Permit (23) 1114CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11 . COMMUNITY DEVELOPMENT Permit#: FPS2017-00085
TfGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/07/2017
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 340
Project: One Up Subdivision: ASHBROOK FARM Lot: 5
Project Description: Fire sprinkler-modification of(2)sprinkler heads.
Contractor: WYATT FIRE PROTECTION INC. Owner: PLAZA WEST OWNER LLC
9095 SW BURNHAM BY CHIEF FINANCIAL OFFICER
TIGARD, OR 97223 680 FIFTH AVE 20TH FL
NEW YORK, NY 10019
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/07/2017 $64.54
12%State Surcharge-Building 06/07/2017 $7.74
Type of Use: COM Plan Review-Fire Life Safety-COM 06/07/2017 $25.82
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
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 $98.10
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
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 •P. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire ' ork is of started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires yo to follow tr- rules adopted by the Oregon
Utility ,. ification Cen -,,,,._ . Those rules are set forth in OAR 952-001-0010 through OAR 952-001-c a•0. Y. may obtai a copy of the rules
or.irect questions to OUNC b>:. ing •. .232.1987 or 1.800.332.2344.
Issued By: 'A / J Permittee Signature:
—AlldOAdt
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 7
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 Applicatio>� �.,��1�Vf�
Fire Protection System D
FOR OFFICE USE ONLY
City of Tigard JUN 7 2017 Received ��
Date/B Permit No.: /,�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
11111 = Phone: 503.718.2439 Fax: 503.59:P of OF TIGARDDate/B Other Permit:
T I G A R D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Jur s: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
El New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
V Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling .0 Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 4767 v U Sul GC,_ ( New dwelling area: square feet
City/State/ZIP: ) ,Glut ef 0 i2, ZZ, (7i0f_ u P Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: ( 3 t( >3 Coveredporch area: square feetC p q
Cross street/directions to job site: G h,.z,�k,, 6 J i 5 Deck area: square feet
Other structure area: square feet
'4;s IJIOD DATA COMMERCIAL-USE CHECKLIST
Subdivision: 4LI6 roe([ L4—.`_ Lot no.: Permit fees*are based on the value of the work performed.
.( , S p),t)e I 0 Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.:
equipment,materials,labor,overhead,and the profit for the
,,,fir, DESCRIPTION OF WORK 14 Vv work indicated on this application.
Valuation: $
irk0 2. 3r ,A (<L 1.1 c-_-,--el s /oQ
1 Existing building area: square feet
New building area: square feet
' a'; OPERTV 0 ` $. •,,[ N ;':' Number of stories:
Name: 'Oa ZGti 5 1-L,JC Type of construction:
Address: Gj(..; D S" 11 es-- cth.�
�'I Occupancy groups:
City/State/ZIP: /L) yA.)'/ t be, (q• Existing:
Phone:( ) Fax:( )
New:
.x 4 _ C C t ACT: RSO 4 i''..., =NO iri}
Business name: � Y' ��*'.'s .� �
fp lit e Uci ri„�k S F/U f t _,\.,\. All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
--7 under ORS 701 and may be required to be licensed in the
Address: S u-3,' 3 r, z�'7 jurisdiction in which work is being performed.If the
City/State/ZIP: $ ..!7.
�� y`� �j applicant is exempt from licensing,the following reasons
9 E'1 apply:
Phone:(q7(>46-t, /
`�"Q?Ce Fax::( )
E-mail:EA , 1ie „-` , .( =t.J
.-- CON CTOR -_`"
A. ? �,-, �.� '� ���. BUILDING PERMITFEES's 04,,
Business name: ` ij refer to fee sc le) -
L ..,----.-• �-.7-,,_. Permit fee:
Address: 1/Gt- T /- 1 e igprLC�otO i'/J ---•
City/State/ZIP: 9,0 S6w ite. ,..,, / r �Q a y7a„� State surcharge(12%of permit fee):
/ 0 ) 0FLS plan review(40%of permit fee):
Phone:(y) ) 6 8'L.f a-9 g Fax:( ) (Due upon application submittal.)
CCB lic.: 6 =� ,40-77 • - Total permit fees:
Authorized signature:
Amount received: pife7®
Of This permit application expires if a permit is not obtained
Print name: Zt� 6;0„,,,.I.„e. Date: , ..-1. i �`� within 180 days after it has been accepted as complete.
( * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PemitApp_031016.doc 440-4613T(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:
El New system Number of sprinkler heads: Number of alarm devices:
❑ Addition or j:1-11-6 heads: Affidavit required and El 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 _et El Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Fire Suppression Syster, n ° _x k . .: -r
Hood Project Valuation: $
C)f ire Alam
��, om,. :�
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
fi
D.) Residential Sprinkler Sta a to« k _') {
Square Footage: Permit Fee: 1 ,
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.
rx
At.„: Tire Protection ermit;;.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_PermitApp_031016.doc 2
City of Tigard Permit No.: /g5d-4?-G0(J9 5
111 13125 SW Hall Blvd.,Tigard,OR 97223
= Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 6/71/7
Inspection Line: 503.639.4175 (L)
T I G n IZ D Internet: www.tigard-or.gov By:
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS RECEIVED
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) JUN_ 7 2017
CITY OF TIGARD
BUILDING DIVISION
Project Name: r 1.i , WAS , 1- 3`f O Occupancy: . F,
Job Address: 7(o G Vii'.; Type of Construction: C( 6
Suite: 3`f 6 rr
Contractor: ( ulCk_�,& Phone: 7 CcA3 c?
Number of Proposed or Altered Heads:
Type: V""e--'t' Hazard: L. k c7 l ( Density:
I cc,1 Oregon Construction Contractors Board No, ZtJ(c 3 cY,
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinlder 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 sprinlder 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 sprinlder 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 o ection system permit.
• A copy of, : I ent with a copy oft. • etch attached shall be available for all inspections.
Signature: Date: G, 7i ( 7
Print Name: C2c.tA-,1/4_,
I:\Building\Forms\FireSprinlderAffidavit_071514.docx Page 1 of 1