Permit j'-' .1151'.''':'-'11 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1 ': COMMUNITY DEVELOPMENT Permit#: FPS201500176
t` ri 13125 SW Hall Blvd,Tigard OR 97223 503 718 2439 Date Issued: 11/03/2015
TIGARU. Parcel: 2S112DA01400
Jurisdiction: TIGARD
Site address: 15350 SW SEQUOIA PKWY 105
Project- Jessica Conwell,PsyD Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description• Fire sprinklers for new TI Relocate(1)sprinkler head
Contractor WYATT FIRE PROTECTION INC Owner: PACIFIC REALTY ASSOCIATES
9095 SW BURNHAM ATTN N PIVEN
TIGARD, OR 97223 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE 503-684-2928 PHONE
FAX 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/03/2015 $53 78
12%State Surcharge-Building 11/03/2015 $6 45
Type of Use: COM Plan Review-Fire Life Safety-COM 11/03/2015 $21 51
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0 50(up to 11/03/2015 $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 $85.24
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation $558 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 N. a ion Cen- Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy of the rules
or di -ct questions to OUNC b c- ,g 503 232 1987 or 1 800 332 2344
I-.sued By: k , / / Permittee Signature:
i
Call 503.639.4175 by 7:00 a.m.for the next available inspection .. e.
This permit card shall be kept in a conspicuous place on the job site until completion o the project
Approved plans are required on the job site at the time of each inspection.
Building Permit Application �{T
Fire Protection System RECIE F��� FOR OFFICE usE ONLY
City of Tigard Received. // 3//S A., Permit No. 1:15a(tJ-....pp/7 -
q 13125 SW Hall Blvd.,Tigard,OR 97223'/ 1 2015 Plan Review 6(4 be,/ 3 3
' I: Phone: 503.718.2439 Fax: 503.598.1960 Date/By Other Permit: DO O
TIGARD' Inspection Line: 503.639.4175 g d (A Date Ready/By: tuns El See Paget for
>;§= Internet: www.tigard-or.gov �i n i UT It nunnu Notified/Method: Supplemental Information
OM PING 1iWiStiON
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.
dwelling Valuation: $
❑ I-and 2-famil y g ®Commercial/industrial
❑ 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:15350 SW Sequoia Pkwy New dwelling area: square feet
City/State/ZIP:Portland,OR 97225 Garage/carport area: square feet
Suite/bldg./apt.no.:105 Project name:Jessica Conwell PSYD PC 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.: Penult 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.
Relocate Fire Sprinkler head away from light Valuation: $$558.00
Existing building area: square feet
New building area: 0 square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: I
Name: Type of construction: Il-B
Address: Occupancy groups:
City/State/ZIP: Existing: Light Hazard
Phone:( ) Fax:( ) New: ii
® APPLICANT ® CONTACT PERSON NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ashley Nishihara 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.nishihara @wyattfire.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection (Please refer to fee schedule,
Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application)
CCB lic.:64077 Total permit fees:
Amount received: 85.24
Authorized signature: ' �/'
i, This permit application expires if a permit is not obtained
Print name:Ashley Nishihara Date: 11/3/2015 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1\Budding Wermts\FPS-PennnApp doc Rev 01/05/2012 44046t3T(1 I/02/COMJWEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
El Addition ® 1-10 heads: No plan review required.
® Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 1
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 0.10
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 558
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.
W\Max\Permit Applications\Tigard App doe 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
15350 SW SEQUOIA PKWY 105, TIGARD, OR,
97224
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2015-00176
Chip Barnett
Violation Summary:
Inspector Contractor
-' City of Tigard Permit No.: 1P'J 3O6---CEO/7(0
13125 SW Hall Blvd,Tigard,OR 97223
II _ Phone: 503.718.2439 Fax: 503.598.1960 Date Received: (t 3 f/`'
TIGARD` Inspection Line: 503.639.4175 ��r
Internet: www.tigard-or gov By: ,1P 'r7'k(rTn
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
NOV 3 2015
OR TENANT IMPROVEMENTS
CITY OF riGARD
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) WOOING DW9 ®
Project Name: Jessica Conwell PSYD PC Occupancy: Light Hazard
Job Address: 15350 SW Sequoia Type of Construction: IIB
Suite: 105
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: 1
Type: SSP-QR Hazard: Light Density: 0.10
I, Ashley Nishihara, 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 document with a copy of the sketch attached shall be available for all inspections.
Signature:)5 1 v. Date: 11/3/2015
Print Name: Ashle Nishihara
I.\Building\Fonns\FireSprinklerAffidavit_071514 docx Page I of 1