Report DEC. 14. 2015 4: 09PM PATRIOT FIRE VANC NO. 8257 P. 4
City of Tigard Permit No.: �PS go i S'no /C/
:13123 5w Hall Blvd.,Tigard,OR 97223
Phone: 503.718 2439 Fax; 503.598.1960 Date Received: ___I____/__ _________
I u,A1dt) Inspection Line: 503.639.4175
Inlemet www.tigard-or.gov By:
6:7)
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: '1� f c , a Occupancy:
Job Address: 7 �,�/V* • /V _ Type of Construction: ,___ __.g
Suite: a 1'10
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Contractor: Tb i r PA� . Phone: 86 , 6-1} .1.4 2
Number of Proposed or Altered Heads: L/
0 I-- /4 kr J. / d
Type: Hazard: Density:
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1, '� �"1`/`y Oregon Construction Contractors Board No. 1aQr-2D---
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 ofNFPA 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 doeent with a copy of the sketch attached shall be available for all inspections.
.rte •Signature: �� Date: --- 7�
Print Name: CIX ,'k Ef e
I:'Buildine\Forms\FireSpr:nklcrAffidavit^07!514 docx Pagc 1 of 1
DEC. 14. 2015 4:08PM PATRIOT FIRE VANC NO. 8257 P. 1
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