Permit (3) I CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2020-00014
TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/05/2020
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 190
Project: Integrity Medical Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Fire alarm permit:Adding(5)fire alarm devices. 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 PKVVY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/05/2020 $77.99
12%State Surcharge-Building 02/05/2020 $9.36
Type of Use: COM Plan Review-Fire Life Safety-COM 02/05/2020 $31.20
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 02/05/2020 $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: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $119.05
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,468.00
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:
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.
RECEIVED
City of Tigard FEB Permit No.: i'.S - e; 'i N
Ni 13125 SW Hall Blvd.,Tigard,OR 97223 3 2Vnn?
s Phone: 503.718.2439 Fax: 503.598.1960 Date Received: R/3
Ina}�ction Line: 503.639.4I75 CITY OF TIGAfRL,
I GAR')' Internet: www.tigard-or.gov BUILDING DIVISIC(Y: (.-i7 i `r T 1
c1.a'it
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Integrity Medical Occupancy: Pacific Corp. Center
Job Address: 6680 SW Redwood Lane Suite: 190
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $1,468
Type of System: (check one) NRequired LiNon-required
(check one) ❑Automatic LiManual ElBoth
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) 5 /To be Relocated(max 5)
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 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: '~. - Date: 1/31/2020
Print Name: Ben Breit
I:\Building\Fonns\FireAlannAffidavit_071514.docx Page 1 of 1
Building Permit Application
Fire Protection System RECEIVrn rot,. ,i, l•: t'SL:OV'1.1
City of Tigard Received
13125 S W Hall Blvd.,Tigard,OR 97223 � 202� Date/By:n Re " Permit No.: 2" �_
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review, l7TYI11 ' jib
Inspection Line: 503.639.4175 Date/By: Other Permit: ,ram ��
rl( ARI) p �IY OF TIGARCD Date Ready/By: '' `S e°ge2for x'�� t/
Internet: www.tigard-or.gov Juris. See Page i for
B(III (�1(�(� ()i�/j 1{ �� Notified/Method: Supplemental Information
TYPE OF WORK __v.. REQUIRED DATA:1-AND 2-F4MILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
El Addition/alteration/replacementIndicate the value(rounded to the nearest dollar)of all
0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CO.1`1S"TRUCT><ON work indicated on this application.
❑ i-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family _ Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:6, 0-SW Redwood Lane New dwelling area:
square feet
City/State/ZIP:Portland,OR 97224 Garage/carport
g carport area: square feet
Suite/bldg./apt.no.:190 I Project name:Integrity Medical
Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
Subdivision:
REQUIREDDATAI'COM11iERCIAL-USE CHECKLIST
I 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
DESCRIPTION OF WORK work indicated on this application.
FIRE ALARM Valuation: $1,468
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ® TENANT Number of stories:
Name:Integrity Medical
Type of construction:
Address:6680 SW Redwood Lane Suite 190
Occupancy groups:
City/State/ZIP:Portland,OR 97224
Phone:( ) Existing:
Fax:( )
E;APPLICANT 0 CONTACT PERSON` New:
Business name:Point Monitor Corp. NOTICE
All contractors and subcontractors are required to be
Contact name:Brooke Williams licensed with the Oregon Construction Contractors Board
Address:5863 Lakeview Blvd#100 under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:Lake Oswego,OR 97035
Phone:(503)627-0100 apply:
Fax::( )
E-mail:bwilliams®pointmonitor.com
CONTRACTOR
Business name:Point Monitor Corp. BUILDING PERMIT FEES*
(Please refer too fee schedule/
Address:5863 Lakeview Blvd#100 Permit fee:
City/State/ZIP:Lake Oswego,OR 97035 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( )
(Due upon application submittal.)
CCB lie.:135901 —
Total permit fees:
-
Authorized signature~ _ Amount received: I
This permit application expires if a permit is not obtained
Print name:Beu Breit I Date: 1/31/2020 I * within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
i.Building'Petmits FPS-PermitApp_031016.doc Service Board.
440-4613T(11 0«COM WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to bcs,done
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices: 5
® 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
El 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work: Fire Alarm
Type of System (Complete A,B G or D as `: hcab1e'
A:yr CommercialConutieriat Sprii ldee. °` t4
Sprinkler Type ❑ Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
Hood Fire'SuppressionpSystem'
Hood Project Valuation: $
�.�y,�iA�y,�y�
C.^ iire.`Atarm� { — `� �.E 9 t:v} µ A?' ' + �,✓YJ' ; "'`�t ri
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1,468
D )� estitentiaf�S rinkter Stand Alone } ��
Square Footage: Permit Fee: y,
d � K
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°A) of permit fee): $
FLS Plan Review (40% of permit fee $
TOTAL: $
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