i` . >n ; y x ' •._, Y �
r s` gin• ,' -` ' 7 A •
2,00,1 to 3,600 $232:50 , } k 1 3 �_r J ,�,:., r ' `,a „�, °i; ' ,
'• y.+is” 'n`,7"t'. Y r �' "'a_ sir J,v 44' ; ��i
-r 1 s.,F✓f ,. i Ath r -V,� ., k"r3' A',�aYti s `i'yy p
3;601' to, 7,200 $292:50 A, ,* : , ,. � , ;� ! ,; •
:7 ? 'i &, x.nir' :( .L.s -ua,atw'eF,C, i s�
,4 r ' `7,201. $381:50 • , , � zAigi -.;, ZF a ."4' ;>;,-,r ?•`,'•' z'.
•
• ' Sprinkler Project Square Footage;' " " . ' "r -''" s ft: '
t ,m
.an - , ✓•V` q `'
1 • r t r.. r, •
prnr�?ky-;?y- r .�"'v;,k�y..^ ��r*;wagasr,�;�,."v < "sa-cl �Efzai ;:4 ash, _ v_rr'•'.v�u; 's�;u^z:= +,.•s 'rcxv.:,: a.E? 3YIin4:•C;`- ^`l"' K: vres3l :Q.t:,':��:',,r,'r,"'n'F,:,r�4;
,t.; =; P -k f '_, ; , �z, , , Eire Fees:.. tT2 . ., r iies „
- _ cx.. .3 .4 FS3T''S.. �� '��= fitY'�!: -. :f.`S x ..
` ' Pro ect,valuation subtotal s ee A B &'C above $'. '
Permit fee based -on p valuation, (see schedule): •$. ',-,1 6'b- - • '
' Permit fee' based' .on square footage (see D above): $ jJ •A• ",,,, - ,
. , State Siirchar a 8% of permit fee): $ r • , •
• FLS ,.PIan Review (40% of permit fee): $ ( • � ' t ' '
' TOTAL: $ a3q -%., • , . ,
Plan review requires a completed application and 2 sets - of plans a submittal. Plan review fees are required at submittal.
,'• New ' fire.pro
' tection systems require that plans bear the original seal of an Oregon licensed fire suppression '
' engineer, or NICET level 3 technicians. ..
• a
l: \ Budding\ Permits\ PPS -Fermi tApp.doc 2
a .
J AN. /16 /2008 /WED 08:16 AM FAX No. �"��� oa 3/ P. 004
FILE COPY
CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR A ROVEGROUND 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 Data
FANNO CREEK BUILDING B
PROPERTY ADDRESS
16063 SW UPPER BONNES FERRY RD.
ACCEPTED BY APPROVING AUTHORITY('S) NAMES
City of Tigard
ADDRESS
13125 SW Hall Blvd Tigard. OR 97223
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
9. NFPA 25 ® YES ❑ NO
LOCATION SUPPLIES BUILDING:
OF SYSTEM First Floor
YEAR OF K FACTOR TEMPERATURE
MAKE MODEL MANUFACTURE QUANTITY RATING
Reliable GFR 5.6 106 166F
Reliable PI FR 5.8 25 155F
SPRINKLERS
PIPE AND Type of Pipe: Schd. 40 and Lightwall
FITTINGS Type of Fittings: Malleable Iron Class 150 and Grooved
MAXIMUM TIME TO OPERATE
ALARM DEVICE THRU TEST CONNECTION
ALARM VALVE TYPE MAKE MODEL MIN. SEC,
OR FLOW Water Flow Switch Potter Electric VSR -F O 3 b
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.0.D.
With ❑ ❑
Q.O.D.
IF NO, EXPLAIN:
'MEASURED FROM TIME INSPECTOR'S TEST CONNECTION OPENED. (OVER)
1
ECEWED
r 1 ZU08
CITY OF fIGA 3D
BUILDINGDW1S1ON
JAN /16 /2008 /WED 08:16 AM FAX No, P.005
OPERATION
❑ PNEUMATIC ❑ ELECTRIC 0 HYDRAULIC
PIPING SUPERVISED ❑ YES ❑ NO 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 MAXIMUM TIME TO
MAKE MODEL SUPERVISION LOSS ALARM? VALVE RELEASE? OPERATE RELEASE
YES NO YES NO MIN. SEC.
❑ ❑ ❑ ❑
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.8 bars) for two hours or 80 pal (3.4 bars) above static pressure In excess of 150 psi
TEST (10.2 bars) for Iwo hours. Differential dry -plpe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped.
DESCRIPTION PNEUMATIC: Establish 40 i (2.7 bars) air pressure and me asure drop which s hall not exceed 1 -1/2 psi (0.1 bars) In 24 hours. Test
Ps ( ) P P ( ) 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 HYDROSTATICALLY TESTED AT 200 PSI FOR _2 HRS. IF NO, STATE REASON:
DRY PIPING PNEUMATICALLY TESTED ❑ YES ❑ NO
EQUIPMENT OPERATES PROPERLY 11 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 GAG JaCATED 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. 855 ❑ YES ❑ NO
FLUSHED BY INSTALLER OF UNDER-
GROUND SPRINKLER PIPING ❑ YES ❑ NO
BLANK NUMBER USED LOCATIONS: NUMBER REMOVED
TESTING 0
GASKETS
WELDED PIPING El YES ❑ NO
IF YES...
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS D10.0, 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? El 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 CI 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:
V [s.# F t/tC //VC-. TESTS WITNESSED BY
FOR PROPERTY OWNER (SIGNED) TITLE DATE
SIGNATURES
F R KLER O D) TI D
L L RE MARSHAL (SIGNED) TITLE DATE
FOR RESPONSIBLE MANAGING EMPLOYEE (SIGNED) TITLE DATE
ADDITIONAL EXPLANATION AND NOTES (BACK)
CITY OF 'MAR*
,i
ct MING DIVISION PERMIT #: m two r ke g tewe
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7j1E„'")00
Phone: (503) 639-4171 :z4ttk:
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/6/20013 TIME: 1:00At4A PAGE: 30
SITE ADDRESS: 16083 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: FAWN() CREEK PLACE
DESCRIPTION: ms p
OWNER: OPUS NORTHWES1 I.LC, PHONE #: 603.916
CONTRACTOR: °PUS NORTHWL:ST CONST LLC*111001 , PHONE #: F303
Inspection Request Scheduled For: Date: 216/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Messa
rfq Final impection 064696-01 603-571(1422 y &................... ,
,
Cf.rections/Comments/Instructions: ,‘
,•/
• ,./....- Alb. . '-------- --..-___----__-____„--..
ql- Aarill iV 1 --- vi11111••
----.
. . • • A
-,,
1
1
1
- I
I
112 P. - TIAL APPROVAL El CANCEL El NO ACCESS
n FAIL II .. L FOR INSPECTION
El ADDITIONAL FEES ASSESSED •
Inspector: Date: Z,„4/0eG Phone #: (503) 718-
i
CITY OF TIGARD
BUILDING DIVISION _ PERMIT #: BUP2006 -00634
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2J 2/20107
Phone: (503) 639 -4171 � r lP
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/15/2008 TIME: 7 :02AM PAGE: 41
SITE ADDRESS: 16{183 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: FANNO CREEK PLACE
DESCRIPTION: Bld B Fire sprinklers.
OWNER: OPUS NORTHWEST LLC, PHONE #: 503 - 9 %&8963
CONTRACTOR: DELTA FIRE INC.; PHONE #: 5.03-620.4020
Inspection Request Scheduled For: Date: //16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 063217 -01 503 572 -6422 N
Corrections /Comments / Instructions:
il
IIP e l..
( f: ' . ' O C. tea' s .ice ' >�`
El PASS �' ;'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ' CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ! Phone #: (503) 718- 7,(2Yy
CITY OF TIGARD
BUILDING DIVISION PERMIT #: B1)P2008 00634
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/2.712007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .,&.. II."
INSPECTION WORKSHEET FOR DATE: 1/10/2008 TIME: 7:00AM PAGE: 51
SITE ADDRESS: 16083 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: FANNO CREEK PLACE
DESCRIPTION: f3idg. 13 fire sprinklers.
OWNER: OPUS NORTHWEST LLC, PHONE #: 5w-91G-8963
CONTRACTOR: DELTA FIRE INC PHONE #: 503 - 4020
Inspection Request Scheduled For: Date: 1/10/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Messase
299 Final inspection 062942 -01 503 -260 -5844
0 .
