Permit (49) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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COMMUNITY DEVELOPMENT Permit#: FPS2015-00192
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/07/2015
Parcel: 2S 112AA01000
Jurisdiction: Tigard
Site address: 14100 SW 72ND AVE
Project: Williams Controls Subdivision: 1992-007 PARTITION PLAT Lot: 2
Project Description: Adding(1)sprinkler head and relocating(2)heads
Contractor: DELTA FIRE INC Owner: WILLIAMS CONTROLS INDUSTRIES INC
14795 SW 72ND AVE 14100 SW 72ND AVE
PORTLAND, OR 97224 TIGARD, OR 97224
PHONE: 503-620-4020 PHONE:
FAX: 503-620-1058
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/07/2015 $145.24
12%State Surcharge-Building 12/07/2015 $17.43
Type of Use: COM Plan Review-Fire Life Safety-COM 12/07/2015 $58.10
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 12/07/2015 $2.00
Occupancy Grp: Height: ft 1107)
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 $222.77
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $6,875.00
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 Notification Center. 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 questi NC by calling 503.232.1987 or 1.800.332.2344.
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Issued B Permittee Signature:
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.
Buildin2 Permit Applicatim
^Tn
Fire Protection System
VEIP FOR OFFICE USE ONLY
Received
City of Tigard nn r 7 2015 Date/B : .? , /S PermitNo.: $gyp/�"QOI
° 13125 SW Hall Blvd.,Tigard,OR 973 Plan Review
Phone: 503.718.2439 Fax: 50 6 Date/Bv: r' Other Permit:
• Inspection Line: 503.639.4175 L `f T�GARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigat-d-or.gov BUILDING i�p DIVISINotified/Method: Supplemental Information
TYPE OF WORK 9 N �1 Y1` 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.
$
El1-and 2-family dwelling X Commercial/industrial Valuation:
❑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:14100 SW 72nd Ave. New dwelling area: square feet
City/State/ZIP:Portland, Oregon 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Williams Controls 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.: Permit fees*are based on the value of the work performea.
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.
Adding 1 and relocating 2 sprinkler heads
Valuation: $6,875.00
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:1
Name:Williams Controls I Type of construction:
Address:14100 SW 72nd Ave. Occupancy groups:
City/State/ZIP:Portland, Oregon 97224 Existing:
Phone:( )503-684-8650 Fax:( )
New:
(K APPLICANT ® CONTACT PERSON NOTICE
Business name: Delta Fire, Inc. All contractors and subcontractors are required to be
Contact name:Melissa Boughton licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 14795 SW 72nd Ave. jurisdiction in which work is being performed. If the
City/State/ZIP: Portland, OR 97224 applicant is exempt from licensing,the following reasons
apply:
Phone:( 503) 620-4020 Fax: :(503 ) 620-1058
E-mail:melissab@deltafire.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: Delta Fire, Inc.
Permit fee:
Address: 14795 SW 72nd Ave.
State surcharge(12%ofpermit fee):
City/State/ZIP: Portland, OR 97224 FLS plan review(40%of permit fee):
Phone:( 503) 620-4020 Fax:(503) 620-1058 (Due upon application subiniltal.
CCB lie.: 64174
Total permit fees:
Amount received:
Authorized signature:
(/ This permit application expires if a permit is not obtained
Print name:Melissa Boughton Date:12-3-15 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PmnitApp_071514.doe 440-4613T(I 1/02/COM/WEB)
City of Tigard Permit No.: &W/9c;
a 13125 SW Hall Blvd.,Tigard,OR 97223 /
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: / 1711 6—
Inspection
Inspection Line: 503.639.4175 1
Internet: www.tigard-or.gov By: ��
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIO� ��9
OR TENANT IMPROVEMENTS DEC 7 ?
(Ito 10 SPRINKLER HEADS WITHOUT PLANS)
BUILD G' v
Project Name: Williams Controls Occupancy:
Job Address: 14100 SW 72nd Ave. Portland Type of Construction:
Suite:
Contractor: Delta Fire, Inc. Phone: 503-620-4020
Number of Proposed or Altered Heads: 3
Type: Wet Hazard: Light Density: -1
I, 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.
` 12-3-15
Signature: Date:
Print Name: Melissa Boughton
1:\Building\Fonns\FireSprinklerAffidavit_071514.docx Page I of I
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: 3 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
■❑ We ❑ Dry
Additional Standpipes
Information: Hazard Group Light
Density .1
Design Area
K. Factor 5.62
Sprinkler Project Valuation: $6,875.00
B. Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall BatteryCalculations ❑ 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): $6,875.00
Permit fee based on project valuation see fee schedule): $220.77
Permit fee based onsquare footage see D above): $
State Surcharge 12% of ermit fee): $
FLS Plan Review 40% of ern-lit fee): $
TOTAL: $222.77
C:AUsers\hcidis\Apel)ata\LocalV'I'cmpAI1 PS_PcrtTkApp.doc