Permit (183) CITY OF TIGARD FIRE PROTECTION SYSM
.', COMMUNITY DEVELOPMENT Permit#: FPS2018TE00019PERMIT
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/12/2018
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 300
Project: Pactrust Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Fire alarm permit:Adding(4)fire alarm devices for TI. Affidavit submitted.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/12/2018 $102.20
12%State Surcharge-Building 03/12/2018 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 03/12/2018 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 03/12/2018 $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 $155.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,300.00
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.:•e.- . :'4.
Issued By: - Permittee Signature: /�+} -7-,
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.
IFPI' i-N IT,,, NA :`"1":,''' -t
Buiidin. Permit A s i licati 1„... Ei r lei 0 P
Fire Protection System
FoR OFFICE USE ONLY y
City of Tigard 6 2U1 9'
MAR f L Received , iiirApramis, permiiN .
Da it 13 : Af92/ II ' '
: 13125 SW Hall Blvd.,Tigard,OR 9.z2,2. .t. i-s ',tart Review Milli alai
= Phone: 503.718.2439 Fax: '-.10.3:1-1.rt—s Dat,g
II
Other Permit: 414• ' .! ..,..- •
.., ,....11 Y ...41,.....4. ,
Insnection Line: 503 639 4175
TIGArtu) = - •Internet; www.tigard-or.g01,-.1..:IIIDateReady,3y: Fvngifitg. r. See Page 2 forNon,edivehoSupplemental Information
TYPE OF WORK REQL1RED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 Demolition
Permit fees*are based on the value of the work perfornied.
------ — Indicate the value(rounded to the nearest dollar)of all
1 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 1-and 2-family dwelling k.4 Commercial/industrial Valuation: $
0 Accessory building
0 Multi-family
Number of bedrooms.
0 Master builder
0 Other:
Number of bathrooms:
.....___
JOB SITE INPORNIATION'AND LOCATION Total
number of fl°°rs:
Job site address:15350 SW Sequoia PKWY
New dwelling area: square feet
City/State/Z1P:Portland,OR 97224
Garage/carport area: square feet
Suite/bldglapt.no.:300 Project name:PacTnistiIreel Covered porch area: square feet
Cross street/directions to job site: ,Deck area: square feet
Other structure area: square feet
REQUIRED DATA:"COM-MEReattlieCRECKLIST
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
equiptitent,materials,labor,overhead,and the profit for the
DESCRIPTION OF VV°RKwotk indicated on this a •licallom
$$2,300.00
Fire Alarm Notification Devices Valuation:
Existing building area: square feet
New building area: square feet
1:1PROPERTY OWNER , • -"`:'. eit TENANT ' ' • Number of stories:
Name:PacTrust Breakroont Remodel Type of construction:
Address: 15350 SW Sequoia PKWY Suite 300 Occut)ancy groups:
City/State/ZIP:Portland,OR 97224
Existing:
Phone:( )
New:
C
,4 APPLICANT 0 CONTACT PERSON
1112.1IaIIIIIIIIIIIIIIIIIIIIIIIIIII
NOflc
Business name:Point Monitor Corp,
All contractors and subcontractors are required to be
Contact name:Brooke Williams
licensed with the Oregon Construction Contractors Board
Address:5863 Lakeview Blvd#100
jurisdiction in which work is being performed.If the
under ORS 701 and may be required to be licensed in the
City/State/ZIP:Lake Oswego,OR 97035
-------- applicant is exempt from licensing,the following reasons
a sly:
Phone:(503)627-0100 Fax::( )
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
E-mail:hwilliams@pointinonitor.com
CONTRACTOR BUILRM.!"FEES DING PE *
,
Business name:Point Monitor Corp. i piI ere re et to
cc
*c4edale
Permit fee: 1.IIIIIIIIIII
Address:5863 Lakeview Blvd#100
State surcharge(12%of permit fee):
City/State/Z1P:Lake Oswego,OR 97035
FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( ) iDite u on a lication submittal '
........._ .__...._.._......._,.,_._.___.___ , ,
CCB lie.:135901
Total permit fees:
Authorized signature,
Amount received:
-• — This permit application expires if a permit is riot obtained
Print name:Ben Breit Date:3/6/18
.......
within 180 days after it has been accepted as complete,
* Fee methodology set by Td-County Building Industry
Seiviee Board.
