Permit (36) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
ti COMMUNITY DEVELOPMENT Permit#: FPS2017 00001
JD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/18/2017
T f °j �' g Parcel: 1S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE#150
Project: American Family Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Phase 3-Fire alarm modifications: add(3)devices and relocate(1)device.
Contractor: POINT MONITOR CORPORATION Owner: PNWP LLC#2
5863 LAKEVIEW BLVD STE 100 PNWP LLC
LAKE OSWEGO, OR 97035 6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/18/2017 $102.20
12%State Surcharge-Building 01/18/2017 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 01/18/2017 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 01/18/2017 $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 $156.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,300.00
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. ions to e•• by calling 503.232.1987 or 1.800.332.2344.
Is- ed By: / Permittee S gnature: Adak
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 sit until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Applicatiot. I ,a', 'v
Fire Protection System .1:.);,-° s `i v�'7,7
hely OFFICE USE ONLY
City of Tigard Received ( i � avy�l7~ f
J g Permit No.:
13125 SW Hall Blvd.,Tigard,OR 972 i f Date
Plan Review
Phone: 503 718.2439 Fax: 503 598.1960 Date?g : Other Permit: Au P0116/6 D�j,2?
Inspection Lane: 503.639.4175 e "< : '+a
1 1 GA R I) p a Date Ready Juris: See Page 2 for
Internet: www.tigard-or.gov 1 a Notified/Method:
£ w � !` Y , n�t��,rt Supplemental Information
9R V;
' WO ' -0 :-4t g 1{i -
, ' i fi 't -
0 New construction 0 Demolition Permit fees*are based on the value of the`.41A4 trwork performed.
Indicate the value(rounded to the nearest dollar)of all
DD Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
El p.,,,,, It_ 11;',.y It A:0,4.'7' *4 = work indicated on this application.
D 1-and 2-family dwelling 181 Commercial/industrial Valuation: $
❑Accessory building ElMulti-familyNumber of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
' �q.a. s li AFA Ulv AD QG�' IQ
`° � Total number of floors:
''642 6_s Arcot,. nGrr .- Ahw �.�... .� h , .
I.
Job site address:11850 SW 67th Ave. New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
SuitelbldgJapt.no.: /60 I Project name:American Family Insurance Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
e w°�i _' �k h�e
t ) �A e t .C .1 litHr
Subdivision: 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
,iliwiwimlb
Int Qm . t' work indicated on this application.
Fire alarm notification devices — I h 3 Valuation: $$2,300.00
Existing building area: square feet
r New building area: square
s ua feet
° DI 0-W.orim -'1 . Number of stories:
Name:American Family Insurance Type of construction:
Address: 11850 SW 67th Ave. Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:( ) Fax ( )
`. TC -
New:
OW
ris-
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#100 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
if1 nll - ceTfRA oR j ') �iPlli'n i
il,6,. ,' i'.. ,+�w,o ,,,,o < -.11,0,.' ",.ii•' BU t i I..G P.F }EE'S
Business name:Same as above is -ff®ra ; ufe'< ,,
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.:135901 Total permit fees:
--- V "" Amount received: /56) 3y
Authorized signature: �P—*- d
2 . This permit application expires if a permit is not obtained
Print name:Ben Breit Date:1/10/17 within 180 days after It has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I Buildineeimits,FPS-PennkAp_031016.doc 440-4613T(11.02,COM`WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
�$ a tk 1„..ti- Ullt#' 1nJ:
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
0 1-10 heads: Affidavit required and ►ZI 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 f heads: Plan review required and 0 6+devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Sprinkler Type 0 Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes 0 No
Hazard Group
Density
Design Area
K. Factor
((,,,yjy Sprinkler Project Valuation: $
Hood Project Valuation: $ .
Submittal shall Battery Calculations )1 Yes
include: Individual Component IN Yes
Cut Sheets
Fire Alarm Project Valuation:_I $
Square Footage: Permit Fee: =
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05 r. ` ` `
7,201 and greater $404.39 �.
Sprinkler Project Square Footage: sq,ft
ter%'” ' N W�� � yUa. i [ '1 Frote u( [31L FCr nit $ iyi ium w wi
mIa P"'
a s 1 ,p^ ,r T, s� � ?� e,
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: $
C::\Users\bwillivms\Desktop\PERMIT F()RhiS\Fire permit- city of tigard.doc 2
S ' o- e' it 1w
1111 City of Tigard 11.1N U �; Permit No.: Y P-5 09d/7- exec,/
v 13125 SW Hall Blvd.,Tigard,OR $7223
• X Phone: 503.718.2439 Fax5.04 ,1 Date Received: 0/7
�, It l Inspection Line: 503 417 •, ,, '• v
Internet: www.ngard-orgo,yr, j " ,v By:
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: American Family Insurance Phase 3 Occupancy: Same
Job Address: 11850 SW 67th Ave.,Tigard 97224 Suite:
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $2,300
Type of System: (check one) Required Non-required
(check one) DAutomatic [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(max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated( 5)
Number of Proposed Notification Appliances: To be Added 0max5) 3 /To be Relocated 0.5) 1
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.
Signature: _____.„„,„,„.___ 6.66 ,___________________ Date: 1/10/17
Print Name: Ben Breit
1:\BuildinglForms\FireAlarmAffidavit 071514.docx Page 1 of 1
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11850 SW 67TH AVE STE 150, TIGARD, OR,
97223
Record Type:
Commercial - Fire Protection System
Inspection Type:
998 Alarm Final
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
FPS2017-00001
Inspector:
Jeff Grove
Contractor