Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
s COMMUNITY DEVELOPMENT Permit#: FPS2014-00172
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/30/2014
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 160
Project: Michael O'Brien Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25.PT
Project Description: Adding(2)horn strobes and(3)strobes.
Contractor: STANLEY SECURITY SOLUTIONS INC Owner: PACIFIC REALTY ASSOCIATES
15495 SW SEQUOIA PKWY STE 100 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-968-3353 PHONE:
FAX: 503-968-3398
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/28/2014 $67.23
12%State Surcharge-Building 10/28/2014 $8.07
Type of Use: COM Plan Review-Fire Life Safety-COM 10/28/2014 $26.89
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 $102.19
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,100.00
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 No' - -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire• questions to O'' • •Iling.f503.232.1987 or 1.800.332.2344.
Issu d By: / • ,/ / � Perm ittee Signatur .
•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.
1111 q City of Tigard Permit No.: tg a b/y- OCX 7 Z
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received:�- i7 i Inspection Line: 503.639.4175 n Internet: www.tigard-or.gov By:
c5/30//(7/
l----/Z/1-S2-06
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: / / he / u V Ern Cori 44550C 4C- / C Occupancy:
Job Address: 0.0109' 5' b� l�✓ Suite: /.60
Contractor: ST/6"-(L 6`' 5c-5---60K I ( (/ Phone:
Valuation of work: $
Type of System: (check one) ERequired ❑Non-required
(check one) WAutomatic 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(mroc 5) 0- -
Number of Proposed Manual Alarm Stations: To be Added(..5),6?" /To be Relocated(max5) E%
Number of Proposed Notification Appliances: To be Added(max 5) ) /To be Relocated(max 5),0
I, /(Aq /1Zc— Oregon Construction Contractors Board No. / 6 /5[.,7
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:
• 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 docume with a copy of the sketch attached shall be available for all inspections.
Signature: '4 AI-i Date: /()(07k(.20(y •
Print Name: / ii/t/ %er
I:\Building\Forms\FireAlarinAffidavit_071514.docx Page 1 of 1
pugging Permit Application
Fire Protection System
FOR OFFICE USE ONLY
p�4
City of Tigard 21 Received
Permit No.:
h' g CI DateBy: �la! I H7 Fp3ap I H-C1517.L
• 1 3125 SW Hall Blvd.,Tigard,OR 97223 � P Revie ��';�D
s Phone: 503.718.2439 Fax: 503.598.1960 �� tem : Other Permit:�"`" oaf''� . �
r 1 G n 1:t� Inspection Line: 503.639.4175 COO, to Ready/By: jam: See Page 2 for
Internet: www.tigard-or.gov ��, , Notified/Method: 7 Supplemental Information
TYPE OF WORK R�j��� 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
®Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1:1 1-and 2-family dwelling ®Commercial/industrial Valuation: $
El Accessory building El Multi-family Number of bedrooms:
El Master builder 1:1 Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12909 SW 686 Pkwy New dwelling area: square feet
City/State/ZIP:Tigard/OR/97224 Garage/carport area: square feet
Suite/bldg./apt.no.:p I Project name: f7/k�/__ ( 0t Cr �� Covered porch area: square feet
Cross street/directions to job site: (/'�01� lJ 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.
Add 5 indicating devices Valuation: $1100.00
2 Horn Strobes Existing building area: square feet
3 Strobe only New building area: square feet
® PROPERTY OWNER El TENANT Number of stories:
Name:Pactrust Type of construction:
Address:15350 SW Sequoia Pkwy Ste#300 Occupancy groups:
City/State/ZIP:Portland/OR/97224 Existing:
Phone:(503)624-6300 Fax:( ) New:
C4 APPLICANT ❑ CONTACT PERSON NOTICE
Business name:Stanley CSS All contractors and subcontractors arc required to he
Contact name:Tim Hungate licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15495 SW Sequoia Pkwy Ste#100 jurisdiction in which work is being performed.If the
City/State/ZIP:Portland/OR/97224 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)968-3300 Fax::(503)968-3398
E-mail:
1,,r.„‘ �nGnLti,.� fv z) �„r.<L tn•�.
V CONTRACTOR BUILDING PERMIT FEES*
Business name:Stanley CSS (Please refer to fee schedule)
Permit fee:
Address:15495 SW Sequoia Pkwy Ste#100
City/State/ZIP:Portland/OR/97224 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)968-3300 I Fax:(503)968-3398 (Due upon application submittal.)
CCB lic.:161567 Total permit fees: �a`�q
Amount received:
Authorized signature: aeffy-L--
This permit application expires if a permit is not obtained
Print name:Tim Hu gate Date: 10/22/2014 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_071514.doc 440-4613T(11/02/COM/WEB)
4
1
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: 5
® 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: 1 $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
C.) Fire Alarm 1
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: I $ 1100.00
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): $ 1100.00
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: $
L:\Users\tch0702\Documents\FPS-PermitApp Tigard.doc 2
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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
12909 SW 68TH PKWY 160, TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2014-00172
Chip Barnett
Violation Summary:
Inspector Contractor