Permit (173) INCITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
•' COMMUNITY DEVELOPMENT Permit#: FPS2016-00197
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 11/21/2016
TfCAIi(� 9
Parcel: 2S 102 BA05000
Jurisdiction: Tigard
Site address: 12353 SW GRANT AVE
Project: Elite Care Subdivision: 2013-021 PARTITION PLAT Lot: 1
Project Description: Fire sprinklers-Replace pipe,heads&anti-freeze system.
Contractor: AFP SYSTEMS INC Owner: ELITE CARE GRANT LLC
19435 SW 129TH AVE PO BOX 12564
TUALATIN, OR 97062 PORTLAND, OR 97212
PHONE: 503-692-9284 PHONE:
FAX: 503-692-1186
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/21/2016 $88.75
12%State Surcharge-Building 11/21/2016 $10.65
Type of Use: COM Plan Review-Fire Life Safety-COM 11/21/2016 $35.50
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 11/21/2016 $2.00
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 $136.90
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,850.00
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 N. . . enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir: 'questions to O. C :• ailing 503.232.1987 or 1.800.332.2344.
Iss ed 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.
Building Permit Application
Fire Protection System a lf Vt
FOR OFFICE ISE ONL}"
IIICity Of Tigard Received
q 13125 S W Hall Blvd.,Tigard,ORi?j3 I n DateBy: n, Permit No.: 97
■ 1kk�� A ll Plan Review �/ aN r�0 �/�ja�!'�p�D 1
Phone: 503.718.2439 Fax: 503. 6
Inspection Line: 503.639.4175. Date/By: Other Permit:
T I G A R U p , t li , Date Ready/By: Juri5. I ® See Page 2 for
Internet: www.tigard-or.gov IA I I .. iRD Notified/Method:
Supplemental Information
BtL IN G DIVISION
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction
❑Demolition Permit fees*are based on the value of the work performed.
Addition/alteration/replacement - Indicate the value(rounded to the nearest dollar)of all
0Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 1-and 2-family dwelling pi.Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
/ 353 JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ' i V,,- f 613 y
��`�-`1 '1"� � '�,� rit,'>/1 1 New dwelling area: square feet
City/State/ZIP: 'L
t�
15 , Garage/carport area: square feet
Suite/bldg./apt.no.: ` I Project name: ,( l .k( ( 7
Covered porch area square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
Subdivision: •,_:,,,i lvai!j,1.,1,, �
a .1„ + r ' , ,'. ! e,i IST
I 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 r work indicated on this application.
!�� e.( p) 11 f�(�t �:r C t i i-� i."l�r Valuation: $ 12+50nc
/"�` 1 Existing building area 3 0017 square feet
New building area: --_..square feet
0 PROPERTY OWNER I 0 TENANT Number of stories: 7•.>
Name:
Type of construction: Lte)p ! 'Ppt.. 13
Address:
City/State/ZIP: Occupancy groups: 0,10_ L1,,_ _
Existing: e
Phone:( ) Fax:( ) � 4l
R APPLICANT - New: �l
❑ CONTACT PERSON
Business name: - NOTICE
,-�.1,—/-).{-t_;,-.)--; -ti 1 L All contractors and subcontractors are required to be
-�� -' '.
��i irk �� <4 �r
, '� --- licensed with the Oregon Construction Contractors Board
Contact name:
Address: ( (L c.. .5 (� t(on ,'L under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
City/State/ZIP: 4 up,, (n_ � G;l `,`G,, applicant is exempt from licensing,the following reasons
' _ p
apply:
Phone:(L °G4 ) �i- E! e €,:,(4I Fax :(�t l,) ( cL j i l ' G.
E-mail: -k(L,L-'''v'%tC x t c)
CONTRACTOR
BUILDING PERMIT FEES*
Business name: �'�� )(44--)1 Z c l� (Please refer to fee schedule)
Address: 1 1 Permit fee:
City/State/ZIP: l t State surcharge(12%of permit fee):
FLS plan review(40%ofpermit fee):
Phone:( ) t t I Fax:( ) t
CCB lic.: `1 -� s� -
(Due upon application.)
