Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11 COMMUNITY DEVELOPMENT Permit#: FPS2014-00126
T I GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/24/2014
Parcel: 1 S136AD06507
Jurisdiction: Tigard
Site address: 11460 SW PACIFIC HWY
Project: Quality Inn Subdivision: WAY LEE Lot: 3
Project Description: Adding(1)radio communicator to existing control panel for monitoring.Fire alarm affidavit submitted.
Contractor: ACTION TECHNOLOGY SYSTEMS LLC Owner: AISLING CREATION LLC
835 SE 17TH AVE PO BOX 1120
PORTLAND, OR 97214 BEAVERTON,OR 97075
PHONE: 503-231-1992 PHONE.
FAX: 503-231-1402
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/24/2014 $61.85
12%State Surcharge-Building 07/24/2014 $7.42
Type of Use: COM Plan Review-Fire Life Safety-COM 07/24/2014 $24.74
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: No 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 Gales Provided: Cut Sheets Required:
Total $94.01
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $870.00
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 • .::.. .-
Issued By: / ? /J Permittee Signature:
- • -•- 2k:61.6.--)t ..
Call 500175 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 of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) Type of-Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices:
❑ Addition or ❑ 1-10 heads: Affidavit required and 1 5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
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 ❑ Ye
include: Individual Component Yes Ai /i9-
Fire Alarm Project Valuation: I $
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: $
C:\Users\Steve Barry\Documents\Fire Alarm Permit and Affidavit Forms\Tigard Fire/' arm Permit Application.doc
City of Tigard Permit No.: FfS A0 y_oo 1010
• 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 7Aii/Pi
r c,n Kt Inspection Line: 503.639.4175 ��,�
Internet: www.tigard-or.gov By: �� `_e ��
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: � \---f T_W, Occupancy:
Job Address: t'14 6 fc, SLJ P car_ i-p.■,,.►-c o� -1223 Suite:
Contractor: At,cso,--, i .--Co vo.00 4 s -1 sst-- Phone: S -3— 2 3 i —t °1°12—
.7)
Valuation of work: $ �S 1 0'
Type of System: (check one) Zequired ❑Non-required
(check one) ['Automatic ['Manual EI.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 (max 5) /To be Relocated (max 5)
Number of Proposed Notification Appliances: To be Added (max 5) I To be Relocated (max 5)
I, 'r A- -),Pr Yz H—( Oregon Construction Contractors Board No. ( 5.--)a C.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.
t) 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:
• Submit(3) copies of a sketch showing the area of work within the building's structure.
• Building fire protection system permit.
• Electrical permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
>,
Signature: ` 1SLj'Ak Date: 1 f 2 L 4
Print Name: 1A.
1:1Building\Forms\FireAlarmAffidavit 071514.docx Page 1 of 1
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Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard Received Permit No.
71w iy .13125 SW Hall Blvd.,Tigard,OR 9722 j,cj\iEO Plan Review /
Phone: 503.718.2439 Fax: 503.598.l Date/By: Other Permit:
TI v A RD Inspection Line: 503.639.4175 JuL 2014 2 4 Date Ready/By: furls: 0 See Page 2 for
Internet: www.tigard-or.gov —-,.�^ Notified/Method: �C Supplemental Information
TYPE OF W s 1 `l�i�!j .,IM) REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑ Demolition V 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
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation:El 1-and 2-family dwellin g ®Commercial/industrial $
❑Accessory building El Multi-family Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11460 SW Pacific Highway New dwelling area: square feet
City/State/ZIP:Tigard OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Quality Inn Covered porch area: square feet
Cross street/directions to job site:South Side of 99W-Below Grade Deck area: square feet
must enter north bound on 99w Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
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
DESCRIPTION OF WORK work indicated on this application.
add aes 7788f radio communicayor to existing control panel for monitoring Valuation: $$870.00
Existing building area: 14000 square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: 2
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: R2
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 licensed in the
Address: jurisdiction in which work is being performed.If the
CitylState/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax: :(
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:ACTION TECHNOLOGY SYSTEMS LLC
Permit fee:
Address:835 SE 17TH AVE
City/State/ZIP:PORTLAND OR 97214 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)231-1992 Fax:(503)231-1402 (Due upon application submittal)
CCB lic.:157630 Total permit fees: hi. U
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name:STEVEN A BARRY Date:7/24/2014 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_0715I4.doe 440-4613T(11/02/COM/WEB)
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
11460 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2014-00126
Jeff Grove
Violation Summary:
Inspector Contractor