Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
a COMMUNITY DEVELOPMENT Permit#: FPS2020-00063
T t G A A D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06f03/2020
Parcel: 2S113AA00500
Jurisdiction: Tigard
Site address: 16100 SW 72ND AVE B18
Project: Moda Health Subdivision: ROSEWOOD ACRE TRACTS Lot: PT A&F
Project Description: Fire sprinkler. Relocating(4)and adding(4)sprinkler head drops off of existing wet system to cover new full height
office wall for TI.
Contractor: AFP SYSTEMS INC Owner: PACIFIC REALTY ASSOCIATES
19435 SW 129TH AVE ATTN: N PIVEN
TUALATIN,OR 97062 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-692-9284 PHONE:
FAX: 503-692-1186
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/03/2020 $77.99
12%State Surcharge-Building 06/03/2020 $9.36
Type of Use: COM Plan Review-Fire Life Safety-COM 06/03/2020 $31.20
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 06/03/2020 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: .10 Design Area: 1500
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 $119.05
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,500.00
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. hose rules are t forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to O C calling 503.232. 7 or 1.800 332.2 44.
Issued By: Permittee Signature:
CCr
•
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. �r
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.
City of Tigard Permit No.: ppisezo_0.- ed
• Phone SW Hall Blvd.,Tigard,OR 97223S�,Z 1 /�
I Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 7 / J
Inspection Line: 503.639.4175
TI CARD Internet: www.tigard-or.gov By: JL.
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONNFcFivFD
OR TENANT IMPROVEMENTS MAY 2 7 a20
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
CITY C.
BUILDING DIVF: !N
Project Name: Moda TI Occupancy: B-office
Job Address: 16100 SW 72nd Ave., Tigard, OR 97224 Type of Construction: III-B
Suite:
Contractor: AFP Systems Phone: 503-692-9284
Number of Proposed or Altered Heads: 8
Type: Wet Hazard: light Density: 0.10
1 Steve Frost/AFP Systems Oregon Construction Contractors Board No. 67534
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 copy of the sketch attached shall be available for all inspections.
Digitally signed by Steve Frost
Steve Frost DN:cn=Steve Frost,00ro,c=stems,ou,
email=steve�aafpsys.com,c=US 05/26/2020
Signature: Date:2020.05.26 13:19:55-07'00'
Date:
Print Name: Steve Frost
I:\Building\Forms\FireSprinklerAffidavit_071514.docx Page 1 of 1
Building Permit Application _
Fire Protection System RECEIVED FOR 01 1 1( 1_( SE OIA1.1
City of Tigard MAY 2 7 020 Received
DateB : At i ��. r ✓6'
i • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ,/ „/
Phone: 503.718.2439 Fax: 503.598 196�lTY CAR�t Da S/B :
/ F�t'I r '
Inspection Line: 503.639.4175 Date Ready/By:
® e Page for
TIGARD 7 ❑� � 7DIV , nNNotified/Method:Internet: www.tigard-ongoV Supplemental
Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Ii4 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 ®Commercial/industrial
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
i
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:16100 SW 72°d Ave New dwelling area: square feet 1
1
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: /31 r Project name:Moda TI Covered porch area: square feet
Cross street/directions to job site:Oregon Business Park Bldg 18 Deck area: square feet
Other structure area: square feet
REQUIRED DATA: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 z
`s-. '�F e *40::�ir'DESCRIPTION OF WORK work indicated on this application.
, �3
Relocate 4 and add 4 sprinkler head drops off of existing wet system Valuation: $$1 500.00
to cover new full height office wall. Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER 0 TENANT Number of stories: 1
Name: Type of construction: III-B
Address: Occupancy groups:
City/State/ZIP: Existing: B-office
Phone:( ) Fax:( ) New: no change
® APPLICANT 0 CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Y
Phone:( ) Fax::( )
E-mail:breanna@afpsys.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:AFP Systems Inc.
Permit fee:
Address:19435 SW 129n Ave
State surcharge(12%of permit fee):
City/State/ZIP:Tualatin,OR 97062 •
FLS plan review(40%of permit fee):
Phone:(503)692-9284 Fax:(503)692-1186 (Due upon application submittal.)
CCB lic.:67534 Total permit fees:
Amount received:
Authorized signature: 't'(/
This permit application expires if a permit is not obtained
Print name:Steve Frost Date:05/26/2020 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board. •
I:\BuildtngtFermits1FPS-P neitApp 071514.doc 440-4613T(11/02/COM/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:
❑ New system Number of sprinkler heads: 8 Number of alarm devices:
® Addition or ® 1-10 heads: Affidavit required and El 1-5 devices: Affidavit requited 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:
Type of System (Complete A,B,C or D as applicable):
A.) Commercial Sprinkler
® Wet ❑ Dry
Additional Standpipes
Information: Hazard Group LH
Density 0.10
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ 1,500.00
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ 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): $ 1,500.00
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: $
N:\Steve\Prints TI\moda partners TI\moda TI submittal\moda TI FPS_Pem itApp.doc2