Permit (110) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
' COMMUNITY DEVELOPMENT Permit#: FPS2018-00025
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/04/2018
rrr,;ai<.r g
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 130
Project: Bridgeport Family Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Installing(10)pendent sprinklers due to new walls.
Contractor: EXPRESS FIRE SYSTEMS INC Owner: G&S FC LLC
1913 41ST STREET 16083 SW UPPER BOONES FERRY RD,
WASHOUGAL,WA 98671 STE
TIGARD, OR 97224
PHONE: 360-953-8432 PHONE:
FAX: 360-953-8394
FEES
Description Date Amount
Specifics: Permit Fee-COM 04/04/2018 $156.00
12%State Surcharge-Building 04/04/2018 $18.72
Type of Use: COM Plan Review-Fire Life Safety-COM 04/04/2018 $62.40
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 04/04/2018 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 04/04/2018 $1.00
11x17)
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .1 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 $240.12
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $7,665.00
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. 187 or 1.800 32.2344.
Issued By: Permittee Signature: A��
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
I fir' ',;: FOR OFFICE USE ONLY
City of Tigard Received
Permit No.: /
13125 SW Hall Blvd.,Tigard,OR 972 Date/B : /�� `r ._r0 _ '
i S ' ' '' Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1"96&:' Date/ : r0 /A �0 —
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov " ,a . x� � Notified/Method:
Supplemental Information
1
TYPRii;_" Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑New construction ❑Demolition equipment,materials,labor,overhead,and the profit for the
®Addition/alteration/replacement 0 Other: work indicated on this application.
CATEGORY OF CONSTRUCTION Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial Number of bedrooms:
❑Accessory building 0 Multi-family Number of bathrooms:
0 Master builder 0 Other: Total number of floors:
JOB SITE INFORMATION AND LOCATION New dwelling area: square feet
Job site address:16083 SW Upper Boones Ferry Rd. Garage/carport area: square feet
City/State/ZIP:Tigard/Oregon/97224 Covered porch area: square feet
Suite/bldg./apt.no.:130 Project name:Bridgeport Family Medical Deck area: square feet
Cross street/directions to job site: Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Subdivision: Lot no.:
equipment,materials,labor,overhead,and the profit for the
Tax map/parcel no.: work indicated on this application.
- DESCRIPTION OF WORK Valuation: $7,66$;00
Install(10)pendent sprinklers due to new walls. Existing building area: square feet
0"PROPERTY OWNER 0 TENANT New building area: square feet
Name: Number of stories:
Address: Type of construction:
City/State/ZIP:
Occupancy p y groups:
Phone:( ) Fax:( )
Existing: Light
El APPLICANT 0 CONTACT PERSON
New: Light
Business name:Express Fire Systems
NOTICE
Contact name:Tiffany Cole All contractors and subcontractors are required to be
Address:670 S.28th St. licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
City/State/ZIP:Washougal/Washington/98671 jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
Phone:(360)953-8432 Fax::(360)953-8394
apply:
E-mail:Design®ir expressfresystems.corii
CONTRACTOR
Business name:Express Fire Systems BUILDING PERMIT FEES*
Address:670 S.28th St. (Please refer to fee Schedule)
City/State/ZIP:Washougal/Washington/98671 Permit fee:
Phone:(360)953-8432 Fax:(360)953-8394 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
CCB lie.:193272 / (Due upon application submittal.)
Authorized signature._:. c' / J / /=>...::? Total permit fees:
___,.,c,...___-___-_-___,/,
���/ Amount received:
Print name:Tim -25-_,, 7 NDate:04/04/18
v''��"' `� This permit application expires if a permit is not obtained
REQUIRED DATA:1-AND 2-FA Y DWELLING within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I.\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
4 .
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
%r {,t' `, `$�,-✓,. 8 ' ;,^cox ,IIs ac' • N 1.) Type of Work:,Qw 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only toe alarm devices:
D New system Number of sprinkler heads: /D Number of alarm devices:
RI Addition or j21 1-10 heads: Affidavit required and
Alteration ❑ 1-5 devices: Affidavit required and
(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: n� )
/-( / r.,ti e t i` L` vi 4, LJ u.)cc
t f e 1 s?
