Permit (122) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
ill `' COMMUNITY DEVELOPMENT Permit#: FPS2017-00025
GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2017
Parcel: 25101 BD00100
Jurisdiction: Tigard
Site address: 7650 SW BEVELAND RD 200
Project: Women's Healthcare Associates Subdivision: None Lot: None
Project Description: (2)fire alarm notification appliances:adding(1)and relocating(1). Affidavit submitted.
Contractor: POINT MONITOR CORPORATION Owner: PNWP LLC
5863 LAKEVIEW BLVD STE 100 MILDREN, WALTEN E JR
LAKE OSWEGO, OR 97035 KRIZ, THOMAS J ET AL
6600 SW 105TH AVE STE 175
PORTLAND, OR 97008
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/07/2017 $75.30
12%State Surcharge-Building 03/07/2017 $9.04
Type of Use: COM Plan Review-Fire Life Safety-COM 03/07/2017 $30.12
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 03/07/2017 $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 $114.96
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,400.00
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.
c �
Issued By: Permittee Signature: G�
Call 03.639.4175 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` i
Fire Protection System FOR OH IC lSl,OyI.1.
City of Tigard MAR r i t, ReceL Permit No.: 7.
>�u Bisives e
13125 SW Hall Blvd.,Tigard,OR 97223 PlanDaleB Review
C Phone: 503.718.2439 Fax: 01r599 1,9NQ fi t
Other Permit: ,
Al-
T I( A R Il Inspection Line: 503.639.4175- & § ' l' Date Reads BY ®Sec Psge 2 for
Internet: www.tigard-or.g 1 F i ;?' t y+'f.,, Notified/Method: 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.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
gg "-y ort . C :k ,, :4 ., work indicated on this application.
A"!'EGU1tY OF CONSTItIJC1`ION �
❑ 1 and 2-family dwelling ® m
Comerciallindustrial Valuation: S
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
)QB SITE INFORMAflOr'l AND LOCATION Total number of floors:
Job site address:7650 SW Beveland Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/catport area: square feet
Suite/bldg./apt.no.: 0 Project name:Woemn's Healthcare Associ Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
. i r .�t`�,CUI►MERCIA'L-ACTS ' I }_'
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
rN " 1�` t it11C�4C PTION`OF WORK t „� ,. this application.
�� work indicated on plication.
Fire Alarm-notification devices Valuation: $$1,400.00
Existing building area: square feet
New building area: square feet
i ° ie a �vN . , Number of stories:� -t
Name:Women's Healtcare Associates Type of construction:
Address:7650 SW Beveland Rd. Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
�5rvave' w..m i k y.1 A t b3 tl P -ti t •-.. kt_ +{4M 9 M, .1�..4_ � %- ,�' '�Aes N-'«,s£ .%. stYN^q'-s sKY -•w+ac.
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 from licensing,the following reasons
apply:
Phone:(503)627-0100 Fax::( )
E-mail:bwilliams®pointmonitor.com
rc4.. . CONTRACTOR ',t BUILDING PEAT FEES*
Business name:Point Monitor Corp. ` ' 81�' eC "d"l°1 T
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:( ) (Due upon application submittal.) //yr CCB lie.:135901 Total permit fees e,Amount received:
Authorized signature: , -.F.--.)----- ) This permit application expires if a permit is not obtained
Print name:Ben Breit Date:3/1/17
within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I.Building Ponnits FPS-PermitApp-031016.doc 440-4613T(11 02 COMA 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:.
►,1 Addition or 0 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:
Colli:let B C or D a ®ilc$ e cs
A t e. Spriinkler
Sprinkler Type ❑ Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes 0 No
Hazard Group
Density
Design Area
K.Factor
�l tp Sprinkler Project Valuation: I $
::11,C72111;1:2 ''1 ?z
Hood Project Valuation: I $
Submittal shall Battery Calculations ❑ Yes
include: Individual Component 0 Yes
Cut Sheets
gaita
�i
S°uare Foota_•e: Permit Fee:
0 to 2,000 $198.75 ' . •. �_.
2,001 to 3,600 $246.45 �Ta
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: $
C:\Uscrs\bwilliams\I)csktop\PERMJ'I'FORMS\FPS_PcrmitApp-Tigard.doc 2
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City of Tigard Permit No.: 5, a 7--e, �?,5"
13125 SW Hall Blvd.,Tigard,OR 9724 Aj R I 1 �'I
• Phone: 503.718.2439 Fax: 503.598.1960 ' Date Received: /i//? i•T.
Inspection Line: 503.639.4175
lU4R[)
Internet: www-tigard-or.gov @ f_= By: er ,*-4)
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Women's Healthcare Assoc.Touch Down Rooms Occupancy: Same
Job Address: 7650 SW Beveland Rd.,Tigard 97223 Suite:
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $1,200
Type of System: (check one) ['Required [Non-required
(check one) ['Automatic OManual ['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 51 /To be Relocated(max 5>
Number of Proposed Notification Appliances: To be Added c 5) 1 /To be Relocated(max 51 1
Ben Breit
I, 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.
-Y- -• =` -- 86Frl.,-r -.. 8=.,=- :- anal-111ti iav iii
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: 3/1/17
Print Name: Ben Breit
1:\BuildinglForms\FireAlannAffidavit_071514.docx Page 1 of 1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
7650 SW BEVELAND RD 200, TIGARD, OR,
97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00025
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor