Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
!NIa . ' COMMUNITY DEVELOPMENT Permit#: FPS2016-00091
T i G. RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/10/2016
Parcel: 2S 113AB00600
Jurisdiction: Tigard
Site address: 16125 SW 72ND AVE
Project: St.Jude Medical Center Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Installing(8)sprinkler heads for TI.
Contractor: DELTA FIRE INC Owner: PACIFIC REALTY ASSOCIATES LP
14795 SW 72ND AVE ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-620-4020 PHONE:
FAX: 503-620-1058
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/10/2016 $112.96
12%State Surcharge-Building 05/10/2016 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 05/10/2016 $45.18
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 05/10/2016 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .10 Design Area: 1500
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 $172.20
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $4,000.00
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ‘2..e0„......"0.•••: Permittee Signature: Liq
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.
Building Permit Application
Fire Protection System RECEIVED FOR OFFICE I.Sl:0y1.1
111111 City of Tigard III Dale/BReceivea /0 (a i.- Permit No.: I . , `.JI
13125 SW Hall Blvd.,Tigard,OR 97223 w/ O ZOIs Plan Review
Phone: 503.718.2439 Fax: 503.598.11 Date/B : Other Permit:ii4 /, f 0--
I I t ,\R I) Inspection Line: 503.639.4175 TIGARD Date Ready/By: ® See 'age 2(or '
Internet: www.tigard-or.gov CITY OF Notified/Method: II - Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
0 New construction 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
- CATEGORY OF CONSTRUCTION work indicated on this application.
0 1-and 2-family dwelling Commercial/industrial Valuation: $
❑Accessory building D Multi-family Number of bedrooms:
❑ Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site addressto G� -7 /761 I)-PeNew dwelling area: square feet
:
City/State/ZIP: or an) 1 ,_
Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 5-f-4 u di Cafe, 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 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.
1 rl Sft2// Q
OP U l'e4_ /-c Valuation: $/�00� 00
Existing building area: `�'t/ square feet
New building area: square feet
0 PROPERTY OWNER (TENANT Number of stories:
Name: $7, J�4/c1e-- Ca re-- Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
&APPLICANT 0 CONTACT PERSON NOTICE
Business name: /"17 el r I n C , All contractors and subcontractors are required to be
Contact name:/22 e,h S c I o h licensed with the Oregon Construction Contractors Board
L r 79.5 5 w 7 i c�/ under ORS 701 and may be being
be licensed in the
Address: l� jurisdiction in which work is being performed.If the
City/State/ZIP: /7Qr+land q 7 di) applicant is exempt from licensing,the following reasons
apply:
Phone:6-03) &ec - 1-0d-CDFax:
/�jFax�:(j/�) �^,�yj�
Email:�J 11 .YC,. b@- (ye
l k- S ` r l . ( uz '
CONTRACT OR = BUILDING PERMIT FEES*
�n, ,^_ ,� _ (Please rej�'to fee schedule
Business name: (�(�j Y►-•r
Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal)
CCB lie.: 77! 7 y Total permit fees: / V, Rt,
72,) 1,4,-
� Amount received:
Authorized signature:
�o This permit application expires if a permit is not obtained
Print name:ft i s- 0 /5�7 Date: 5-70 -/ Within 180 days after it has been accepted as complete.
h� "I * Fee methodology set by Tri-County Building Industry
Service Board.
1:Building Permits FPS-PermitApp 031016.doc 440-46131(1 102 CONI WEB)
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: 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 El 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
Sprinkler TypeWet ❑ Dry
Additional Standpipes "(111
-
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density •tQ
Design Area t
K. Factor
Sprinkler 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 1 _
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 P. otecton Pett Flees
Project valuation subtotal (see A,B & C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12`)/o of permit fec): $
FLS Plan Review (40% of permit fee): $
TOTAL: $
ABuilding\lknnits\I.PSPcrrnit\pp_(i111I6.doc 2
City of Tigard �,.y Permit No.: r 9/ "MO 9
13125 SW Hall Blvd.,Tigard,OR 97223 �,,7 C
' Phone: 503.718.2439 Fax: 503. �ldl �1 Date Received: n 4) /(o
InspectionLine: 503.639.4175
T1GAiD Internet: www.tigard-or.gov By: 6TD1(/ +
FIRE SPRI A' 146. IT FOR ALTERATIONS 1/
pal
i ,c,� NT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: St. Jude Care Center Occupancy: Light Hazard
Job Address: 16125 SW 72nd Ave. Type of Construction:
Suite:
Contractor: Delta Fire, Inc. Phone: 503/LI`a-O - L-0>0 1, 11q
Number of Proposed or Altered Heads: 8
Type: NC* Hazard: Light Density: ,10
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.
Signature: u ! Al ,_4111X11, 1,_Now
Date: 5/5/16
Print Name: Melissa Boughton
1:\Building\Fonns\FireSprinklerAffidavit_071514.docx Page 1 of 1
41 VIA)
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
16125 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2016-00091
Jeff Grove
Violation Summary:
Inspector Contractor