Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IN COMMUNITY DEVELOPMENT Permit#: FPS2015-00078
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/30/2015
Parcel: 1 S136DA00101
Jurisdiction: Tigard
Site address: 11410 SW 68TH PKWY
Project: OREGON Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: Fire sprinkler-Add(2)heads for TI on the third floor.
Contractor: VIKING AUTOMATIC SPRINKLER CO Owner: OREGON, STATE OF PUBLIC
3245 NW FRONT AVE EMPLOYEES' RETIREMENT FUND
PORTLAND, OR 97210 11410 SW 68TH PKWY
TIGARD, OR 97223
PHONE: 503-227-1171 PHONE:
FAX: 503-227-1552
FEES
Description Date Amount
Specifics: Permit Fee-COM 04/30/2015 $86.06
12%State Surcharge-Building 04/30/2015 $10.33
Type of Use: COM Plan Review-Fire Life Safety-COM 04/30/2015 $34.42
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 04/30/2015 $3.50
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 $134.31
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,800.00
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
Utilit ification r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or rect questions to OUNC by calli • 503.232,1987 or 1.800.332.2344.
slued By: ' 4011.zA Permittee Signature: 40. --
•
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.
City of Tigard Permit No.: - 1 , 5 i 00
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.7182439 Fax: 503.598.1960 Date Received: e
, Inspection Line: 503.639.4175
Internet: www.tigard-or.gov By: .
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONNECEIVED
OR TENANT IMPROVEMENTS APR 3 0 2015
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
CITY OF TIGARD
BUILDING DIVISION
Project Name:-Fee , o tt Occupancy: oFFIt.
Job Address: 11'k c 4,1k Fit it..k ww ti Type of Construction:
Suite: 1?tc re_
Contractor: qt k„� Sri_ li tc Phone: $o3-ZZ-1 -t t'l
Number of Proposed or Altered Heads: Z
Type: \4g Hazard: 1%BHT Density: . 1°
■
I,"D,WE - v. ..,e„J Oregon Construction Contractors Board No. (0li83 )
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.
Signa `( — Date: 130 /c
Print Name:"Dtkgc w:Ev-- .tat
I:\Building\Forms\FireSprinklerAfdavit_071514.docx Page 1 of I
Building Permit Application
Fire Protection System RECEIVED I (lll Ill I It I I `NI I)\I 1
City Tigard np Permit No.:
1.11 .
13125,SW Hall Blvd.,Tigard,OR 97223 R 3 0 2015 �' � ,� 1,5g6/5.1•506
Phone: 503.718.2439 Fax: 503. O OF Da«heW Other Permit: C 1'O415'�/!g'
Inspection Line: 503.639.4175 r^r,
1 I t.,11:I) �_'•. " .- ` Date Ready/By: lug: 0 See Page 2 for
Internet: www.tigard-or.gov BUILD NC: 1 1 Notified/Method: Supplemental Information
it d�..• l.. i'YY�ft„ii
TYPE OF WORK REQUIRED DATA:1<-AND2 FAMIIw " KHG-
❑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 work indicated on this application.
❑ 1-and 2-family dwelling at ommercial/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: sRD New dwelling area: square feet
11�lD 5�.� �� �Q1cwq�� Rtob►z
City/State/ZIP..^�4a otcz.-� 6 Z- g-YLZ3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: pe 2S Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: 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.
Valuation: $ (Soc.
A vc ttEt*f O S IR5 1ScE 4:::. 'CL TEt-xien i
hMQ Ro%..)E IAA E.1.31— Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I 111 TENANT Number of stories:
Name: 'F,E¢ Type of construction:
Address: '+i4 to Sh.,v tgek T Qv W Occupancy groups:
City/State/ZIP:Tl ookr Q o2 S12Z3 Existing:
Phone:(sp-3) 33z._ ( ,te, Fax:( ) New:
ADAPrucANT CONTACT PERSON Niyl'ICE
Business name: V gLtr►X 4. 5rIT t l‘C (ER All contractors and subcontractors are required to be
Contact name: - vE ,IGR i.Etr�v, +� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: "tj2ls IT+. FQ4"..ST 140C jurisdiction in which work is being performed.If the
City/State/ZIP . ea_ ¶i tl c7 applicant is exempt from licensing,the following reasons
l r apply:
Phone:(y'a3) z.V) -l -?\ Fax::(503)ZZ7-1S5z
E-mail:D4.aL . le V.A A t.. 41 K t SP¢11..tL1�, 1,- --
CONTRACTOR 1 BUILDING PERMIF FEES"
Business name: \it le 1,....) t r. to tee
Mere
Permit fee:
Address: 1J W ~
State surcharge(12%of permit fee):
City/State/ZIP: 'Wiry k, .,..A- te 007._to FLS plan review(40%of permit fee):
Phone:(s-) l-)^ill I Fax:(�,, 2"L1 _ tSSQ (Due upon application submittal.)
CCB lic.: tolka3'1 Total permit fees:Authorized signa Amount received: /3 f. '?1
This permit application expires if a permit is not obtained
Print name. e . IJ�A-r Date: tk(sc, J within 180 days after it has been accepted as complete.
• Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permits\FPS-PermitApp_071514.doc 440.4613T(I 1/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Abe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
El New system Number of sprinkler heads: Z Number of alarm devices:
Addition or 7f 1-10 heads: Affidavit required and El 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
El 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 Systaem(Compile At B,C or D as applicable):
A.) Commercial Sprinkler
'Ft Wet ❑ Dry
Additional Standpipes
Information: Hazard Group tkr
Density . l0
Design Area
K. Factor S.(p
Sprinkler Project Valuation: I $ •
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: I $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
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: $
C:\Users\dave.bateman\Desktop\Permit Applications\City of Tigard\City of Tigard FPj'ermitApp.doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11410 SW 68TH PKWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2015-00078
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor