Permit (31) CITY OF TIGARD111 'IN FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00124
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/26/2016
Parcel: 2S 113AB00101
Jurisdiction: Tigard
Site address: 16101 SW 72ND AVE 140
Project: Perlo Construction Subdivision: None Lot: None
Project Description: Fire sprinklers-Relocate(8)heads for TI
Contractor: CROSSFIRE SPRINKLER CO Owner: PACIFIC REALTY ASSOCIATES LP
17400 SE 82ND DR ATTN: N PIVEN
CLACKAMAS,OR 97015 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-210-5506 PHONE:
FAX: 503-210-5538
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/26/2016 $80.68
Type of Use: COM 12%State Surcharge-Building 07/26/2016 $9.68
Plan Review-Fire Life Safety-COM 07/26/2016 $32.27
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 07/26/2016 $1.00
Occupancy Grp: Height: ft 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 $123.63
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,523.00
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 gerLsstions td QUNC b callingll503.232.1987 or 1.800.332.2344.
Issu d By: /J( 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.
City of Tigard Permit No.: fPit,-o0 la 7"
13125 SW Hall Blvd.,Tigard,OR 97223
g ��Phone: 503.718.2439 Fax 503.598.1960 Date Received:
r 1 t 4: G7 Inspection Line: 503.639.4175
Internet: www.tigard-or.gov By: (v,�)
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS OFFICE COp►y
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Perlo Office Remodel - Bldg A Occupancy: Office
Job Address: 16101 SW 72nd Ave Type of Construction:
Suite:
Contractor: Crossfire Sprinkler Company Phone: 503 210 5506
Number of Proposed or Altered Heads: 8
Type: Recessed Pendent Hazard: Light Density: •10
I, Crossfire Sprinkler Company Oregon Construction Contractors Board No. 174746
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 t ection system permit.
• A copy of is docu • j With a cop the ketch attached shall be available for all inspections.
p•
Signature: /�� 1 Da L I..
te: 1 I vv
Print Name: Timothy A Bishop - President
I:\Building\Forms\FireSprinklerAffidavit_071514.docx Page 1 of 1
Building Permit Application
Fire Protection System y .� FOR OFFICE USE ONLY
t� $ Received
City of Tigard 1 v La 1, _, Permit No.: ,
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: J//Z if A ri�/(o.,d(j !a
Plan Review
Phone: 503.639.4171 Fax: 503.598.19,4(UL 21 2016 Date/By: Other Permit: &Le�.o/i,QQ!74,
T[G A R D Inspection Line: 503.639.4175 Date Ready/By: /�/ Juris: I ® See Page 2 for
Internet: www.tigard-or.gov 3 ' Notified/Method: (il 'QIP
jr ,T • Supplemental Information
z <A� la tr r / - r7MiWITI,Wetwv I, � I
❑New construction 0 Demolition of the
work perfomied.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 Other: equipment, overhead,
�M � ��e; �� • ; � 3 � /pct;,
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
❑Accessory building 0 Multi-family ' ' "
❑Master builder 0 Other: Number of bathrooms:
Job site address:16101 SW 72"d Ave New dwelling square
City/State/ZIP:Portland,OR ,
ort area: square feet
Suite/bldg./apt.no.: Project name:Perlo Office Remodel-A Covered,, square
Cross street/directions to job site: -
ck area: square feet
Other structure area: square feet
idt Ia •'t,.E aI C i'
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
`'' ';'"'i'i'"'- [t t%f t i work indicated on this a..lication.
Relocate Existing Sprinkler Heads into new ceilings to maintain proper coverage • 00
Existing building area: square feet
New building area: square feet
Name: Type of construction:
Address:
Occupancy groups:
City/State/ZIP:
Phone:( ) Fax:( )
Business name:
All contractors and subcontractors are required to S.
Contact name: •. , 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
Phone:( ) I Fax::( )
E-mail: %Iw‘o-iN-/' Fa2E'P21r- teQ.- C, (V'
il'�>3 `'
Business name:Crossfire Sprinkler Company •
Address: 17400 SE 82"1 Drive Permit fee:
City/State/ZIP:Clackamas,OR 97015
State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)210-5506 Fax:(503)210-5538 (Due upon application)
CCB lic.:174746 / Total permit fees:
Authorized signature: / Amount received: —��'
�-`� ,, This permit application expires if a permit is not obtained
Print name:Timothy A Bishop Date:7/21/16 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp.doc 10/01/09 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
1.) ❑ New 2.) Modification to sprinkler heads only
El Addition ® 1-10 heads: No plan review required.
Alteration ❑ 11+ heads: Plan review:equired.
❑ Repair
Number of sprinkler heads:
Additional description of work ,,, \, ,,,‘ 7,,,,,, .,7t,1 ,,i ,.1 ,, ,,,i,,f,i, , 7tillif::::::,:iiit';':-.:-.,, ,.:...!,y,f,,,::,!,:ii:::1:,i:.
:
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,, ,,,asereirf;, (4,1!" ,t,4"tef.*:--sof\ lb,\ 1111111tz qc::: 0.21,,,',.4, .,i:0.‹.iig6'--:-!,,',"%f,'''''N'a'' —
® Wet ❑ Dry
Additional Standpipes
Information: Hazard Group Light Hazard
Density .10
Design Area 1500
K. Factor 5.6
Sprinkler 7,,,,,,,,,,:::::,::,,, ,,, aluation: $ 1523.00
�t t tit Ott `
,,,,,,
Hood Project Valuation: $
..,,�,..2, .,;;:.. it�..<..' ..; ;�„ `;�. y4,,•• f cia...\.. "`-�\ ,. .
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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 eater \
gr $404.39 �'
Sprinkler Project Square Footage: sq. ft.
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% of permit fee): $
FLS Plan Review(40% of permit fee): $
TOTAL: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
C:\Documents and Settings\CAD\My Documents\Permits\tigard permit.doc 10/01/09L