Permit ,1 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111 Y COMMUNITY DEVELOPMENT Permit#: FPS2015-00116
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/28/2015
Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Scholls Clinic Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Fire sprinklers-add(1)fire sprinkler head,remove(1)head and relocate(8)heads.
Contractor: CENTURION FIRE PROTECTION LLC Owner: PROVIDENCE HEALTH SYSTEM-OREGO
PO BOX 1705 ATTN: REAL ESTATE&CONSTRUCTION
OREGON CITY, OR 97045 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-593-9791 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/28/2015 $102.20
12%State Surcharge-Building 07/28/2015 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 07/28/2015 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 07/28/2015 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 07/28/2015 $9.00
11x17)
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 $166.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,935.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance. or if w is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notifi ion Cente . Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct estions to OUNC b c in. 503. 2.1987 or 1.800.332.2344.
Issued y: /
)11°...4 Permittee Signature: y A
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1111 City of Tigard Permit No.: �>i ' /5 �OO/�
• 13125 SW Hall Blvd.,Tigard,OR 97223 i
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 7 p$' /.
1 i; , �� n �
Inspection Line: 503.639.4175
Internet: www.tigard-or.gov By: ( n.. ...—_
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Pra )0/,ri c . X,"i / 0 0 Re-,,, O el,/ Occupancy: is
Job Address: /Z yY z _r t.✓ SCAo.//f 17,-,),, i Type of Construction: T; '- ///'I
Suite: f o o
Contractor: Cam..n,r(' f,•r 4 Ps..fi. b ,, Phone: ,s—o3_ 7 93 -- 9 7 4/
Number of Proposed or Altered Heads: 8'
Type: Hazard: f f Id
Density: . /oAr'.-) a
I, 5, `,7- 8CAr/f Y Oregon Construction Contractors Board No. Z a 11 8/ 'Z
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: . Date: 7/Z$ //
Print Name: Ri-� h t s -A._. r
I:1 Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1
Building Permit Application ,vI���,�TEp
Fire Protection System li I Ole t 11 t I( I I • 1\I
City of Tigard DatReceived 7✓ni Permit No j$-L'.0
q 13125 SW Hall Blvd.,Tigard,OR 97401_ 2 8 20 15 Plan Review
s Phone: 503.718.2439 Fax: 503.598.1960 Date/ : Other Permit:
T I G A 1 t> Inspection Line: 503.639.4175 ci l OF TIGARD Date Ready/By: Juds ® See Page 2 for
Internet: www.tigard-or.gov I T� � 1��Tnn. Notified/Method: Supplemental Information
BUILDING 1 r
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
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family
N umber of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12442 SW Scholls Ferry Rd. New dwelling area: square feet
City/State/ZIP:Tigard,OR Garage/carport area: square feet
Suite/bldg./apt.no.:Ste.100 Project name:Providence Ste 100 Remode Covered porch area: square feet
Cross street/directions to job site:SW Scolls Ferry Rd.&SW North Dakota St 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.
Add(1)fire sprinkler Valuation: $$2,935.00
Remove(1)fire sprinkler Existing building area: 25817 square feet
Relocate(8)fire sprinklers New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories: 2
Name:Providence Medical Group Type of construction: TYP-IIIA
Address: Occupancy groups:
City/State/ZIP: Existing: B
Phone:( ) Fax:( ) New:
0 APPLICANT ❑ CONTACT PERSON
NOTICE
Business name:Centurion Fire Protection All contractors and subcontractors are required to be
Contact name:Brent Barker licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:PO Box 1705 jurisdiction in which work is being performed.If the
City/State/ZIP:Oregon City,OR 97045 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)593-9791 Fax: :(
E-mail:brentbarker @centurionfirepro.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Centurion Fire Protection (Please rejermjeeschedule)
Permit fee:
Address:PO Box 1705
City/State/ZIP:Oregon City,OR 97045 State surcharge(12%of permit fee):
FI.S plan review(40%of permit fee):
Phone:(503)593-9791 Fax:( ) (Due upon application submittal)
CCB lie.:204812 ; /.g (1(r° Total permit fees:
Amount received: 4/66.39
Authorized signature:
This permit application expires if a permit is not obtained
Print name:Brent Barker Date:7-27-2015 within 180 days after it has been accepted as complete.
■ Fee methodology set by Tri-County Building Industry
Service Board.
I.\Building\Permits\FPS-PermitApp_071514.doc 440-4613T(I 1/01/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: 10 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
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 ❑ Dry
Additional Standpipes 0
Information: Hazard Group Light
Density .1
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: I $ 2,935.00
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: $
C:\Users\DeadElkl2\Documents\CENTURION FP DOCUMENTS\JOBS 2015\1529 Providence-Scholls(Inline CC)\AUTHORIZATION-PURCHASE
ORDER\FPS_PemritApp.docx
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
12442 SW SCHOLLS FERRY RD 100, TIGARD,
OR, 97223
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2015-00116
Chip Barnett
Violation Summary:
Inspector Contractor