Permit (70) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
t Il2. COMMUNITY DEVELOPMENT Permit#: FPS2017 00105
T t GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/13/2017
Parcel: 25101 CB00400
Jurisdiction: Tigard
Site address: 12700 SW HALL BLVD G
Project: Crystal Greens Landscaping Subdivision: None Lot: None
Project Description: Adding(3)heads for TI. Affidavit submitted.
Contractor: FIRE SYSTEMS WEST INC Owner: MCLELLAN ESTATE CO
600 SE MARITIME AVE#300 BY CHRISTOPHER M CAVE ESQ
VANCOUVER, WA 98661 707 OLD COUNTY ROAD
BELMONT, CA 94002
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 07/13/2017 $51.09
12%State Surcharge-Building 07/13/2017 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 07/13/2017 $20.44
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 07/13/2017 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: No Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .10 Design Area: 1500
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: No Cut Sheets Required:
Total $78.16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,200.00
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 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.
Issued By: r .72 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 \SEPFOR OFFICE USE ONLY
City of Tigard pgco - Received °
Date/B : -7 i
.1./ Permit No.: , 1,.. ' _. - *0,
'I 13125 SW Hall Blvd.,Tigard, 223 % 2.61 Plan Review
Other Permit:
:III I Phone: 503.718.2439 Fax: 503598940L . Date/B :
T I GA R D
Inspection Line: 503.639.4175 Date Ready/By:
A tk0\141") ii rupemSpelePeagneta2lItformationr
Internet: www.tigard-or.gov IN1 0.- \SI‘O‘\ Notified/Method:
Oa rImG 0
TYPE MK REQUIRED DATA:b 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
ad cK:lition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
El 1-and 2-family dwelling 15504ercial/industrial
Number of bedrooms:
P Accessory building El Multi-family
El Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: (17_ --7 0 CJ SLA) ,-I--(ck( i-3\,kia New dwelling area: square feet
City/State/ZIP: ------,. _,,....,''x 0 ci, Garage/carport area: square feet
_
Suite/bldg./apt.no.: - Project name: Cc 125,4e, ) 6(--e-e.v-N.) Covered porch area: square feet
Cross street/directions to job site:
AfitSC-e.y0 "J.9 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.:
equipment,materials,labor,overhead,and the profit for the
x*. ,,, ONthiiy* -4, :, ,eV P,., ''' work indicated on this application.
I4d d -S hc?.‘,s s .,,g-,-- ,-Fev,..6,471-- -,(v\ m Jefrioft)- Valuation: $ c).., C.')0
Existing building area: square feet
New building area: square feet
, -....k.
OcROP,ERW OWNER j:::: IV .1c '.,,,* aToaffe,- -1: . . Number of stories:
Name:
Type of construction:
Address:
Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( ) ,,. New:
:i:11!.* IA :g; it *A 00.0 P '''°°' •::::k ,i' P--4 .,---,-,',:: ,kat 1 ''e.4 , -"5' '''',1,',„, "kJ-
Business name: .--Ni J\ ...,c_
Ci're OA S \A) 2 C>..—1--- All contractors and subcontractors are required to be
Contact name: 5
licensed with the Oregon Construction Contractors Board
,.. --7,,,AA...,‘‹ 0, , i
under ORS 701 and may be required to be licensed in the
Address: 60 e <,,E hiko,i-. , .4; iv\€ 4 k\.) -..? jurisdiction in which work is being performed.If the
City/State/ZIP: k..2 a v...„Loc.,,c......k-t. ,...A.)A q53-66 1 applicant is exempt from licensing,the following reasons
apply:
Phone:(36d ors ... 6 Fax::( )
E-mail: _set,( K Sc,--, Z ...) 4- -c s'''A 71ero,Sk,1/4) 9I-..c,c)4,:‘,,,
„,. titroil., 774, ,, :::•' ',* ,..,, :' .1V; -,41g... -BLYILDING„P.%I. I . ES**.f.
-- (Please refer fol;efichikulf) - A--*
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.: LI a .-1-. )..._ Total permit fees: i 73-,1
,-------7
Authorized signature:
Amount received:
This permit application expires if a permit is not obtained
Print name: .)Old( Z0' ir1e-r- Date: 67 I('37( -1 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\BuildingTermits\FES-PermitApp_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:
ElNew system Number of sprinkler heads: Number of alarm devices:
❑ Addition or -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
❑ 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 pplicable):
A.) Commercial Sprinkler
S rinkler Type Wet CI Dry
P yP
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes I=1 No
Hazard Group („ , '
Density
Design Area 7?
K. Factor / .
Sprinkler Project Valuation: $ t'J.,0 <�
4B.) Tye I s: ood Fire Suppression.Systeiri, N% ,,, �.
Hood Project Valuation: $
;IpC., ire Al
Submittal shall Battery Calculations❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
�:� tet.
') 5 esi n l er '" ari
Square Footage: Permit Fee:
$198.75
0 to 2,000 k - - ,.- ,, ,
2,001 to 3,600 $246.45 �E
3,601 to 7,200 $310.05 " ' �
7,201 and greater $404.39 ,� _' ti
Sprinkler Project Square Footage: sq. ft•
Tot , a ._ it Pas
ri F P otee '
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\Pemuts\FPS_Perm itApp_031016.doc 2
City of Tigard RECEIVED permit No.:
11,1 is 13125Phone:SW
503Hall Blvd.,Tigard,OR 97223 `
.718.2439 Fax: 03,50R.599782.
Received: 7�/ 3//
Inspection Line: 503.639.4175 J U L 2.017��
1 1( 1 I1 D) Internet: www.ri ,qt
gard or.gov CI NOF TlGl riD By �
,�'RSIO'l�
FIRE SPRIA
AVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Crystal Greens Bldg G1 Occupancy:
Job Address: 12700 SW Hall Blvd Bldg GI Type of Construction:
Suite:
Contractor: Fire Systems West Phone: (360)693-9906
Number of Proposed or Altered Heads: 3
Type: QUICK RESPONSE Hazard:LIGHT Density: r
I, Jackson Zeiner Oregon Construction Contractors Board No.49732
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 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: 9/
o---) _
_..-
Date: d� /1( `(
Print Name: jo c K ,�vTh(
I:\BuildingWormsWireSprinklerAf£davit 071514.docx
Page 1 of 1