Permit „ CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 it •' COMMUNITY DEVELOPMENT Permit#: FPS2015 00090
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/26/2015
Parcel: 2S101AD03200
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: Fire alarm,addition of(5)devices.Early am inspection fee paid.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE 503-627-0100 PHONE: 503-624-6300
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/26/2015 $102.20
12%State Surcharge-Building 05/26/2015 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 05/26/2015 $40.88
Class of Work: ALT Type of Const: Hourly Building Rate 05/26/2015 $180.00
Occupancy Grp: Height: ft Hourly Building 12%State Surcharge 05/26/2015 $21.60
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 $356.94
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,200.00
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, work is s -nded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Center. Tho e . :s are set forth in OAR 952-001-0010 through OAR 952-00 ;190. ou may obtain a copy of the rules
or rect questions to OUNC by c- g 503 1987 or 1.800.332.2344.
I ,
Issued By: �// _ 1 A Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspecti• ••
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 AECEIVEU f o/5-00O%
Permit No.:
11111
" 13125 SW Hall Blvd.,Tigard,OR 97 i
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 6I,61/5
I i.i Inspection Line: 503.639.4175 MAY 21 2015 I
Internet: www.tigard-or.gov By:
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name:P(Ii i, 'v Ca✓-P afroo. Cf/'14J'v1 GG�Occupancy:
Job Address: I %� l a Q i°V-4 V '/ Suite: ) I
Contractor: pd ( t' -- vo C ki I lirtt Phone: l0 3-a,)7- O/PO
Valuation of work: $ 2 2-0 C)
Type of System: (check one) IgiRequired ❑Non-required
(check one) [Automatic EManual ❑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(m.x5) /To be Relocated(max5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) .5 /To be Relocated(max 5) 0
I,( /til( Trgia/C4-A-----v Oregon Construction Contractors Board No. ( 5 5
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 this document with a copy of the sketch attached shall be available for all inspections.
Signature: / , Date: V.tk//____)
,
Print Name: /77M7/ Tv /oe q
I:\Building\Forms\FireAlannAffidavit 071514.docx Page 1 of 1
Building Permit Application
Fire Protection System
City of Tigard KEIVEI Received ./mit OFFICE USI' O\l 1
;� 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: V ' f / J pe No.: /� `�� �f7
s Phone: 503.718.2439 Fax: 503.598.1960 Plan Review G�
Inspection Line: 503.639.4175 d 1 2015 Date Re Other Permit I:Page 2 r
1 I I) Date Ready/By: Mris: I H See Page 2 for ` "'D 1F
Internet: www.tigard-or.gov Notified/Method:
Supplemental Information
e6 " C 4I - e " p
ti ; r ti .i ',t Ps *)M' ' `
", . .# 41. r , d , : { . 1f ;•s4��),£�❑New construction ❑Demolition
Permit fees*are based on the value of the work performed.
�1 Addition/alteration/replacement Indicate the value(rounded to the nearest dollar)of all
.• ❑Other equipment,materials,labor,overhead,and the profit for the
1:
w ; work indicated on this application.
!4 i E
❑ 1-and 2-family dwelling 1 'mmercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder
❑Other: Number of bathrooms:
ar. ;'x ` t•s�-;,,y ,,~ ORhf.kTf4'k •ThT) I OCATJO1 `,,,
Total number of floors:
Job site address:
/ '' l V t,/, 'J New dwelling area: square feet
City/State/ZIP: Garage/carport area:
square feet
Suite/bldg./apt.no.: l Project name: it, L; :�
.�aicc4rA Covered porch area: square feet
Cross street/directions to job site:
If
Deck area: square feet
Other structure area: square feet
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
Tax
{ t t a tr t '�'t„ � wr y, equipment,materials,labor,overhead,and the profit for the
°°a .' .ry a€ .1. (1 t work indicated on this application.
., tea r a..
1
ac% /J Valuation: $
Existing building area: square feet
.zS
New building area: square feet L` �: E F :4 , �a �, �k E,4,ta ��%
Number of stories:
Name: v o , a .e, a if 0 ll , � 0 i!/I /✓j Type of construction:
Address: • 0 Gj ` / / / iffiffeliMamin
' , Occupancy groups:
City/State/ZIP: 1.--,1 61/7 ' '7� MEMO Phone:( ) ( )
New:
Existing:
Fax
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Business name: a; 7 �� i "t ,y fe r a ox 1� ' r .
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All contractors and subcontractors are required to be
Contact name: / V / i licensed with the Oregon Construction Contractors Board
Address: f / (/ under ORS 701 and may be required to be licensed in the
Y�I i.% jurisdiction in which work is being performed.If the
City/State/ZIP: p / dlifat>C< / o i- ,= .70 - c applicant is exempt from licensing,the following reasons
apply:
Phone:
( U ) // -a / 0 0 Fax: :( )
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a
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Business name: °D I / 0 J` V Olam t Es _ l.
Address: / 3 LG( � VI PiG� �/ Permit fee:
City/State/ZIP: . 611,1,../..4a-- I- / f� -7 U State surcharge(12%of permit fee):
Phone:(90 a _ ! P Fax:( )
FLS plan review(40%of permit fee):
CCB lic.: 6.2 j (Due upon application)
Total permit fees:
Authorized signaturrpi / Amount received:
[[��// This permit application expires if a permit is not obtained
Print name: ^T6 /I/ `"T P /- I Date: 6/4 r r 5 I within 180 days after it has been accepted as complete.
l( HI/ [ r IJ { * Fee methodology set by Tri-County Building Industry
Service Board.
1:Building}Permits�FPS-PennitApp,doc Rev O1/05/2012
440-4613T(i1/02/COM/WEB)
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
998 Alarm Final
PASS - No C of O
FPS2015-00090
Chip Barnett
Violation Summary:
Inspector Contractor