Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2015-00046
T f G AR 0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/23/2015
Parcel: 2510 1 AA00101
Jurisdiction: Tigard
Site address: 12000 SW 66TH AVE
Project: Landmark Ford Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Adding sprinkler tamper valve to existing fire alarm control panel. Affidavit submitted.
Contractor: ACTION TECHNOLOGY SYSTEMS LLC Owner: CORLISS, JAMES L&CORA K
835 SE 17TH AVE LEASE TO: FORD LEASING
PORTLAND, OR 97214 DEVELOPMENT COMPANY
PO BOX 23970
TIGARD, OR 97281
PHONE: 503-231-1992 PHONE:
FAX: 503-231-1402
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/23/2015 $51.09
12%State Surcharge-Building 03/23/2015 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 03/23/2015 $20.44
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 03/23/2015 $0.50
Occupancy Grp: Height: ft 11x17)
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 $78.16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $400.00
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 th- rules adopted b the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. ou ma obtai a co.y o' the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available i pection 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 ECE lV P Permit No.: FP,f p�l S— 0°0 (i7
13125 SW Hall Blvd.,Tigard,OR 9722
'' Phone: 503.718.2439 Fax: 503.598.1960 Date Received: Vka
I I( `i,i, Inspection Line: 503.639.4175 MAR 2 3 2015
Internet: www.tigard-or.gov By: ."-a j pll f / eArL—-
FIRE ALARM,§' ' $I VfFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: L_1_`v\d Occupancy:
Job Address: 1 -1010 (4,(j4-L five,. Suite:
Contractor: ,�c.hcw Jed-.4Aco5ti Phone:Valuation of work: $
Type of System: (check one) ❑Required ENon-required
(check one) EAutomatic ❑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 (max 5)
Number of Proposed Manual Alarm Stations: To be Added(max5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) ( /To be Relocated(max 5)
•
I, l-e_t V1, Oregon Construction Contractors Board No.
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 docu •nt wit ��• s y of 'e sketch attached shall be available for all inspections.
Signature: Date: ' ‘a/2 go I
Print Name: I L • /.e v
I:\Building\Forms\FireAlarmAffidavit_071514.docx Page I of 1
Building Permit Application
Fire Protection System OCVAN til FOR OFFICE USE ONLY
City of Tigard pew ,.j®�5 Permit No.. I-�.� •-/IS _ ! --
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
IIII 1 M Phone: 503.718.2439 Fax: 503.598.1960 } n 0 % 2015 Date/B Other Permit:
TIGARD
Inspection Line: 503.639.4175 +'^ Date Ready/Sy: Iii See Page 2 for
Internet: www.tigard-or.gov ��,p�1_ Notified/Method: > Supplemental Information
■ v l V -
TYPE OF 1 •Fli TRED 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 CONSTRUCTI work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION xf Total number of floors:
Job site address:12000 sw 66TH AVENUE New dwelling area: square feet
City/State/ZIP:TIGARD OR 97281 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Landmark Ford Covered porch area: square feet
Cross street/directions to job site:Haines Street 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.
Valuation: $ ,°-
Add sprinkler tamper valve to exisyting Fire Alarm Control Panel ADO
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
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
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax::( )
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
Business name:ACTION TECHNOLOGY SYSTEMS LLC (Please rejerto fee schedule)
Permit fee:
Address:835 SE 17TH AVENUE
City/State/ZIP:PORTLAND OR 97214 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)231-1992 Fax:( ) (Due upon application submittal.)
CCB lic.: 157630 Total permit fees: "7g-- to
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name:STEVEN A.BARRY Date:2/27/2015 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:WiuildingTermits\FPS-Permit App_071514.doc 440-4613T(11/02/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
Pi". system
❑ 11+ heads: Plan review required and El 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 ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: I $ . o 3
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
Sprinider 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: $
http://www.tigard-or.gov/document_ccnter/Building/i pS_PermitApp.doc 2
Mar 23 2015 1 : 17PM HP LASERJET FAX p. 1
RECEIVED
MAR 2 3 2015
CITY OFTIGARD
BUILDING DIVISION
•
TAMPER SWITCH TO NEW PAINT BOOTH
FIRE ALARM CONTROL PANEL
1P
SITE LOCATION; FIRE ALARM CONTRACTOR:
LANDMARK FORD ACTION TECHNOLOGY SYSTEMS LLC
12000 SW 66T" AVE 835 SE 17TH AVENUE
TIGARDOR 97281 PORTLAND OR 97214
CCB#157630