Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
Permit#: FPS2015-00016
s COMMUNITY DEVELOPMENT
Date Issued: 01/27/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S112DC00500
Jurisdiction: Tigard
Site address: 15895 SW 72ND AVE 120
Project: Dr.Thistle Subdivision: FANNO CREEK ACRE TRACTS Lot: 40
Project Description: Add/relocate(1)sprinkler head for TI
Contractor: WESTERN STATES FIRE PROTECTION Owner: PACIFIC REALTY ASSOCIATES
13896 FIR ST STE B ATTN: N PIVEN
OREGON CITY, OR 97045 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-657-5155 PHONE:
FAX: 503-657-5182
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/27/2015 $56.47
12%State Surcharge-Building 01/27/2015 $6.78
Type of Use: COM Plan Review-Fire Life Safety-COM 01/27/2015 $22.59
Class of Work: ALT Type of Const: IIB
Occupancy Grp: B Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .10 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $85.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $675.00
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 1.800.332.2344.
Issued By: 1 . • /�� Permittee Signature:
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.
Building Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY
City of Tigard Received/ „ ermit No.:Fit
13125 SW Hall Blvd.,Tigard,OR 97223 JAN 2 7 2015 Date/B . 017 `�s�_ o�/ �lv
g Plan Revi
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permja'D, //5:-/Ot10
I I t; I:I I Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: la See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION 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
'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 laCommercial,'industrial Valuation: $
❑ Accessory building ❑ Multi-family Number of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1525 9 c 560 72,4 Avg, c>\iP 12o New dwelling area: square feet
City/State/ZIP: PUVk-‘,..4, R C O 722L. Or TI,A,TI --y Garage/carport area: square feet
—
Suite/bldg./apt.no.: Project name: r ..._ t�. (3 Covered porch area: square feet
�s��wys Durk� _
Cross street/directions to job site: d` Deck area: square feet
Other structure area: square feet
I--
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.
Valuation: $ 6 75
A act i1k,r.0.,t-z 1 5 e.4/Nk,t cr.) Ve_AA: i n t ► 1_,
Existing building area: square feet
New building area: NM square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: A,- 1, )az
Phone:( ) Fay:( 1
New: I t ini k r(l
❑ APPLICANT CONTACT PERSON - uZU NOTICE
Business name: Wesh-,.n 5 Few rt n f�tf� -,., , All contractors and subcontractors are required to be
Contact name: �US�'iT M l� 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
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( sa3) (15-3-l'1l ti`•t Fax: :( )
E-mail: ` USwca. VV - 0 (A);�i, . U i
J CONTRACTOR BUILDING PERMIT FEES*
•
Business name: e 5turn 5,a�5 E 1-�rt�Z-t.+���-. (Please refer to fee schedule!
W
Permit fee:
Address: Viliakr I 3 Aq‘ R .- 5frtet Sv i Iti
State surcharge(12%of permit fee):
City/State/ZIP:
# ot 70 4s FLS plan review(40%of permit fee):
Phone:(503) 9 S 3_yZHK Fax:( ) - (Due upon application.)
CCB lie.: 104 sl o Total permit fees:
Authorized signature: // Amount received:
_ /�4��L[,,.... This permit application expires if a permit is not obtained
Print name: 051.„ " t I I La/ Date: (/2 7/ 1 5 within 180 days after it has been accepted as complete.
1 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Perml[s\FPS-PermitApp.doc Rev 01/05/2012 440-4613T(II/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.
Igt Alteration ❑ 11+ heads: Plan review required.
El Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A B C or D as applicable):.
A.) Commercial Sprinkler
.BSI Wet ❑ Dry
Additional Standpipes
Information: Hazard Group 1; t �U ,.d
u�
Density • 1.0
Design Area
K. Factor S,C
Sprinkler Project Valuation: $ 67L
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
C.) Fire Alarm : --
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
S.uare Foot.lc: 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 Fe
Project valuation subtotal(see A,B&C above): $
Permit fee based on project valuation(see fee schedule): $ S,,q7
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $ , 7,
FLS Plan Review(40%of permit fee): $ 2,59
TOTAL: $ y
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
C:\Users\joshua.miller\Downloads\F PS_PemutApp.doc Rev 01/05/2012 2
City of Tigard Permit No.: F-la-Sc2O/_—000/6
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: /,27//j
i c \Iz i Inspection Line: 503.639.4175
Internet: www.tigard-or.gov By:
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS RECEIVED
OR TENANT IMPROVEMENTS JAN 2 7 2015
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) CITY OF TIGARD
BUILDING DIVISION
Project Name: n-- V/51 T f Occupancy:
Job Address: Pcp- ate(( ()k' 'T 722-1 Type of Construction: J 77
Suite: 1 2 b
Contractor: (A)r-S '{ 4-n 5 .s Pre* , Phone: 5( 3 - cic 3 -LI7(1'A
Number of Proposed or Altered Heads:
Type: 0 cn(k Reiri -Iazard: R t- L6, Density: , /D
I, 1 V\A, Oregon Construction Contractors Board No. I Ul-tc 7-c)
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: 74 / Date: I/2 7//5-
Print Name: 3---ckst,
I:\Building\Forms\FireSprinklerAffidavit_071514.docx Page 1 of 1