6 licliding Perxngs FPS.Pernut App J:13.1016 doe
440-4613if 11 02 C()NI WE'Ll)
r "
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:
0 New system Number of sprinider heads: Number of alarm devices: 4
13 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 withiti building structure
system
0 11 t heads: Plan review required and 0 6+ devices: Plan review required and
_ (3)sets of plans. (3) sets of plans.
Additional description of work: Fire Alarm Notification Devices -(4) New Devices
T j#e of Sstern Coni a lete A,13. C or D as a, •licable :
A.) Commercial S./Mulder'
n Wet n D ,
,_...,
EMEMMElli ,.......,
Additional Stand i es
Information: S.rinkler Su I-Line Yes 0 No
EMZMIZMMIIIIMIIIIIIIMIIIIIIIIIIII.m.mem/nmnei
Densi '
wmu.............m........__aIMIIIIIIIIIIIIIIIIIIIIImuu....
Desi. Area lioniiiii............i........___________........m........1........
K. Factor
______ .....,.................."
Sorinkler. Pro'ect Valuation: $
.„. •
B. •• - - 00 Ate Su• •tession S stem
Flood Pro'ect Valuation: $
C.) Fite Mann
Submittal shall Batte Calculations n Yes
,...4
include: Individual Component Yes
Cut Sheets
Fire Alarrn Pro'ect Valuation: $ 2,300
D.) Residential Sptiumer(Stand Alone System)
S uare Foota.e: Permit Fee:
0 to 2,000 -
$198.75
mm 2,001 to 3,600 $246.45
IIIII 3,601 to 7,200 $310.05
MN 7,201 and greater $404.39
Sprinkler Project Square Footage: sq.ft.
Fire Protection Permit Fees
Pro'ect valuation subtotal see A,B& C above :
Permit fee based onproject valuation see fee schedule :
Pertnit fec based on s uare foota.e (see D above : IEMIIIIIIIIIIII..g
State Surchar e 112%of errnit fee :
7—g- -1– an ?xview(40% of of*emit fee :
TOTAL'
. IEIIIIIIIIIIIIIIIIIM
__.... _
c.\Iii.crs\tiwilltarnsADesktop\pElairr l'ORMS\Firit permit-city of tigard.doc 2
City of Tigard m R 6 c2, Permit No.: sr' c
• 13125 SVV Hall Blvd,Tigard,OR 97223
.
Phone 503 7IS 2439 Fax 503 ps,,,a 94g ,•
Date Received:
Inspeenon Line. 503 639 4175 -,, I; 5f i
TIC,\RD
' Internet' www.tigard-or gov By:
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: PacTrust Breakroom Remodel
Occupancy: Same
Job Address: 15350 SW Sequoia PKWY
Suite: 300
Contractor: Point Monitor Corp.
Phone: 503-627-0100
Valuation of work: $2,300
Type of System: (check one) ORequired INNon-required
(check one) ElAutomatic DManual OBoth
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/fleatl)etectors: To be Added( 5) /To be Relocated(.5)
Number of Proposed Manual Alarm Stations: To he Added(max 5) /To be Relocated (max 5)
Number of Proposed Notification Appliances: To be Added 0.5) 4 To be Relocated
1, Ben Breit
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.
c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having
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 lire 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: 3/6/18
--••••••::
Print Name: Ben Breit
113wIding1Forms\fireAlarmArtidavit_071514 docx Page 1 of I
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15350 SW SEQUOIA PKWY 300, TIGARD,
OR, 97224
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00019
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor