Permit (162) NIS ,
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
S. '> COMMUNITY DEVELOPMENT Permit#: FPS2016-00190
13125 SW Hall Blvd.,Ti Date Issued: 11/16/2016
3 [G��1t.L and OR 97223 503.718.2439 9
Parcel: 2S 113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 320
Project: Allstate Insurance Company Subdivision: None Lot: None
Project Description: Fire alarm-(5)devices to be relocated.
Contractor: POINT MONITOR CORPORATION Owner: PORTLAND SW CENTER LLC
5863 LAKEVIEW BLVD STE 100 BY FELTON PROPERTIES INC
LAKE OSWEGO, OR 97035 ATTN: FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/16/2016 $102.20
12%State Surcharge-Building 11/16/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 11/16/2016 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 11/16/2016 $0.50
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 $155.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,511.00
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 toQUNC by calling 503.232.1987 or 1.800.332.2344. E
! -____�
Issu By: �+ OA I Permittee Signa�ure: , /e. //_E,1--,
Call 503.639.4175 by 7:00 a.m.for the next available ins.•ction 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.
.t,. t
Building Permit Auplic , I i E�
Fire Protection System
FOR OFF ICI';USE ONLY
City of Tigard NOV f 1. 4 2016 Receives
qII 13125 S W Hall Blvd.,Tigard,OR 97223
Date/By: if /(F hk Permit No.: n
N Plan Review Gpsaa��—�l7�
Phone: 503.718.2439 Fax: 1 +'1{ Other Permit: Q A lD �
i t R� DateBy: .8 4, 1!" -045
I'1 GAR U Inspection Line: 503.639.417 Date Read)B : Ea See Page 2 for
Internet: www.tigard-ar:g i'y _ z y Dale hos: ions:
uI LDIN( [A' .riOi I Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
®Addition/alteration/replacement 0 Other:
Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑1-and 2-family dwelling TACommercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder ElOther: Number of bathrooms:
.LOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:7632 SW Durham Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: 3aO Project name:Allstate Insurance 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 ail
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Fire alarm notification devices Valuation: $2,511
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ►i TENANT Number of stories:
Name:Allstate Insurance Type of constructions
Address:7632 SW Durham Rd.3rd Floor
Occupancy Pa y groups:
City/State/ZIP:Tigard,OR 97224
Existing:
Phone:( ) Fax:( )
New:
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
Address:5863 Lakeview Blvd#100 under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
City/State/ZIP:Lake Oswego,OR 97035 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)627-0100 Fax::( )
E-mail:bwilliams@pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Same as above (Presse refer to fee schedule
Address: Permit fee:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.:135901 Total permit fees:
e
Authorized signature: Amount received: /5-5, gT
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Ben Breit Date:11/14/16
* Fee methodology set by Tri-County Building Industry
Service Board.
1..Building Permits\FPS-Permit App_031016.doe 440-4613TO 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
0 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 0 Wet 0 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 ED 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: r$
C:\Users\ \Desktop\PERMIT FORMS\Fire permit-city of tigard.doc 2
City of Tigard Permit No.: /j1.d/ —x/90
III 11 13125 SW Hall B1vd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: //h9/j(o
TIGARD Inspection Line: 503.639.4175
Internet: www.tigard-or.gov By:
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Allstate Insurance Occupancy: Same
Job Address: 7632 SW Durham Rd.,Tigard 97224 Suite: 3rd Floor
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $2,511
Type of System: (check one) ❑Required QNon-required
(check one) ❑Automatic []Manual ❑Both
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(max5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated tmax 51
Number of Proposed Notification Appliances: To be Added 0max5) I To be Relocated on.5) 5
I, 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 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.
AIM
Signature: -- 11/14/16
Date:
Print Name: Ben Breit
I:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1