Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
at
11111 • COMMUNITY DEVELOPMENT Permit#: FPS2015-00026
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/18/2015
Parcel: 2S113AB00101
Jurisdiction: Tigard
Site address: 16101 SW 72ND AVE 200
Project: Perlo Construction Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Relocating(3)sprinkler heads. Affidavit submitted.
Contractor: DELTA FIRE INC Owner: PACIFIC REALTY ASSOCIATES LP
14795 SW 72ND AVE ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-620-4020 PHONE:
FAX: 503-620-1058
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/18/2015 $51.09
12%State Surcharge-Building 02/18/2015 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 02/18/2015 $20.44
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .1 Design Area: 1500
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 $77.66
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $500.00
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 cop of the rules
or direct questions to OUNC by calling 503232.1987 or 1. I 912.2344.
Issued By: Permittee Signature: 14/. e , 4 /``I,
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.
F.7ire Pl Qte °tTO h , :Aerie
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Eta! `: {' t A alcation RECEIVE ' IR I I I(1 l-,l vl 1 '
{Received
!CEf:' of T 1! fvf Permit No.: E5 �� q
Date/BY: ir � o1/ Ll'����� LMa7
f uO 13125 SW Hall Blvd.,Tigard,OR 97223 FEB 1 2015 '
Plan Geview r, D�-c)!
•■ , Other Permit:
� ��, Phone: 503.634.4:71 Fax: 503.598.1960 Date/By: Z{ ♦<9�� 1
r i i;.- r t i Inspection Line: 503.639.4175 ail' l T G A Date Ready/By: Juris: to See Page 2 for•
. Internet: www.ttgard-or.gov v�a L "� "� ""'� Notified/Method: M Supplemental Information
TYPE OF WORK —1 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
IN Addition/alreration/replacetnent ❑Other: equipment,materials,labor,overhead,and the profit for the
t'ATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling ffil CotnmercialIindustrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
• E Master builder 0 Other: Number of bathrooms:
1011 SITE INFORMATION AND LOCATION Total number of floors:
_ -A
Job site address: 16101 SW 72nd Ave. New dwelling area: square feet
City/State/ZIP: Tigard, OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Suite 200 Project name: Perlo Construction TI 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_ I
Subdivision: —1 Lot no.: Permit fees*are based on the value of the ,cork performed. -
Indicate the value(rounded to the nearest dollar)of all i
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
'7
s', • o: r : o 1.,, , ,3 4 work indicated on this application.
Relocate 3 sprinkler heads Valuation: $ 500.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER C7f TENANT Number of stories:
Name: Perlo Construction Type of construction:
Address: 16101 SW 72nd Ave. Occupancy groups:
City/State/ZIP: Tigard, OR 97224 Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT ❑ CONTACT PERSON
NOTICE
Business name:Delta Fire, Inc. _ All contractors and subcontractors are required to be
Contact name: Heidi Scarbrough licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 14795 SW 72nd Ave. jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
Portland, OR 97224 apply:
Phone:( 503) 620-4020 Fax::(503)620-1058
E-mail: heidis @deltafire.com -
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee.scheduler
Business name: Delta Fire, Inc.
Permit fee:
Address: 14795 SW 72nd Ave.
State surcharge(8%of permit fee):
City/State/ZIP: Portland, OR 97224 FLS plan review(40%of permit fee):
Phone:(503)620-4020 Fax:( 503) 620-1058 (Due upon application.)
CCB lie.: C4174 Total permit fees:
Authorized signature: j / I I - Amount received: 77 1j(O-
/j� . , ��l�/ This permit application expires if a permit is not obtained
Print name: Heidi Scarbrough / Date: 2-18-15 within 180 days after it has been accepted as complete.
--— * Fee methodology set by Tri-County Building Industry
Service Board.
r:'Building\Permits\FPS-PermitApp.doc 03/23/06 440-46131(11/02/COM/WFt3)
City of Tigard: Fire Protection Permit CheckJi o:
Page 2- Supplement=;!Information .
r
1.) ❑ New 2.) Modification to sprinkler heads only:
U Addition ® 1-10 heads: No plan review required.
E Alteration ❑ 11+ heads: Plan review required.
0 Repair
Number of sprinkler heads: 3
Additional description of work:
Tree o€'System (Complete A, B, C or D as applicable):
A.) Commercial Sj rinkler j
® Wet ❑ Dry
Additional Standpipes N/A
information: Hazard Group Light
Density 0.1
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 500.00
B. T I Hood Fi;-e Suppression System
Hood t);,,;e-T Vaiu 1.*.(,:1: — j $
C.) Fire Manta
Submittal shall Battery Calculations ❑ Yes —
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ —
D.) Residential Sprinkler(Stand Alone System)
Square Footage: Permit 1-ee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A,B &C above): $ 500.00
_ Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (8% of permit fee): $
_ FLS Plan Review(40% of permit fee): $
TOTAL: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
"New"fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer,or NICET level"3" technicians.
I:`BuildineennitsFPS-PermitApp.doc 03;23/06 440-16131(11.02COM/WEB)
RECEIVED
City of Tigard Permit No.: F75aa j 5"--UcacJ 2c,
. ll Blvd.,Tigard,OR 97223 /g/
$ Phone:13125 SW 503Ha.718.2439 Fax: 503.598.1960 FEB 18 2015 Date Received: Q2/ /S
Inspection Line: 503.639.4175
I' Internet: www.tigard-or.gov 1"I'Y 01'T1tAKU By. Q rAvdrAi T --
FIRE SPRINAFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Pactruct Business Center - Perlo Construction Occupancy:
Job Address: 16101 SW 72nd Ave. Type of Construction:
Suite: 200
Contractor: Delta Fire, Inc. Phone: 503-620-4020
Number of Proposed or Altered Heads: 3
Type: Wet Hazard: Light Density: 0.1
1, Heidi Scarbrough Oregon Construction Contractors Board No. 64174
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 docu ent with copy of the sketch attached shall be available for all inspections.
Signature: Date: 2-18-15
Print Name: Heidi Scarbrough
I:\Building\Forms\FireSprinkIerAffidavit_071514.docx Page 1 of 1
RECEIVED
FEB 1 S 2015
CITY OFTIGARD
BUILDING DIVISION
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PLOT PLAN
SCALE - 1/16" = 1`-0"
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
16101 SW 72ND AVE 200, TIGARD, OR, 97224
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2015-00026
Chip Barnett
Violation Summary:
Inspector Contractor