Permit (9) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 .' COMMUNITY DEVELOPMENT Permit#: FPS2016-00147
T fGAy 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/01/2016
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 215
Project: Home Mortgage Alliance Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Fire alarm:Adding(3)and relocating(2)notification appliances. Affidavit submitted.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE: 503-624-6300
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/01/2016 $102.20
12%State Surcharge-Building 09/01/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 09/01/2016 $40.88
Class of Work: ALT Type of Const: Misc Administration Fee 09/01/2016 $2.00
Occupancy Grp: Height: ft Hourly Building Rate 09/01/2016 $180.00
Stories: Hourly Building 12%State Surcharge 09/01/2016 $21.60
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: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $358.94
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,000.00
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 q ions—to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: ..._.1 .-2L0,..4/./A..4.16.: XPermittee Signature`--� /
--� ic..s._ J
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 Applic l\
irr
Fire Protection System `'
Y °FOIi OFFICE USE ONLY
City of Tigard AUG 31 2016 Received ,k-
'ih
Date.B / iffJr PermitNo.: tl�+J SO a l'
= 13125 SW Hall Blvd.,Tigard 0 t.,23 Plan Review
Phone: 503.718.2439 Fax: 51' Jt IS:,rA. a /
Date/B
TIGARD
Inspection Line: 503.639.41 1 Ib a Iit h. Date Read!B : _ . See Page 2 for
p l3E_lILJIt -)IVIS,Ct $ y y
Internet: www.ttgard-or.gov Notified/Method: II% Supplemental information
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.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessorybuilding 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
.JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:6650 SW Redwood Lane New dwelling area: square feet
City/State/ZIP: Portland,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.:215 Project name:Home Mortgage Alliance 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.
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.
Fire Alarm-notification devices Valuation: $3000
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER LE TENANT Number of stories:
Name:Home Mortgage Alliance Type of construction:
Address:6650 SW Redwood Lane#215 Occupancy groups:
City/State/ZIP:Portland,OR 97224 Existing:
Phone:(503)558-1009 Fax:( ) New:
Cs APPLICANT 0 CONTACT PERSON NOTICE
Business name:Point Monitor Corp. All contractors and subcontractors are required to be
Contact name:Brooke Williams licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:5863 Lakeview Blvd.Suite 100 jurisdiction in which work is being performed,if the
City/State/ZIP:Lake Oswego,OR 97035 applicant is exempt fromlicensing,the following reasons
apply:
Phone:(503)627-0100 Fax::( )
E-mail:bwilliams@pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Point Monitor Corp. (Please refer to/ee cchedule)
Permit fee:
Address:5863 Lakeview Blvd.,Suite 100
State surcharge(12%of permit fee):
City/State/ZiP:Lake Oswego,OR 97035
FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( ) (Dur:upon application submittal.) 1
CCB lic.: 135901 Total permit fees: ,/5 `7'3 r/
! Amount received:
Authorized signature: �-
_ ro This permit application expires If a permit is not obtained
Print name:Ben Breit Dater$/30/16 within 180 days after it has been accepted as complete,
* Fee methodology set by Til-County Building,industry
Service Board.
1:Buitding`d'ermitslFPS-lk neApp_031010.Ow 440-40131311'02'C'OMlWEB) + ��
35g, 71
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: 5
® 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:
Tae of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler SupplyLine 0 Yes 0 No
I-lazard Group
Density-
Design Area
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 0 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 on square footage (see D above): $
State Surcharge (12%of permit fee): $
FLS Plan Review(40%of permit fee): $
TOTAL: $
<::Atisers1tiamr\tkslktopvPERMI't 1 C)lt\IS ITS_hcrmit:App.'figard.doc 2
RECEIVED
City oJ'Tigard G 31 2016 Permit No.: riPa20d
111 44 13125 SW Rall Blvd.,Tigard,OR 97 ��
L Phone: 503.718 2439 Fax 503,5..9,y60,,,,- Date Received: 7/311/6
Inspection Line: 503.639.4175 Y r 1 I .J r,H i s
T1GARL Internet: wxtw.tigard-or.gov BUILDING i)i\/tS°f)N By: ,
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Home Mortgage Alliance Occupancy: Same
Job Address: 6650 SW Redwood Lane Suite: 215
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $3,000
Type of System: (check one) [Required [ Non-required
(check one) *Automatic [Manual EBoth
Total number of devices added or moved under this permit process is S total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added (max 5) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(nax 5) /To be Relocated on.,5)
Number of Proposed Notification Appliances: To be Added (max 5) /To he Relocated(max 5)
1, Ben Breit Oregon Construction Contractors Board No. 135901
certify the following is true and defines the scope of work for this project:
a) All work complies with the current state-adopted NEPA-72 and the authority having jurisdiction.
b) All notification appliances are located in accordance with the current state-adopted NEPA-72.
c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having
jurisdiction.
d) Exposed wiring will not be covered until inspected.
e) Final approval shall be subject to on-site tests and inspections.
f) Voltage drop is adequate to operate all appliances.
g) Battery supplies are capable of supporting the system modifications.
h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications.
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.
• Electrical permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature: (52 w. Date: 8/30/16
Print Name: Ben Breit
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