Permit (102) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00035
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/25/2016
Parcel: 2S112DD00400
Jurisdiction: Tigard
Site address: 15940 SW 72ND AVE B17
Project: SCS Engineers Subdivision: None Lot: None
Project Description: Fire sprinklers-modification of(5)heads for TI
Contractor: WESTERN STATES FIRE PROTECTION Owner: PACIFIC REALTY ASSOCIATES L P
13896 FIR ST STE B 15350 SW SEQUOIA PKWY#300-WMI
OREGON CITY, OR 97045 PORTLAND, OR 97224
PHONE: 503-657-5155 PHONE:
FAX: 503-657-5182
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/25/2016 $67.23
12%State Surcharge-Building 02/25/2016 $8.07
Type of Use: COM Plan Review-Fire Life Safety-COM 02/25/2016 $26.89
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 02/25/2016 $4.50
Occupancy Grp: Height: It 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 $106.69
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,097.00
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 directqu UNC by c ,5O3�2321 987 or 1.800.332.2344. �J///
Issued y: ---'� Permittee Signature: `7/� / `W�—�
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.
Buildin Permit A licati � � �> �
Fire Protection System /
City of Tigard fig 2 5 2016 Date/ReceiB d� 7 PermitNo.: �
13125 SW Hall Blvd.,Tigard,OR 97 2 Plan Review
s Phone: 503.718.2439 Fax: 503.5 Date/By: other Permit: ��� j� �/opC>'`�
Inspection Line: 503.639.4175 clyf ov i'IGA�y D Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING ., , Notified/Method: Supplemental Information
❑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
work indicated on this application.
El1-and 2-family dwelling Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
Total number of floors:
Job site address: r f39 qp 6W 7 New dwelling area: square feet
City/State/ZIP: ` OR Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 5[5 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
Subdivision: Lot no.: 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
work indicated on this application.
A _ _ 1 S �� A)pp Valuation: $ )CM-7
��/l0 !V Existing building area: square feet
New building area: square feet
Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
Business name: All contractors and subcontractors are required to be
Contact name: -(� M + licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:(503 ) c S 3-- LJ7 � Fax::( )
E-mail: .D- ` (NS V 3
Business name: ,
Permit fee:
Address:
(� 4 1 �i State surcharge(12%of permit fee):
City/State/ZIP:
—1`7 FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.
CCB lic.: C 04 —7b Total permit fees:
,`'V,"` i/�„ Amount received:
Authorized signature: �/�,'��',f`� ,1J/
This permit application expires if a permit is not obtained
Print name: OS Date: Z/057/14 * within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board.
InBui)dingsPermilsiFPS-PermitApp_071514.doc 440-4613T(11�02,COMWEB)
City of Tigard Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: a S f
Inspection Line: 503.639.4175
Internet: www.tigard-or.gov By:
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS `� � �
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) FEB 2 5 2016
CITUITIF
i( �
Project Name: S �,�,.,! ��, Occupancy: "
Job Address: 0 iw `]2 n Type of Construction:
Suite:
Contractor: W us;rn 5WK,5 E^e Pr-cLh`oy) Phone: 503- +13 LO 4L}
Number of Proposed or Altered Heads:
Type: 5fto� Hazard: Lr,ki Density: , 10
I, josh ! 1 i��P,,i Oregon Construction Contractors Board No. I OLJ5'—7 6
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: _/V4, Date: 212 s_ll 4,
Print Name:
1:\Building\Fonns\FireSprinklerAffidavit_071514.docx Page I of 1
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
15940 SW 72ND AVE B17, TIGARD, OR, 97224
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2016-00035
Chip Barnett
Violation Summary:
Inspector Contractor