Report City of Tigard Permit No.: L _! 50Z0?) — 2L Q f
• 13125 SW Hall Blvd.,Tigard,OR 97223 /Iq
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: .oZ {
Inspection Line: 503.639.4175 r'
.1I G:\ILI) Internet: www.tigard-or.gov By: 1�rmireba 4/
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Ameriprise Financial Occupancy: Pacific Corp. Center
Job Address: 6650 SW Redwood Lane Suite: 160
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $1,183
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(ma.5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5> 2 /To be Relocated(max 5) 2
I 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: 02/17/2020
Print Name: Ben Breit
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