Permit (180) IIICITY OF TIGARD
o FIRE PROTECTION SYSTEM PERMIT
mF Permit#: FPS2017-00185
COMMUNITY DEVELOPMENT
Date Issued: 11/30/2017
'TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE#100
Project: Xerox Subdivision: VARNS ACRES Lot: 9
Project Description: Fire sprinkler permit:(9)sprinkler heads for TI. Affidavit submitted.
Contractor: DELTA FIRE INC Owner: TRIANGLE POINTE TWO LLC
14795 SW 72ND AVE 901 NE GLISAN ST, STE 100
PORTLAND, OR 97224 PORTLAND, OR 97232
PHONE: 503-620-4020 PHONE:
FAX: 503-620-1058
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/30/2017 $123.72
12%State Surcharge-Building 11/30/2017 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 11/30/2017 $49.49
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 11/30/2017 $2.00
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .10 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $190.06
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $4,546.00
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:
—.- Permittee Signature:`"741 11:
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.
•
City of Tigard Permit No.:
11 41 13125 SW Hall Blvd.,Tigard,OR 97223 N(l V 3 0 201 try
11 Phone: 503.718.2439 Fax: 503.598.1960 Date Received: j11314,
'
Inspection Line: 503.639.4175 CITY>1 O,f " IGARD �
T 1 G A K D Internet: www.tigard-or.gov A 1 1 4J By: r‘j-.
BUILDING DIVISION
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Xerox-Conduent Occupancy:
Job Address: 13333 SW 68th Parkway, Tigard Type of Construction: Concrete/Steel
Suite:
Contractor: Delta Fire, Inc. Phone: 503-620-4020
Number of Proposed or Altered Heads: 9
Type: Hazard: Light Density: •1
I Delta Fire, Inc. Oregon Construction Contractors Board No. 64174
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.
v. �-�
Signature: (it U�� Date: 11-28-17
Print Name: Melissa Boughton (�
1:\Building\Forms\FireSprinklerAfBdavit_071514.docx Page 1 of 1
j1ildin2 Permit Application 11• 511
Fire Protection System VAN
i FOR OFFICE USE ONLI'
Cityof Tigard t Received
g Date/B : i ,t )1u Permit No.'-' ' ' 6 7
• 13125 SW Hall Blvd.,Tigard,OR 972 ;c`` 1 O� Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 (� V Date/B : Other Permit: ', I j a7
lit,ARD Inspection Line: 503.639.4175 �� kV&" Date Ready/By: '', See Page 2 for
Internet: www.tigard-or.gov �� � &,, led/Method: �C Supplemental Information
Vi
1
TYPEOF '6 � �'` ( t.tl 1. rATA:I 1. 2-FAMILY�- WE" - NG
0 New construction 0 il,: ition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
21 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
0 v ', "" # work indicated on this application.
0 1." `Olt' OF CO CT1° `7.:•,, ,,,
El 1-and 2-family dwelling 150 Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
Total number of floors:
, . ��1wN1)1'f� fII('�' ''
Job site address: 13333 I.v 1pSTn T ark-1/11 New dwelling area: square feet
City/State/ZIP: I'(Ic / DR Garage/carport area: square feet
Suite/bldg./apt.no.: Jl,y Project name:x ,'0 x_ Co rid U Al f Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
:")EQ < DA IMMRRI LY F.E 5 !F KL ;..
Subdivision: 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
CRIPTIO OF YORK = work indicated on this application.
1 nSial loch or DC 1 5 I1 1Icicr head's Valuation: $91 4(5.00
Existing building area: square feet
New building area: square feet
{ ['�OPERTY r1 ° , E 2 v ® TEN ANT", ",„/ Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
o '".1 AAA:T ICAN . " .." 1 i "i"s TACT P SON x # 0 •CE
Business name: � � "�' �""'
Delta Fire,Inc. All contractors and subcontractors"are required to be
Contact name: (vie`e l i Sea 130u9 V-1 Cy1 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 14795 SW 72nd Ave. jurisdiction in which work is being performed.If the
City/State/ZIP: Portland, OR 97224 applicant is exempt from licensing,the following reasons
apply:
Phone:( 503) 620-4020 Fax::(503 ) 620-1058
E-mail , 106, CJ, 0t !frA. !re, C
CONT CTOR ;-'-'1;4:':'?' - ,,,,, -,
„:t...'' z �..k Ht :.1.:,,-
7 .�LllI1�I -�'���T � r
-(Please re a-sched --
,?
Business name: Delta Fire, Inc.
Permit fee:
Address: 14795 SW 72nd Ave.
State surcharge(12%of permit fee):
City/State/ZIP: Portland, OR 97224
FLS plan review(40%of permit fee):
Phone:( 503) 620-4020 Fax:(503) 620-1058 (Due upon application submittal.)
CCB lie.: 64174 / Total permit fees:
Authorized signature: V �p� Q�� Amount received: '/( . Q
c Z��/e`�1 -DlY-1 This permit application expires if a permit is not obtained
Print name:me,`i ssc. 50 U G�h� V Date: I 1— 2q- I/ within 180 days after it has been accepted as complete.
J * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Pennits\FPS-PermitApp_071514.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
+ cn a u°do a .Atte ,.
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
D New system Number of sprinkler heads: Number of alarm devices:
j Addition or 1-10 heads: Affidavit re uired and
q 0 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing a
to existing of work within building structure of work within building structure
system
0 11+ heads: Plan review required and 0 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
_I � ct :Y ?r � b e� ;� t o 4mpt to� oysN
[ Wet 0 Dry
Additional Standpipes
Information: Hazard Group Ln N.t"
Density I J
Design Area
K. Factor 5:6,
Sprinkler Project Valuation:
leI $ ��Q� DO
M
.
n; , .- I o r Supp s is n y n ' . '' *
m '
};
Hood Project Valuation: ) $
s ' ' '
❑ Yes
Submittal shall Battery Calculation
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: I $
r �� O''''',74* P tom-
Square Footage: Permit Fee: P ' f '
0 to 2,000 vz
2,001 to 3,600 $198.75 ... Y
$246.45 t, f,.
3,601 to 7,200 / ti, x
$310.05
: zz.4 A5t
7,201 and greater $404.39 � ;
Sprinkler Project Square Footage:
t
�rti 1
Project valuation subtotal (see A,B&C above)•. $ t4[j L�(P ,oo
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\heidis\AppData\Local\Temp\FPS_PermitApp.doc 2