Permit 111 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 3 COMMUNITY DEVELOPMENT Permit#: FPS2015-00075
Date Issued: 04/27/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112AA00300
Jurisdiction: Tigard
Site address: 14200 SW 72ND AVE
Project: Gerber Subdivision: MILLMONT PARK Lot: 49
Project Description: Add(2)fire sprinkler heads in CCM room
Contractor: WYATT FIRE PROTECTION INC. Owner: ASGARD LLC
9095 SW BURNHAM BY GERBER LEGENDARY BLADES
TIGARD, OR 97223 14200 SW 72ND AVE
PORTLAND, OR 97223
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 04/27/2015 $67.23
12%State Surcharge-Building 04/27/2015 $8.07
Type of Use: COM Plan Review-Fire Life Safety-COM 04/27/2015 $26.89
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 04/27/2015 $6.50
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 $108.69
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,066.00
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• - •• • OUNC by calling 503.232.1987 or 1.800.332.2344.
Is ued By: / / Permittee Signature: A
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 ••'he pro ct.
Approved plans are required on the job site at the time of each inspection.
City of Tigard RECEIVED
Permit No.: �i O/"- e7`�
• 13125 SW Hall Blvd.,Tigard,OR 97223
II Phone: 503.718.2439 Fax: 503.598.106PR 2 7 2015 Date Received: 9/2.77/5
1 I t n It i) Inspection Line: 503.639.4175
Internet: www.tigard-or.gov CITY OF TIGARD By:
BUILDING DIVISION
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Gerber CMM Room Occupancy: Ordinary 1
Job Address: 14200 SW 72nd Ave Type of Construction: IIIB
Suite:
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: 2
Type: SSP Hazard: Ordinary Haz. 1 Density: 0.15
I, Ashley Payne, Wyatt Fire Protection Oregon Construction Contractors Board No. 64077
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 with a copy of the sketch attached shall be available for all inspections.
Signature: h r. Date: 4/27/15
Print Name: Ashley Pa e
1:\Building\Forms\F reSprinklerAffidavit_07I514.docx Page 1 of 1
Building Permit Application
Fire Protection FOR OFFICE USE ONLY
Syste
mRECEIVED ® r
City of Tigard �B""d i ; a Permit No.: ' _�L ��I�►��]
II II • 13125 SW Hall Blvd,Tigard,07224 Plan Review
Phone: 503.718.2439 Fax: 50590.1460i 4U15 Date/B . Other Permit:
Inspection Line: 503.639.4 Date Ready/By: lures: ® See Page 2 for
TIGARD
Internet: www.tigard-or �Ty dF TIGARD Notified/Method: Supplemental Information
��lLpING DIVISION
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.
❑ I-and 2-family dwelling Valuation: $
® Commercial/industrial
❑Accessory building ❑ Multi-family Number of bedrooms:
❑Master builder CI Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:14200 SW 72"d Ave New dwelling area: square feet
City/State/ZIP:Tigard,Oregon 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Gerber CMM Room 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
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.
Add 2 fire sprinklers in CCM room Valuation: $$1,066.00
Existing building area: square feet
New building area: 0 square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: Ordinary I
Phone:( ) Fax:( ) New:
® APPLICANT 0 CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ashley Payne licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham Rd jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)684-2928 Fax::(
E-mail:a.payneCwvattfire.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection (Please refer to fee schedule)
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application)
CCB lic.:64077 Total permit fees: jj�
Amount received: log, (Q?
Authorized signature:A,
This permit application expires if a permit is not obtained
Print name:Ashley Payne Date:4/27/15 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\BuildinemnitsTPS-PemtitApp.doc Rev 01/052012 440-4613T(I1/02/COM/WEB)
L
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.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 2
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes 0
Information: Hazard Group Ordinary 1
Density 0.15
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 1066
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: $
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: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
C:\Users\Ashley\Desktop\Permit Applications\Tigard App.doc Rev 01/05/2012 2
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
14200 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Fire Protection System
910 Sprinkler rough-In
PASS
FPS2015-00075
Jeff Grove
Violation Summary:
Inspector Contractor
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
14200 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2015-00075
Jeff Grove
Violation Summary:
Inspector Contractor