Corrections /Comments /Instructions:
•
I
❑ PASS PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
7A FA II CALL FOR INSPECTION ❑ ADDITI 1 NAL EES ASSESSED
Inspector: / .718- . _ . Date: I . ° 0 , Phone #: 503 Z- g
P \ C )
TIGARD
1
TI
C9TY OF G
BUILDING DIVISION ., PERMIT #: BUP2006-00534
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/2712007
Phone: (503) 639 -4171 44i ,p r,,
Inspection Requests (24 Hrs.): (503) 639 -4175 ''I l i..
INSPECTION WORKSHEET FOR DATE: 111012008 TIME: 7:00AM PAGE: 6 1
I
SITE ADDRESS: 16083 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: FANNO CREEK PLACE
DESCRIPTION: Bldg. B Fire sprinWers.
OWNER: OPUS NORTHWEST LLC, PHONE #: 503-916-8963
CONTRACTOR: DELTA FIRE INC PHONE #: 503-620-4020
- Inspection Request Scheduled For: Date: 1/10/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
910 Sprinkler rough- in /test 062983-01 503. 572 -6422 N
Corrections/Comments/Instructions:
6 RO C-f r" ° ° itt3
• PASS • PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITI NAL EES ASSESSED
Inspector: ( ....----.• Date: 1 1 6 0" Phone #: (503) 718- 7 .lD �� 9
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2008.00534
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2f22/2007
Phone: (503) 639 -4171 . � 1 q41
Inspection Requests (24 Hrs.): (503) 639 -4175 J.. I ..
INSPECTION WORKSHEET FOR DATE: 12/10/2007 TIME: 7 :01AM PAGE: 68
SITE ADDRESS: 16063 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: FANNO CREEK PLACE
DESCRIPTION: Bldg. B Fire sprinkle's.
OWNER: OPUS NORTHWEST LLC, PHONE #: 503-9i6 -6963
CONTRACTOR: DELTA FIRE INC PHONE #: 503 - 62041020
Inspection Request Scheduled For: Date: 12/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Messase 4—,___11.
295 Misc. inspection 061122 -01 9/1-235-0082
Corrections /Comments /Instructions:
L- f 5 1 Z i rtookS
❑ PASS d' L APPROV. ❑ CANCEL ❑ NO ACCESS
❑ FAIL ,CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
r
Inspector: � —.. Date: 140/07 Phone #: (503) 718 -
1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP200 €- 00534
13125 SW Hall Blvd., Tigard, OR 97223 , - DATE ISSUED: 2/22/2007
Phone: (503) 639 -4171 r�
Inspection Requests (24 Hrs.): (503) 639 -4175 .�' "''.��
INSPECTION WORKSHEET FOR DATE: I t11/2g(j7 TIME: 7:02AM PAGE: 40
SITE ADDRESS: 16083 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: FANNO CREEK PLACE
DESCRIPTION: E3Idg_ B Fire sprinklers.
OWNER: OPUS NOFUTHWE.ST LLC, PHONE #: 503916 -8963
CONTRACTOR: DELTA FIRE INC PHONE #: 503 - 620 - 4020
Inspection Request Scheduled For: Date: 11/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
295 Misc. inspection 059604 -01 971 - 236-0082 N
Corrections/Comments/Instructions:
J4uZ-- 2U Qz,� k. C - , ft. -..e..-
❑ PASS - ' ' AL APPR• • El CANCEL ❑ NO ACCESS
ty
❑ FAIL ' CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718- Z _ - g
•
' CITY OF TIGARD .
BUILDING DIVISION : . - :,' " - PERMIT #: t3UP2006-00534
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/72/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 f L
INSPECTION WORKSHEET FOR DATE: 11/8/2007 TIME: 7 :00AM PAGE: 35
SITE ADDRESS: 16083 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: FANNO CREEK PLACE
DESCRIPTION: Bldg. B Fire sprinklers.
OWNER: OPUS NORTHWEST LLC, PHONE #: 503-916 -8963
CONTRACTOR: DELTA FIRE INC PHONE #: 503 - 620.1020
Inspection Request Scheduled For: Date: 11/8/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
295 Mi:.c. inspection 059270 -02 971 - 235-0082 N
Corrections /Com ents /Instructions:
l S , y(a ' < �L
t= C 1- ■/ U - 1 - 1 , 41- - ri M T
/ ci PAS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL / El CALL FOR INSPECTION ❑ ADDITI NAL FEES ASSESSED
Inspector: ■— —
/ IIIIIP
1 j Date: b'' 0� Phone #: (503) 718- i
lb