Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT
Permit#: FPS2020-00066
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/10/2020
Parcel: 1S136DC03200
Jurisdiction: Tigard
Site address: 11714 SW 72ND AVE
Project: Dirt By Design Subdivision: Lot: 8
Project Description: Fire alarm permit:Adding(2)fire alarm notification devices for NAC circuit extension. Affidavit submitted.
Contractor: DYNAMIC SERVICE FIRE SECURITY LLC Owner: 72ND AVENUE PROPERTY LLC
1041 FABRY RD SE 4804 NW BETHANY BLVD STE 1-2
SALEM, OR 97306 PORTLAND, OR 97229
PHONE: 503-302-7122 PHONE:
FAX: 503-990-7222
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/10/2020 $51.09
12%State Surcharge-Building 06/10/2020 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 06/10/2020 $20.44
Class of Work: ADD Type of Const: Info Process/Archiving-Sm$0.50(up to 06/10/2020 $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 Gales Provided: Cut Sheets Required:
Total $78.16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $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 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: /pif--"'""74-.4•10.•
Call 3. 39.4175 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.
• City of Tigard Permit No.: I /'/;r Ek-
13125 SW Hall Blvd.,Tigard,OR 97223
t Phone: 503.718,2439 Fax: 503.598.1460 Date Received: 6/,3%)1)
Inspection Line: 503.639:4175 � J
7'I(,ARC). Inuxnet: www.tgard-or.gov By: Cm)ip, of J-7�iret
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name:\(- \ e xk Occupancy:
Job Address: \VA\A `'I a nC\ Suite:
Contractor: f t-Nc),'(`(11 C, F5 Phone:r )) 3 j r'f
�a�
Valuation of work: $
Type of System: (check one) f Required ❑Non-required
(check one) [Automatic ❑Manual L{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 Imflx s1
Number of Proposed Manual Alarm Stations: To be Added I. x si () /To be Relocated(m.s) o
Number of Proposed Notification Appliances: To be Added imax s /To be Relocated max 51 C
Y ) Y' _� Oregon Construction Contractors.Board No. ($\
certify the following is true and deft ies the scope of work for this project:
a) All work complies with the-cuucut 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: C I �` tLVDC
Print Name Date ��CQ
\a�\\Q V L� `
: 1�
I:\BtildingiForms1FireAlarmAffidavit 071514:docx J Page I of I
Building Permit Application
Fire Protection SystemIIIIIIIIIIIII=MIIIIIIIIII.Daidft 6
City of Tigard ' °t p 1
131 SVY Bail Blvd.,Tigard,OR 47223- > cw 1✓�/C) t'wc?\v.: /!� 'L 'C .)
Phew: Sd3.7181439 Fan: 503.59ff,19e0 ,: ahclbrt'..j1pgr i_
Inspection Line 503.639.4175 Date Readyff3 _ / eii€ G�Set-Page-Sim.
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Internet. uv.�e.ti^ard-nr.goc Notified � .�'� , Su lemental lnformatien
r. � 't/(r.t kl,/fc. �j)�.
TYPE op Wcim RE9i1fnavaL -1,App24,04,4 1W.WdaiM=:'
r
1:]New construction
If 0Demolition Petzeritf«s'xpe�seed+actl#,e�lvevrfftfie�,�mrYpelfKa:nod.
`dri0nAn19ewtSemEteplaoement ! ❑Attar: Inchoate the value(sounder:He he amnxt-douse)ofall
equipment,materials,labor,overhead,and the profit for the
'fAYWOWY 1OF•C OAi r; want indicated this.applieatiaa
❑1=and3-fatnilgdwrelling O'CemmerciaVinflostrinl Valuation: S
ElAccessory building ❑Multi-family Number of bedrooms:
a Master builder } 0 Other: Number of bathrooms:
'idly 3i ;oieoiara Tf:lYl: isooc 41T 1
1 E Total MUMber of flows:
Job site adhiTMer J/ 7/q' 7 — /`t�L_.. New dwelling areae square feet
CLry/StatePL�: I /� if V/t�.'�/ a 76f 7 3
, �i l" � � ' area: WNW feet
SuMblik fapt.no.: -s Pr i cct name:Air y L)5' )j Covered parch area: square feet
Cross streetrdirections to ion site: ___J Deck Luca: square feet
Other structure area: square feet
R'E¢iJiRBg:DATAitr4Mikttfte AI.1 .
iSubdivisian: 1 Lama: { Permit fees are based on the valise of the work performed.
