Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2014-00044
T t 6.A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/27/2014
Parcel: 2S 102BD00100
Jurisdiction: Tigard
Site address: 12520 SW GRANT AVE
Project: St Anthony Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 52
Project Description: Add IP communication to existing fire alarm system.
Contractor: ACTION TECHNOLOGY SYSTEMS LLC Owner: ST ANTHONY CATHOLIC CHURCH TIGAR
835 SE 17TH AVE 9905 SW MCKENZIE ST
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503-231-1992 PHONE:
FAX: 503-231-1402
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/27/2014 $59.16
12%State Surcharge-Building 02/27/2014 $7.10
Type of Use: COM Plan Review-Fire Life Safety-COM 02/27/2014 $23.66
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $89.92
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $790.00
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 ca I. 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 di ct questions to ■UNC b calling 503.232.1987 or 1.800.332.2344. 4
Is ued By: / ' Permittee Signature: • 'ta
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.
City o f Tigard Permit No.: 1::::/9 C 1 el- 00 4 5"
;. 13125 SW Hall Blvd.,Tigard,OR 97223
r II Phone: 503.718.2439 Fax: 503.598.1960 Date Received: /0V 7//4/
1, ,D Inspection Line: 503.639.4175
Internet: www.tigard-or.gov By: ,
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
fiEGFIVED
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
FEB 272014
Project Name: s Occupancy: CITY OF flGARD
Job Address: , Suite:
2.c) c LJ G.-~vvf7
Contractor: G c��,,, i� a-r w s2w,.s Phone: 5)7— 2-3 1 — l`ice 2.
Valuation of work: $ 1°1 D • 0-7---%
Type of System: (check one) ZRequired [Non-required
(check one) ['Automatic ['Manual Both
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added(max 5) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added cmax 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) /To be Relocated cmax 5)
I, ) % -ysJ Pr - -r\\(2-'`2`-t Oregon Construction Contractors Board No. 15 1 I, .3 0
certify the following is true and defines the scope of work for this project:
a) All work complies with the current state-adopted NFPA-72 and the authority having jurisdiction.
b) All notification appliances are located in accordance with the current state-adopted NFPA-72.
c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having
jurisdiction.
d) Exposed wiring will not be covered until inspected.
e) Final approval shall be subject to on-site tests and inspections.
f) Voltage drop is adequate to operate all appliances.
g) Battery supplies are capable of supporting the system modifications.
h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications.
In addition, I understand the following is required:
• A sketch attached to this document and the building permit showing the area of work within the
building's structure,
• A copy of this document shall be available for the authority having jurisdiction,and
• Electrical permit.
Signature: t!j if' Date: 2/ 2-1
/
Print Name: `1/t�� ID A. (2--(
l:\Building\Forms\FireAlarmAffidavit_022514.docx Page 1 of 1
Building Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY
City of Tigard B 2 7 2014 Received 7 Permit No.: �I a/
'r 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
' a Phone: 503.718.2439 Fax: 503.598.1.960 Date/By: Other Permit:
I I GARD Inspection Line: 503.639.4175 GI(Y Or IIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov 711p t1lrltrt 1-num 1—nut 1n p,t Notified/Method: Supplemental Information
TYPE OF WORK 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
V.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 __ii / ❑Other: Number of bathrooms:
1 r0,,5a-0 Law 4JTOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 4.,,14-,<-4-'S - -'-'mot e i_ i_1' ,t r:U.,,,A 1 New dwelling area: square feet
City/State/ZIP: -- -TC C:-11)6■2(D G) Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:—_y-r .t.u.iv..(.5:: ...Sc 4...x ___ 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.
E3...r- �� G--- Q
1 ��7 Ciwvvh !� Valuation: $ 79D . Co
t✓y z C ^, --t�c, f [-- -\.L
i'� --(SZ-.7 -1_.
� 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: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be lensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax: :( )
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name: �. (Please refer to fee schedulel
(��vt-v 'T(rz 4-LNO ,.-)C s-( ,-.s.1 s t.`r L L C
Address: Permit fee:
�3-S �� lam'`" ��_
State surcharge(12%of permit fee):
City/State/ZIP: n�.n; Q 2_ C j`l a- (,
FLS plan review(40%ofpermit fee):
Phone:(5-63 ) 0,Z \ Il CIO")'Z. Fax:( ) (Due upon application.)
CCB lic.: 1 5----t(, 33 ////7/ Total permit fees:
Authorized signature: J`.AP yA/■._/ p Amount received: �4 '• T y -
,,-A This permit application expires if a permit is not obtained
Print name: �7L-ti�3 lA Fir vci Date: 2/2_—/i I 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.doe Rev 01/05/2012 440-46131(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.
El Alteration ❑ 11+heads: Plan review required.
❑ Repair
Number of sprinkler heads:
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
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations El Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ '�F69 -15"C
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): $
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 three (3) sets of plans at submittal.
Plan review fees are required at submittal.
I:\Building\Permits\FPS_PermitApp.doc Rev 01/05/2012 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12520 SW GRANT AVE, TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2014-00044
Chip Barnett
Violation Summary:
Inspector Contractor