Plans City of Tigard Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223
s Phone: 503.718.2439 Fax: 503.598.1960 Date Received: /0/6/
to/
Inspection Line: 503.639.4175
TIGARD Internet: www.tigard-or.gov By:
RECEIVED
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS OCT 6 2015
OR TENANT IMPROVEMENTS CITY OF TIGARD
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) BUILDING DIVISION
Project Name: Immunogology Consultants Occupancy: a
Job Address: 15862 SW 72nd Ave Type of Construction: S 1,3
Suite: 150
Contractor: Delta Fire, Inc. Phone: 503/620-4020
Number of Proposed or Altered Heads: 2
Type: F3 Hazard: Light Density: • 1 / I CO17
1 Beverly Genung Oregon Construction Contractors Board No. 64174
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.
0 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.
Beverly Genung DpbiyapmebyBeroyDenmy 10/6/15
DN cn-Bawdy Ganuq.e�eXe f.e,wtc.ou.email-ue enycenane ccr r--u
Signature: Dais 2015IBBe 1345°a 0700 Date:
Print Name: Beverly Genung
I:\Building\Fonns\FireSprinklerAflidavit_07I514.docx Page 1 of 1
RECEIVED
I OCT 6 2015
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SYM. TYPE MFG./MODEL SIN# TEMP. SIZE FINISH CANOPY FINISH OTY.
SSU DXISTING SPRINKLER - 155F 1/2 BRS
PACIFIC CORPORATE CENTER
DELT • SSP RELIABLE F30R DRY PENDENT R5734 155F 1/2 CHROME REC CHROME 2
IMMUNOLOGY CONSULTANTS
15862 SW 72ND AVE,SUITE 150,TIGARD OR FIRE, INC.
TITLE FIRE SPRINKLER COOLER 11 FIRE PROTECTION CONTRACTORS
DATE 10/5/2015 SCALE 1/8" = 1'-0" SHEET 1 OF 1 14705 w.10, PORTLAND.OR 0722.1 (603)0201020
CONT. 15-5496 DRWN. DCG SYSTEM WET