Permit Zq CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00006
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/19/2016
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9779 SW WASHINGTON SQUARE RD D11
Project: Champs-Landlord Work Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Fire sprinklers-demo piping at mezzanine to be removed
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR WASHINGTON SQUARE LLC
9095 SW BURNHAM PO BOX B47
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE. 503-684-2928 PHONE.
FAX 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/19/2016 $56.47
12%State Surcharge-Building 01/19/2016 $6.78
Type of Use: COM Plan Review-Fire Life Safety-COM 01/19/2016 $22.59
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 01/19/2016 $6.00
Occupancy Grp: Height: N 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 $91.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation. $693.00
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 180days. 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 questions to DUNG by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:60 a.m.for the next available inspectil date.
This permit card shall be kept in a conspicuous place on thejob site untif'completion of the project.
Approved plans are required on thejob site at the time of each inspection.
Building Permit Application UD
Fire Protection System RECEIV L I I 4111311111411=�
City of Tigard Fm/i PenaitNo.:
Plan
an iie,v
DatelB .
•
Date Ready/By: 17
13125 SW Hall Blvd.,Tigard,()Rq�% 2 2016 Plan Review her Perrin:
DlelB
Ready/By:
'ifi= '
NotifiedNe had:
Phone 503.718.2439 Fax: 503.59 7t7 of
Inspection Line: 503.639.4175 Juns: 13 See Page 2 for
Intemet: www.tigud�.gov Cily oV I HARD Supplemental Information
Ali"11INVA
w"
TYPE"Or01,
REQUIRED DATA.I-AND 2-FAMILY DN04j0@7
El New construction ❑ Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/altmtion/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
E] i-and2-family dwelling 0 Commercial/industrial Valuation:
El Accessory building El Multi-family Number of bedrooms:
❑Master builder D Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9779&>KWashington Square Rd New dwelling area: square feet
City/State/ZEP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:DI I V'Dil. I Project name:Champs LL Work Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Odiff structure area: square feet
REQUIRED DATA.COMMERCL4L-USE CHECKLIST
Subdivision: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Dema piping at mezzanine to be removed Valuation: $$693.00
Existing building area: square feet
New building area: square feet
[3 PROPERTY OWNER [3 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: Ordinary I
Phone: Fax: New:
APPLICANT',. [0 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
applicant is exempt from licensing,the following reasons
City/State/ZIP:Tigard,OR 97223 apply:
Phone:(503)684-2928 Fax:
E-mail:si.nishihara(kwyattfire.corn
CONTRACTOR BUILDING PERMIT FEES*
ee sdieduk,
Pken mer as
Business name:Wyatt Fire Protection ( ill
Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) I Fax: (Due upon application.)
CCB lic.:64077 Total permit fees:
Amount received:
Authorized signature: k
J This permit application expires if a perml. not o twined
Print name Ashley Nishibara Date:1/12/2016 within 180 days after It has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board
1ARWIdmaT.im&7S-PemM,A. Re,011052012 4404613711 I!W/COMMEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1-10 heads: No plan review required.
® Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 4
Additional description of work:
T e of S 'tem' Com Tete A,B,C"or D as a' licable
ctal S nakler x
t
A. Commer
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
S rinkler Project Valuation: $
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 onsquare 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:A%Ia VPermit Applicatinns\Tigmd App.doc Rev 01/05/2012 2
City of Tigard Permit No.: P5a0 t to
• 13125 SW Hall Blvd,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: / / /(O
Inspection Line: 503.639.4175
Internet www.tigard-or.gov By: n[�RRy ]]jj
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIO>�S "{{��''EIVEP
OR TENANT IMPROVEMENTS JAN 12 2016
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) CITYOF N6ARI)
BUILDING DIVLSJOI
Project Name: Champs LL Work Occupancy: Ordinary 1
Job Address: 9779 &9�Vashington Square Rd Type of Construction:
Suite: Dll
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: e�
Type: Hazard: Ordinary 1 Density:
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
1 off this document with a copy of the sketch attached shall be available for all inspections.
Signature: X51A] 4' A4", Date: 1/12/2016
Print Name: Ashley Nishihara
I:\Building\FormsiFireSpinklerAfTdavit_071514.docx Page 1 of 1