..l, €,' r" I f ' ` r e,.,,, .Vg;<�-2,,,,,,, ,_.;;;=.7.1t...2„,,,,,,;-
-': s' y�, tart, , T - TI",-,I)- ..,
'-,� t -. °�'� r-' , „Y .,' ,-- "t •:as's S " ;:g:',1-.;•";.-- '
:`%,s E� C I ev ,t i e ;-.1,,k f�/`k1'4 s,` „4u zIc +T P'. --*'. "' .' i ri � 4* � � �-` " ,.z s <`"Ii
f'' .,,, x..i kac rc_i ..„, F`r;_� ;A, -S .s- ar"` .r ,: P € .�, 3 f" ' "". ` a" I �fi�'� "" %---...' ''',-``k`;''''7`4'i `�
��''�.`. �rcta.s ..a�������x �`acs^ , °•r'� ! a, rot'. x•�":a-'Q '�" t, + x ,�; l��- 7+
� � a" � Ss x?5 �s mr �.''� '� `� �� , 4
IEEZIEIMIIIIIIIIIIIII I. Wet ❑ D
Additional
Stand.i.es rIYWA ,
Information:
0 Yes 0 No
Hazard Grou. L
Densi
AP
Desi. Area
K.Factor
S E rinkler Pro ect Valuation: $ '1 <
_.-e n'"roas�i'e6 y;4,,.ry.,y.°�'^�������t�E��e ���` P C&`�{ xq �.= ''� �% ��,� ;,s yx^
Hood Pro Sect Valuation:
� ,� d'y4�x�� '�A` r,�� �..ew -..-'1. O � ,fix °Y b ri L*' �' �.
*41
E_r :,,,•,,,11%
6 1 E '''4,,:'''' r � ,. ,n. *' .i4 E"L'# 'x '� ' s 'ra' -'
-.. tee+ k- .,.:z,.,.. L..:,-.% '' .. 4 ''rte t - , ,",, '
Submittal shall . 6. _e ti ..� :.. �M,- _ :..., _ - '- ,._ .t
Batte Calculations "Y
include: 0 Yes
Individual Component 0 Yes
Cut Sheets
Fire Alarm Pro•ect Valuation: $
't a ,�,:bi� 'ittx� z$i r *f.**"..?:'-' e1x"t 17tee"
A ? E 4 E ,," 0. .t'e'er«- i`,taxa a T,� � i''....4-4,4: 1-':',- -'" r . .€
S.uare Foota_e: s
Permit Fee: � �
-
nt..-c,,:---474->�- � �` � � -x-
� �to 2,000 $198.75 f ���2,001 to 3,600 $246.45
3,601 to 7,200 $310.05 `'
lk, t -4
7,201 and eater $404.39 �� u " "'" prl �"
Sprinkler Project Square Footage: sq..ft.
ire Prr tec it
Pro'ect valuation subtotal see A,B&C above : $
Permit fee based on .ro'ect valuation see fee schedule : $
Permit fee based on s.uare foota•e see D above : $
State Surchar•e 12%of.ermit fee : $
FLS Plan Review 40% of.ermit fee : $
TOTAL: $
1:\Building\Permits\FPS_PermitApp_031016.doc
2
INCity of Tigard Permit No.: P-�%�`i--COQ2 S
13125 SW Hall Blvd.,Tigard,OR 97223
■ Phone: 503.718.2439 Fax: 503.598.1960 Date Received: d//v/4r
Inspection Line: 503.639.4175
"' a Internet: www.tigard-or.gov By: ✓ . .. A "-ft,-
/
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIQ $ f ' ` ,
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
,
Project Name: 0—, ,,,),(,,,,,-,2- Fa,,,,.,„21 p_d.,c,w( Occupancy: i 1, I,'r,c.., I ( '-r r e
Job Address: //,178 3 S eiJ Eaa.-=s. ,Ge 7 cid 1-az) Type of Construction:
Suite: MD
Contractor: J'c-le I Phone: Co ..- (, t7-- zib 8 y
Number of Proposed or Altered Heads: /O
Type: 0-RA Hazard: L. C'J Density: e") /
I, c).e ..e, I"el Oregon Construction Contractors Board No. / A 3 L 7 2,
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 'py of the sketch attached shall be available for all inspections.
Signature: • Date: 2-/-- /?
Print Name: 3-7e.`"`"?
`"`"? (D- 2,r,,
I:Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16083 SW UPPER BOONES FERRY RD 130,
TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00025
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor