Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2014-00162
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/08/2014
Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 206
Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Relocating(6)sprinkler heads. Affidavit submitted.
Contractor: BASIC FIRE PROTECTION INC Owner: PROVIDENCE HEALTH SYSTEM-OREGO
8135 NE MARTIN LUTHER KING BLV ATTN: REAL ESTATE&CONSTRUCTION
PORTLAND,OR 97211 4400 NE HALSEY BLDG 2 STE 190
PORTLAND,OR 97213
PHONE: 503-285-1855 PHONE:
FAX: 503-285-0713
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/08/2014 $102.20
12%State Surcharge-Building 10/08/2014 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 10/08/2014 $40.88
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 $155.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $3,000.00
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'.. 44.
Issued By: Permittee Signature: OP
/��...1.111GL
Ca .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 ‘60\ OFFICE USE ONLY
City of Tigard Received _
DateB : I `f_ Permit No.: •I• +, 1
13125 SW Hall Blvd.,Tigard,OR
( Plan Review
Phone: 503.718.2439 Fax: 503.59 '
� S l Date/B :
Other Permit: ! • t
--..• Yr
Inspection Line: 503.639.4175 Date Ready/By:I t A t I Internet: www.tigard-or.gov le ,• Notified/Method: Supplemental
TYPE OF WORK] REQUIRED DATA:1-AND 2-FAMILY DWELLING
s-New construction ❑ Derliolition 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 V Mil work indicated on this application.
El I-and 2-family dwelling X..Commercial/industrial Valuation: $
El Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: i 2.442$vJ 3 C1ADLL5-tE .,)11 g 2. New dwelling area: square feet
City/State/ZIP: wee.. o k, 9/223 Garage/carport area: square feet
Suite/bldg./apt.no.: 20 lora Project name: tcrztA c ou,5 Hog 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
OF WORK •'-` work indicated on this application.
B E N aN c f ho K E 3 N 1 T - ' s e p r,SK(. S g.ELLCAi J/ Valuation: $ 3 J.
c c' A9-45 i o . a-S � .u.s Lt NCO, Existing building area: square feet
t`�1� New building area: square feet
—PROPERTY OWNER iirn-ENANT Number of stories:
Name: p W4 tQ G1Ce- 4 -144LTA Type of construction:
Address: ,44.or O5 tLAL-5 Occupancy groups:
City/State/ZIP: TO('CLf ►O,0.e- et 1 2.13 Existing:
Phone:( ) Fax:( ) New:
21--APPLICANT CONTACT PERSON NOTICE
Business name: 0654.. 6. l (ACC(,Tltg All contractors and subcontractors are required to be
Contact name: 'Sp� V�P�x licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: Q2,k35 ■ E 141{(1c 1-Jp jurisdiction in which work is being performed.If the
City/State/ZIP:�'0,,�,-t u f,tvL O,n Q 121` applicant is exempt from licensing,the following reasons
1_ 1 apply:
Phone:(5E92 2)Ze6'1'6% Fax: :( )2,6_07 t 3
E-mail:John 1 ) brVo ;S-t •cOlA.-
CONTRACTOR BUILDING PERMIT FEES*
Business name: 5 l R erfTECTLOld (Please refer tofeeschedule)
�
Permit fee:
Address: b\ 1�� �LK•t 3t,
Q State surcharge(12%of permit fee):
City/State/ZIP: \ � 'rL,ch,06 �(� �'1�
,l", t1
FLS plan review(40%of permit fee):
Phone:(50)) 28c-(9' Fax:( t )285-013 (Due upon application submittal.)
CCB lie.: 4c3foirk Total permit fees:
Authorized signature:
Amount received:
O. "s This permit application expires if a permit is not obtained
Print name: ., 1 Joe Date: `O- -I it within 180 days after it has been accepted as complete.
N ` * Fee methodology set by Tri-County Building Industry
Service Board.
I:'Building'Permits\FPS-PertouApp_071514.doc 440-4613T(i i/02/COM/WEB)
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):
T T
YP Y ( P A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Des' Area _K.Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
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 Alb _
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: $
http://www.tigard-or.gov/city_hall/departments/cd/docs/FPS-PermitApp.doc 2
IN City of Tigard • CEIVED Permit No.: FPS at ),i.—c i3-
■ 13125 SW Hall Blvd.,Tigard,OR 'r x
I Phone: 503.718.2439 Fax: 503.5':. r.. Date Received: /0) g//'1
Inspection Line: 503.639.4175 OCT C T 8 2014
Internet: www.tigard-or.gov By: 8W/de/NJ 7Z044
-
f1(U
FIRE SP AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project NameTeiSglQe10E SCk(OLLS IA EC-Ik L Occupancy: 1 kEVK1 L O ff ce S
Job Address: t 24k2 SW SCNOLIS c-IE+g`4 W Type of Construction:
Suite: Z9 c l-0042_
Contractor:►C E'Ck.. Flacsi -C uts1 Phone: 5D -Z$5--($55
Number of Proposed or Altered Heads: 6,
Type 1� (, 1,IT 3 , Hazard: L G ill T Density: A C)
I, 3 i M otem(b tc ftRE') Oregon Construction Contractors Board No. *S4D4 I
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits,beams,partitions, walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop (exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads(see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
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.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature: Date: 10- ea—1 't
Print Name: -Totk 14 14Wiz-f4.1LC
I:\Building\Forms\FireSprinklerAffidavit_071514.docx Page 1 of 1
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
12442 SW SCHOLLS FERRY RD 206, TIGARD,
OR, 97223
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2014-00162
Jeff Grove
Violation Summary:
Inspector Contractor