Permit (162) FIRE PROTECTION SYSTEM PERMIT
' CITY OF TIGARD
Permit#: FPS2019-00060
2 : COMMUNITY DEVELOPMENT
T f CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/09/2019
Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Medical Group Subdivision: None Lot: None
Project Description: fire alarm permit for TI:Adding(1)strobe. Affidavit submitted.
Contractor: OEG INC Owner: PROVIDENCE HEALTH &SERVICES-ORE
1709 SE 3RD AVE ATTN: REAL ESTATE&CONSTRUCTION
PORTLAND, OR 97124 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-234-9900 PHONE:
FAX: 503-234-1001
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/08/2019 $112.96
12%State Surcharge-Building 05/08/2019 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 05/08/2019 $45.18
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 05/08/2019 $8.00
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 $179.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,300.00
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 0,913—a52-001-001 0 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 0.332.2344. -----)
Issued By: Permittee Signature: I/1'<
Call 5�!�4175 by 7:00 a.m.for the next available inspe ion 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 RECEIVED
City of Tigard Date/By:ed _
tii / /��, Permit No.: f..."7:•./).•` j 'r I t/ i'
�7�f1 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
_
Phone: 503.718.2439 Fax: 503.598.196CMAy 7 2019 Date/By: Other Permit:‘5;04.1/2,61 i"--612,073
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Jure_ See Page 2 for
Internet: www.tigard-or.gov t'i_1..V OF TIGNRD Notified/Method: $ 7fiq Z( I Supplemental Information
3UILDING DIVISION 69r,a1
TYPE OF WORK REQUIRED DATA:1-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
®Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1-and 2-family dwelling El Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:12442 SW SCHOLLS FERRY RD New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: /ad Project name:PROVIDENCE p?cee,:iepe erre, Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
UIRED DATA:TA: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
DESCRIPTION OF WORK work indicated on this application.
$$3.�
TENANT IMPROVEMENT-FIRE ALARM ADD(1)STROBE Valuation: $ 1.05000:(0. -.),x):;
`'
Existing building area: 2000 square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:SISTERS OF PROVIDENCE Type of construction:
Address:4800 NE GLISAN ST Occupancy groups:
City/State/ZIP:PORTLAND,OR 97213 Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT ® CONTACT PERSON NOTICE
Business name:OEG,INC. All contractors and subcontractors are required to be
Contact name:JEFF HILL licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:1709 SE 3rd Ave jurisdiction in which work is being performed.If the
City/State/ZIP:Portland,OR 97214 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)849-2597 Fax::(503)234-1001
E-mail:laurel.semprevivogonzalez@oeg.us.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:OEG,INC.
Permit fee:
Address:1709 SE 3rd Ave
State surcharge(12%of permit fee):
City/State/ZIP:Portland,OR 97214
FLS plan review(40%of permit fee):
Phone:(503)234-9900 Fax:(503)234-1001 (Due upon application submittal.)
CCB lic.:203 Total permit fees:
/�
su
Amount received:
Authorized sign �� \ G U � 7This permit application expires if a permit is not obtained
Print name:Laur A Sem revivo Date:05/02/19 within 180 days after it has been accepted as complete.
p * Fcc methodology set by Tri-County Building Industry
Service Board.
I:ABuilding\Permits\FPS-PermitApp_031016.doc 440-4613T(1 I/02/CAM/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:
0 New system Number of sprinkler heads: Number of alarm devices: 1
® Addition or ❑ 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 within building structure
system
❑ 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:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type 0 Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes 0 No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations 0 Yes
include: Individual Component 0 Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler(Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
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: $
Y:\PROJECTS 2018\101057 PROVIDENCE PORTLAND 2018 SUSTAINING\Peron\101057-571\101057-571 Fire Alarm App.doc
101057- 57 /
City of Tigard RECEivEn
Permit No.: 7-72-PS j (:r?
13125 SW Hall Blvd.,Tigard,OR 97223
• Phone: 503.718.2439 Fax: 503.598.1960 �p �/ ZO,n Date Received: j/'7//�r
Inspection Line: 503.639.4175 MAY J
IIC,ARD -..
Internet: www.tigard-or.gov �� .I I� By: e.7., l/4 O� is��-�
FIRE ALARM RI 'RAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: PROVIDENCE SCHOLLS Occupancy: CLINIC
Job Address: 12442 SW SCHOLLS FERRY RD Suite: 205
Contractor: OEG, INC. Phone: 503-234-9900
Valuation of work: $300,000
Type of System: (check one) ❑Required ❑Non-required
(check one) *Automatic ❑Manual ['Both
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added(max 5) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) 1 /To be Relocated(max 5)
I, LAUREL A SEMPREVIVO Oregon Construction Contractors Board No. 203
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 Tyof appliances and devices are in accordance with the FACP manufacturer's specifications.ecifications.
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.
• Electrical permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature: LAN\1\ Date: 05/02/19
Print Name: LAUREL A SEMPREVIVO
I:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12442 SW SCHOLLS FERRY RD 100, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2019-00060
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor