Permit (10) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
2Permit#: FPS2016-00166
COMMUNITY DEVELOPMENT
71TJCAfk D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/28/2016
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 190
Project: Integrity Medical Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Fire alarm-adding(2)devices
Contractor: ADVANCED SECURITY&FIRE Owner: PACIFIC REALTY ASSOCIATES I
14140 SW LINDA LN ATTN: N PIVEN
BEAVERTON, OR 97006 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-519-4550 PHONE:
FAX: 503-643-0848
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/28/2016 $51.09
12%State Surcharge-Building 09/28/2016 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 09/28/2016 $20.44
Class of Work: ALT Type of Const: Hourly Building Rate 09/28/2016 $180.00
Occupancy Grp: Height: ft Hourly Building 12%State Surcharge 09/28/2016 $21.60
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 $279.26
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $500.00
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: CI)
/^ Permittee Signature: gat j772171.6d
` -(� 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 ISE ONl.\
ReceivN ' CI of Tigard 3 2 8 2016 Date/Bed ` ppb V� /6133,026/6 �Q�l
`J g O Permit No.:
13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
_ Phone: 503.718.2439 Fax: 50,1q1 �1rq6�(1y t_1 ✓�f� Other Permit:
I'1 G A R D Inspection Line: 503.639.4175 t✓t i f V E" i 1( AA D Date/Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING 0IV S I O N Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
El 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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling 2Commercial/industrial Valuation: $ 50O "
ElAccessory building ElMulti-familyNumber of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 66.56 SL13 /Pad w Oi!,a 61.n, New dwelling area: square feet
City/State/ZIP: Port 1,,,,,f? OR 9, 79 Li Garage/carport area: square feet
Suite/bldg./apt.no.: /go Project name:1 r 10 y r j 7y fr)e of;CA,l Covered porch area: square feet
Cross street/directions to job site: RIA r /oJ;rts * 1/4-).0/4 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.
/701 O[ o) ila r, 1 ,Vrobe S Valuation: $
Existing building area: square feet
New building area: square feet
Er..,P,PROPERTY OWNER 0 TENANT Number of stories:
Name: /19.0 Ttt s./... Type of construction:
Address:/ Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: 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:( ) Fax::( )
E-mail:
CONTRACTOR L �^ BUILDING PERMIT FEES*
Business name: /Pol y4 need s e C, - r,11y A F- /Pe (Please refry to fee schedule)
, 7 e O Permit fee:
Address: /1.4l J/ 5 w' x. i n d A •) n
State surcharge(12%of permit fee):
City/State/ZIP: j3 9 1, .1q 0 n 0/ q ) )O
FLS plan review(40%of permit fee):
9...1.45-51)Phone:(5C)3, S I Fax:( ) (Due upon application submittal.)
CCB lic.: j-9-64 673, /44,176 Total permit fees:
Authorized signature: `,f _ -�``��^ Amount received: �7 2.a`�°
,, -- (,�G�� This permit application expires if a permit is not obtained
Print name: DA v f ci M 0 r' v 1 k Date: b1„2 61 I within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
t:\Building\Pevnits\FPS-PermitApp_03I016.doc 440-4613T(I 1/02/COM/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 ❑ 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 Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard 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 ❑ 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: $
I:\Building\Pemrits\FPS_PermitApp_031016.doc 2
City of Tigard PermitNo.: f/ cvas /13125 SW Hall Blvd.,Tigard,OR9CEIVEp
Phone: 503.718.2439 Fax: 503.598. Gip Date Received: � d�/4
T I G A R D Inspection Line: 503.639.4175 2 2 Q
Internet: www.tigard-or.gov By: s
CITY OF T1GAhi[ `-'� 7
FIRE ALAN-WftIONVFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
•
Project Name: .ri r 1 v / " d i C191 Occupancy:
Job Address: 6 50 SWIZedLUODd n
L Suite: 196
Contractor: AvIvAn C 4 S&Curl Tj/ ss Fyne Phone:
Valuation of work: $ 5OO.00
Type of System: (check one) ,i//Required ONon-required
(check one) BAutomatic gManual ZBoth
Total number of devices added or moved under this permit process is 5 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(max 5) J /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max5) a, /To be Relocated(max5)
I, 19av r Oregon Construction Contractors Board No. 166 1 76
certify the following is true and defines the scope of work for this project:
a) All work complies with the current state-adopted NFPA-72 and the authority having jurisdiction.
b) All notification appliances are located in accordance with the current state-adopted NFPA-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: Date: /a //k3.
9
Print Name: DA Via rn 0 r i V/ r`
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