Permit (84) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
x °
' COMMUNITY DEVELOPMENT Permit#: FPS2017-00150
f fG R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2017
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 350
Project: Cornett,PC Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Fire sprinkler permit:Adding and relocating a total of(3)sprinkler heads for TI. Affidavit submitted.
Contractor: WYATT FIRE PROTECTION INC. Owner: PACIFIC REALTY ASSOCIATES
9095 SW BURNHAM ATTN: N PIVEN
TIGARD, OR 97223 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/02/2017 $61.85
12%State Surcharge-Building 10/02/2017 $7.42
Type of Use: COM Plan Review-Fire Life Safety-COM 10/02/2017 $24.74
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 10/02/2017 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .1 Design Area: 1500
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Gales Provided: Cut Sheets Required:
Total $94.51
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $835.00
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 503.232.1* • 800.332.2344.
Issued By: Permittee Signature: t5
_ .� i—
Call 503.639.4175 by 7:00 a.m.for the next available inspect)- date.
This permit card shall be kept in a conspicuous place on the job site until completiodiirthe project.
Approved plans are required on the job site at the time of each inspection.
City of Tigard Permit No.: 005,261-) -c j (sZ
IN s 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: iC f).f 1 7
Inspection Line: 503.639.4175 � I i�
T I GA R D Internet: www.tigard-or.gov By: /. rzAtAl v ;
vvelliJ
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTSht 9VF-3-
� ,
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) 0 C T 2 2.017
CITY OF 1 i(-,AHO
BUILDING DIVISION
Project Name: Cornett PC TI Occupancy: Light
Job Address: 15350 SW Sequoia Parkway Type of Construction: IIB
Suite: 350
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: 3
Type: SSP-QR Hazard: Light Density: 0.10
1, Wyatt Fire Protection Oregon Construction Contractors Board No. 64077
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: d4 /41.444.4444
Date: 9/29/2017
Print Name: Ashley hihara
I:\Building\Forms\FireSprinklerAffidavit_071514.docx Page 1 of 1
i
Building Permit Application
Fire Protection System
RECENED FOR OFFICE USE ONLY
City of TigardRDecateeisived: 1 Ali :Mill Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223
$11 . Phone: 503.718.2439 Fax: 503.598.1960 0 C T 2 2017 Plan Review
Date/B : Other Permit: ift,)/,;,,,0)7_ -.2 •
A RD
Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
T I G
Internet: www.tigard-or.gov Ci'lY Or 1 ic,:iARD Notified/Method: IM Supplemental Information
atilt PINir: fl)IVISIO
TYPE OF WORK' ',Il i' .:4-r- '-' '''' - ' REQUIRED DATA: 2-FAMI6114ELLOG
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
CI Addition/alteration/replacement 1=I Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY Of aiNstiiik- xi
rst , z $,,,,,,, ,,, - work indicated on this application.
' 6i; '.' '
Valuation: $
El 1-and 2-family dwelling D Commercial/industrial
_
El Accessory building El Multi-family Number of bedrooms:
_
0 Master builder El Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION ' 1 4:!`-' Total number of floors:
Job site address:15350 SW Sequoia Pkwy New dwelling area: square feet
City/State/ZIP:Portland,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.:350 Project name:Cornett PC TI Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
44UIRED DAA:COMMERC*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
DESCRIPTION OF WORK; ,rwork indicated on this application.
Add and Relocate heads for new wall in office space Valuation: $835
Existing building area: square feet
New building area: 0 square feet
0 PROPERTY OWNER '1!,-"," , ' 0 TENANT Number of stories:
Name: Type of construction:IIB
Address:
Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax:( )
New:
'IR APPLICANT ..' - 0 CONTACT PERSON , —- -
NOTICE
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ashley Nishihara licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard, OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:( )503.684.2928 Fax::( )503.684.9657
E-mail:a.nishihara@wyattfire.corn
:'-' , 6t
CONTRACTOR , ,. , ,,,i,, ,.
- , ,i. BUILDING PERMIT FEES*
(Please refer to fee schedule) , •„,t, ,
Business name:Wyatt Fire Protection
Permit fee:
Address:9095 SW Burnham
State surcharge(12%of permit fee):
City/State/ZIP:Tigard, OR 97223
FLS plan review(40%of permit fee):
Phone:( )503.684.2928 Fax:( )503.684.9657 (Due upon application submittal.) i
CCB lie.:64077 Total permit fees: t 911.5./
Authorized signature:„A ,,,,, Aji ,.
A. .,„„.
Amount received:
This permit application expires if a permit is not obtained
Print name:Ashley Nishihara Date:9/29/2017
within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I.\Building\Permits\FES-PermitApp_03 1016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
I?esGribe'"ik'to h..---4.6We:e: „ 4*
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
0 New system Number of sprinkler heads: 3 Number of alarm devices:
❑■ Addition or ❑■ 1-10 heads: Affidavit required and 0 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 Systeia (Complete A,B,Cor I)as appli able . fr t
,,
. ) omrnernial�p nkl
Sprinkler Type SSP-QR ❑� Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes ❑ No
Hazard Group Light
Density .1
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $835
B,) Type I- Hood Fire Suppression System
Hood Project Valuation: $
C.) File M,lar.�i t=4 3
moi'
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
i )',Reaidenttal Sprinkler(St td AloueSys e fix,
Square Footage: Permit Fee: P r1 '16 ,
0 to 2,000 $198.75
2,001 to 3,600 $246.45 q � # ;
4.
3,601 to 7,200 $310.05 '774", "r , `
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: $
W:\Permits\Permit Application Forms(Updated July 2017)\Tigard Fire Permit App.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15350 SW SEQUOIA PKWY 350, TIGARD, OR,
97224
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00150
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor