Permit (80) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
: = COMMUNITY DEVELOPMENT Permit#: FPS2019-00069
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/03/2019
T i[;;+ It Dg Parcel: 1 S135BA00100
Jurisdiction: Tigard
Site address: 10205 SW WASHINGTON SQUARE RD
Project: Thirsty Lion Subdivision: None Lot: None
Project Description: Fire Alarm. Connecting new riser water flow,tamper,and pressure switches installed by sprinkler contractor for
new addition to existing fire alarm for monitoring.
Contractor: GUARDIAN SYSTEMS NW INC Owner: PPR SQUARE TOO LLC
13500 SW PACIFIC HWY PO BOX 847
STE 245 CARLSBAD, CA 92018
PORTLAND, OR 97223
PHONE: 503-639-3723 PHONE:
FAX: 503-624-8258
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/03/2019 $51.09
12%State Surcharge-Building 06/03/2019 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 06/03/2019 $20.44
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 06/03/2019 $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: Yes Cut Sheets Required:
Total $78.16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $500.00
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 • ..'I. .
Issued By: ‘2.....Aert... ...4._
•- .i'tee Signature: e i
11/
Call 51/1by 7:00 a.m.for the next available inspection d te.
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 incpectioo
Building Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY
City TigardUN of Received z
Date/B �' IW /
p
13125 SW Hall Blvd.,Tigard,OR 9722312 9 Plan Review
' C Phone: 503.718.2439 Fax: 503.598. 9(Q, Date/B : ri i ,
Inspection Line: 503.639.4175 U1 1 Y OF TIGARD Date Ready/By: Juris: 0 See Page 2 for
TIGARD
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF ' Rk REQUIRED DATA:i AND 2-FAMILY DWELLING o New construction ❑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 0 Other: equipment,materials,labor,overhead,and the profit for the
4, -,? CATEGORY OF !:al+1L8TR"°�1�3'ION work indicated on this application.
❑ 1-and 2-family dwelling gj Commercial/industrial Valuation: $
ElAccessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE IN4:0481A4'' AND LOCATION Total number of floors:
Job site address: l 0 ZL?S <t.,;) (.4J/ 7 4 ) 5a New dwelling area: square feet
City/State/ZIP: 6„,(3/).4) t Q g._ 41't,z3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: ' 14--k .s f1 (A
1'i / D 3 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
11. .-1 S .,,,A-te Other structure area: square feet
r ( 'j ® i I RCIA4:, U,g,,,,.QRFR.SMST.elg
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
6E73
'
DESCRIPTION5 f `ORK; work indicated on this application.
Valuation: $ C
Comic:--n l,"4-71 K1,SiL2 wATr c.O i -r k-' *L L=a— ed..6 -sc.t_.
Existing building area: square feet
!/,64t/ A-Pi)--7t.).-) '-v
./S-k?./ i.ZAl Aldo-in /q'.G intorivee ✓-/ New building area: square feet
'$ 0 PROPERTY OWNE" '` 0 TENANT Number of stories:
ziix
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
YY?t�' IGA+1T s jERSON rt TI ,,vry , '
27,41'*:�iMdsk �.��„z Y-ti.- .. .. r,., s -r� ,. �y..t� ��1 !�”, k"
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
/�� f%LZ)l� under ORS 701 and may be required to be licensed in the
Address: V >> jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) Fax::( )
E-mail:
Business name: '.. ..... ....... CONTRACTOR ,,: . L MIT ES'4.,,,-,-e' -:.,
IJI
,{Plea ;ffee sch.. fr)_.
1/L) ii i-( -13le/+Z j V 1- Permit fee:
Address: ( 3 s' ) t,i �� -:i,-/-/4,4,,yAt.,Zf/f
City/State/ZIP: State surcharge(12%of permit fee):
��'G.Z�h�, ��- �l �� FLS plan review(40%of permit fee):
Phone:(5-05/) 6..) -',. 7 3? Fax:(,SV/) Ci,„?,_ g- .:Q (Due upon application submittal.)
CCB lic.: it- S all
.i Total permit fees:
/fAmount received:
Authorized signature: 0 .44 :;/' -/(_,/
I" This permit application expires if a permit is not obtained
Print name. J.(/rb,/�e ,Z �1 Date: ls•j . /9 within 180 days after it has been accepted as complete.
J * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PerniltApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
11'
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
El New system Number of sprinkler heads: Number of alarm devices:
IA Addition or ❑ 1-10 heads: Affidavit required and K 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
EI 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Tarn ofys� {Complete A,B Cir D s applicable); , "' ?
.) � e a al$ rinkler
4
P yP ❑ . ❑
Sprinkler T e Wet Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type :a t6 ire Suppression tem xu .,'
Hood Project Valuation: $
.'C) ire Alarm -�° -
Submittal shall Battery Calculations ® Yes Fv �s x'141, -11i ,J (07442--J
include: Individual Component ❑ Yes
Cut Sheets
c';:�� r3{ �PLindit C L��'"i+�t-c" C
Fire Alarm Project Valuation: $ ,‹6- j: ,w
® tie r�®a prinlcler:{S#an Alone Syste®�
Square Footage: Permit Fee:
0 to 2 000 $198.75ti: 1-4
�:
tf.a
$246.45 f
2,001 to 3,600
3,601 to 7,200 $310.054",1-""':::41,. z
7,201 and greater404.39
Sprinkler Project Square Footage: sq. ft.
., ' ti, . + ori.i'ermit;Fe's ...
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: $
I:\Building\Permits\FPS_PermitApp_031016.doc 2
City of Tigard Permit No.: � It'5jr—cw (
a 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: C/3 JAgInspection Line: 503.639.4175
T I G A R D Internet: www.tigard-or.gov By: afff if- 71M,-71
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATElVED TTS
OR TENANT IMPROVEMENTS JUN - 3 2019
ITYTIRD
(MAXIMUM OF 5 DEVICES WITHOUT PLANS) BUILDIONGLF ANS) BUC
Project Name: - -ht..S 1.--104,) Occupancy:
Job Address: i 0 2,05 ,Svv Lk114 4 4 5Q. W. Suite:
Contractor: ( , ;, S"a i i. `at"47 2 Z�
�� S � Phone: SZS ���9% 3 72,3
Valuation of work: $
Type of System: (check one) ARequired ❑Non-required
(check one) Automatic ,Manual Q oth
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(in 5) e- /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) .ct./To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) _5 /To be Relocated(max 5)
I, aliAlev 1- es-et' _ Oregon Construction Contractors Board No. 0- ,5*1,t'
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 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: axe ( 4_,‘„, Date: 7 -if
,
,
Print Name: fl/A . rq 19
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