Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 COMMUNITY DEVELOPMENT Permit#: FPS2015-00071
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/16/2015
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 190
Project: Professional Eye Care Associates of America Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Adding and relocating a total of(10)sprinkler heads. Affidavit submitted.
Contractor: WESTERN STATES FIRE PROTECTION Owner: PACIFIC REALTY ASSOCIATES
13896 FIR ST STE B ATTN: N PIVEN
OREGON CITY, OR 97045 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-657-5155 PHONE: 503-624-6300
FAX: 503-657-5182
FEES
Description Date Amount
Specifics: Permit Fee-COM 04/16/2015 $102.20
12%State Surcharge-Building 04/16/2015 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 04/16/2015 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 04/16/2015 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 04/16/2015 $0.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .10 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 $157.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,279.00
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 1.80 4.
Issued By: e e 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 FOK()Fri( I: l si: OMI.1
Received
City of Tigard DateB : ,II PermitNo.: �. sw tr _ ' AY
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 `` / Date/By: Other Permit: P. 6-:-....00
, i,, \It I, Inspection Line: 503.639.4175 600 Date Ready/By: Juris: ® See Page 2 for `'�/ i
Internet: www.tigard-or.gov V� �0�� Notified/Method: Supplemental Information
TYPE uF ‘% �?�P�� REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑De
�Q`' Permit fees* are based on the value of the work performed.
�`S Indicate the value(rounded to the nearest dollar)of all
jAddition/alteration/replacement dQ equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CO1tUCTION work indicated on this application.
❑ 1-and 2-family dwelling Commercial/industrial Valuation: $
El 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: 12°O t S(/.) G ff'A P,,,,k wq y New dwelling area: square feet
City/State/ZIP: T , OR 00 2 H / Garage/carport area: square feet
eAl., Suite/b1dg./apt.no.: lot Project name: Pti C y e � J 1 Covered porch area square feet
G 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
A / r.1...t.X.ZAk A)c,Pp � 13 Valuation: $ 227c1
V f ' 7 1 Existing building area square feet
New building area: square feet
G.
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
'‘.2C(e-z-Al
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: J e 'kV) 514,dyA 17 p 1._ All contractors and subcontractors are required to be
Contact name: �dSh M'� I , l licensed with the Oregon Construction Contractors Board
�+ t L._ under ORS 701 and may be required to be ftensed 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:(150'3) q S3_Li? Fax::( )
■
E-mail: 11
��hti(A. �r1n e In154. U S
CONTRACTOR BUILDING PERMIT FEES*
Business name: ,`Je4 r_ s F,� D� 1_ (Please refer to fee schedule.
V"`�� v'� °') Permit fee:
Address:
City/State/ZIP: gci b l� j 5.-.4t.t 70�/5 State surcharge(12%of permit fee):
DIe�4� , � l FLS plan review(40%ofpermit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lie.: Total permit fees: is--7.71
Authorized signature: 7�j ti , t144/ Amount received:
This permit application expires if a permit is not obtained
Print name: OA MIL. Date: y/)/ /15 * within 180 days after it has been accepted as complete.
i b/ Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_071514.doc 440.4613T(1 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 '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 ❑ D
Additional Standpipes /V0
Information: Hazard Group ti
Density O,lo
Design Area I 0
K. Factor
Sprinkler Project Valuation: I $ 2Z7\
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: I $
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): $
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: $
I:\Building\Permits\FPS_PecmitApp_071514.doc 2
City of Tigard , Permit No.: Fp,S / v
o S
13125 SW Hall Blvd.,Tigard,OR 97223 . Y"' ,`; _ �7`
■ Phone: 503.718.2439 Fax:
503.598.1960 ` J tQ M
Date Received: 17//1 Ins
inspection Line: 503.639.4175 6 I f( A K ' Internet: www.tigard-or.g ov 1 By: AO/W4/0094--v
() ;p
FIRE SPRINKL 1 i &VIT FOR ALTERATIONS
OR-TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Pr-c, � p Cti Occupancy: 6
Job Address: 12 C)Ccii 1..) GSA` Pci r k tAdev..1 Type of Construction:
Suite: NC)
Contractor: A) ,, ,,.1., J ,5 R- F'r, c,� Phone: TG? -Gf 3- Li 7 Lim
Number of Proposed or Altered Heads: 10
Type: (3R Hazard: 64A k- Density: G,«J
Oregon Construction Contractors Board No. ' C) %mod
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: 775),-, (JL1 . Date: 4/I ()/ 1 c
Print Name: o 5 L, M L
I:1 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
12909 SW 68TH PKWY 190, TIGARD, OR, 97223
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2015-00071
Jeff Grove
Violation Summary:
Inspector Contractor