Plans City of Tigard Permit No.: t5 Oa f Q/
n 13125 SW Hall Blvd.,Tigard,OR 97223 / /
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: /'� 7 /5
Inspection Line: 503.639.4175
TIGARD
Internet: www.tigard-or.gov By:
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIO ECEV
Ep
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) DEC 7 2015
CITV
GARD
BULDINT
Project Name: PCC - Bunce Palmer TI Occupancy:
Job Address: 6650 Redwood Lane Type of Construction:
Suite: #310
Contractor: Delta Fire, Inc. Phone: 503/620-4020 x 118
Number of Proposed or Altered Heads: 3
Type: Wet Hazard: Light Density: •1
1, Delta Fire, Inc. 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.
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: /1174A/11O\ J� `E�"�1---_ Date: 12-07-2015
Print Name: Melissa Boughton
I:\Building\Fonns\FircSprinklerAffidavit_071514.docx Page 1 of 1
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DElT_,
6650 REDWOOD LANE#310,PORTLAND,OR 97224 FIRE, INC.
TITLE SUITE #310 FIRE SPRINKLER n FIRE PROTECTION CONTRACTORS
DATE 12/4/2015 SCALE 1/8" = 1'-0` SHEET 1 OF 1 14795sw 72n0 PORTLAND,OR 97224 (503)620.4020