Total permit fees:
•
Authorized signature: Amount received: j ,ql�
y
a,, G This permit application expires if a permit is not obtained
I Print name: (2`L 7L,i ,ir; ,i.t..,i 4 1 ' Date: t within 180 days after it has been accepted as complete.
� ( tj� ( �itG' � y P P
* Fee methodology set by Tri-County Building Industry
I:\Building\Permits\FPS-PetmitApp.doe Rev 01/05/2012 Service Board.
440-4613 T(11/02/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: /0 Numb; of alarm devices:
❑ Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 de, ces: Affid t required and
Alteration (3) copies of sketch showing area (3) copie of s .--'ch showing area
to existing of work within building structure of work wi :.'building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ dev.'es: Plan .view required and
(3) sets of plans. (3) stets of plans.
Additional description of work: //
Type of System (Complete A,xB,C D as applicable):
A.) Commercial S nnklet
Sprinkler Type Wet 1:1 Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group L ;y
Density
Design Area
K. Factor
Sprinkler Project Valuation: $ /g-r0
B:) Type'`f- Hood Fire Suppression'Systen
Hood Project Valuation: $
C,) Fite Alarm
s ,
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
I ) 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\Permits\FPS_PemutApp_031016.doc 2
Building Permit Application
Fire Protection System FOR OFFICE LSE O1I.v
City of Tigard RDeiBed
- Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
InspectionLine: 503.639.4175 Date Ready/By: Juris: gi See Page 2 for
T 1�'A R D
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK =} REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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/replacem t 0 Other: equipment,materials,labor,overhead,and the profit for the
CATE RY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling 0 Commercial/industrial
Number s bedrooms:
❑Accessory building 0 Multi-family
❑Master builder 0 Other: Num,-r of bathrooms:
JOB SITE.INFORMATI AND LOCATION Ttal number of floors:
Job site address:
New dwelling area: square feet
City/State/ZIP: Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 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: 1 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 1work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
PROPERTY OWNER ; 0 NAN Number of stories:
Name: •e of construction:
Address: Oc pancy groups:
City/State/ZIP: Ex' ting:
Phone:( ) Fax:( New.
APPLICANT M CONTACT PERSON' NOTICE 41' ''''
Business name: All contractors':nd subcontractors are required to be
licensed with th- Oregon Construction Contractors Board
Contact name: under ORS 701 a d may be required to be licensed in the
Address: jurisdiction in wh ch work is being performed.If the
applicant is exem t from licensing,the following reasons
City/State/ZIP: apply:
Phone:( ) 'ax::( )
E-mail:
CONTRA OR BUILDING PERMIT FEES*
- (Please refer to fee schedule)
Business name:
Permit fee:
Address: State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: Total permit fees:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Date:
Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
INCity of Tigard I E h F'
° 13125 SW Hall Blvd.,Tigard,OR 97223 Permit No.: ������ �jO��7
Phone: 503.718.2439 Fax: 503.598 yp/ a 1
Inspection Line: 503.639.4175 w U V G+ Jl 2016 Date Received: I���/ �j(P
TIGARD p
Internet: www.tigard-or.gov By:
( __,_r__y,„,t :t:_______
Cli l' OF IN,Tlikb
FIRES ftI -hAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: f.`i�� Cly U- q,Nz„,.„.A.
Occupancy: ,�
Job Address: 5, J c
/0,..____5_-__—
Suite: Type of Construction: (j
Contractor: jA - i,�, Phone: _1Det7 - 9Z tp 44
Number of Proposed or Altered Heads: 10
Type:4-4))4 Hazard: /4,:91..1�9q�1 Density:
Construction
on
ractors
certify the following is true and reasonably defnesgthe cope of work ortthis poJgot rd No. 1� ��
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: Al iiAt...,
Date: / ZI—ib
Print Name: a
1:\Building\Forms\FireSprinklerAffidavit_071514.docx
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