Tax snap/parcel m.: Indicate the as lue(minded to tbenmest.dellsr)efall
equipment,ratioerias,labor.aNCrTxmd,and the profit Sw1bc
D /C&IT1#Cga litV 1ltfliffif - work itxlieaaed'nn this.applieati as
S ahn tm :
Existing building area: square feet
New building area: mime feet
"Pfl b€•t>b1 WEEi Q?;P cs,t€f` Numbeofatexits: 3
Name: Type of carattaction:
Address:
Occupancy :
City/State/ZiP: Existing:
Phone:( ) j Fax:( )
New.
Burnam mme: All commons and snbooatractms one aagn'irnd m be
Comet name: Jimmiedw th.the•(iresee Cmtx�tieID Ceratarcwts Btwr d
w.aler•On 701 endansy be required to be hanweder the
Address: jt riadicti n m which w rk is being perfermod.lithe
City/State/ZiP: applicant is estaupt from licensing,the toll uviog reasons
apply:
Phone:( 1 Fax: :{ )
&mail:
Bnrsimesa o 1 rn.".ct„,14..,,,,F;res ,/, /Address: /rof/ ,,.�/�4fi .y pF}r-� / Permit fee:
City/State/ZIP Glee I t A l T.'")047 State surcharge pectvit fee):
e F FLS plan review(40%ofpermit tee):
Phone:15-J,3130L57�,s{'/"1 I Fax:i ) I r/)ue upon nppficmion suenninal.l
CCB lic.: i Q J Q !g �C i Total permit fees:
Authorized si asxar, `e:,per ^i�%�/%fi'L" 99 Amount received
This sari espies if a perrait is natebtaiaed
Print name: /� Jiff/] / y� Date: �sJJ �} +� .itithuISO aeYs after itmabaest,�aoeprtidg comp lme
J/!•/ I"'O B7< SFr/ L�CV a F, 'rentlxicielegy Bet by iii,Courny Etailcim GIndustry
Serrioe Bawd.
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City of Tigard: Fire Protection Permit Checklist
Page 2_appt'ementat Information
fl cd mrotic to be'do e .
1.) Type of Work: 2.) Addition/alteration only Lo sprinkler beads: 3.) Mention/alteration only to"alarm devices:
E New system Number of sprinkler heads:. Numberof alarm devices: CZ
Addition or ❑ 1-10 heads: Affidavit required and -5 devices: Affidavit required and
Attention (3)copies of sketch showing area (3)copies of sketch showing area
to existing of work within building structure of work within buik1ing structure
systietn
❑ 11+ heads: Plan review required and ❑ 6+devices: Plain review required and
(3)sets of pawns. (3)seta of plane.
Additional description of work:
on �f�� - c, el71
Type-of System(Complete A,.B,.C oor D as.a pia 6te�:
Sprinkler Type [ Wet ❑ Dry
Additional Standpipes-
Information: Sprinkler Supply Lille ❑ Yes [f No
Hazard Group
Density
Design Art
K.Factor
Sprinkler Project Vahiatton: $
P.) Type I Hood Fire"Suppression System •
Hood Project Valuation: j $
):
'
Submittal shall I Battery Calculations 0 Yes
include; Individual Component ❑tr Nes Pre�+li/k3
Cur Sheets I
Fire Alarm Project Valuation: S 061
D) teal- :mk1er- 5taand. A4glc a
Square Fora : Permit Fee
D so 2,000 S198 75
2,0D1 to 3.600 5246.45
3,601 to 7,200 S310.0;
7,2n1. and greater---- . --- $404.39 - - -
Sprinkler Project Square Footage: sq.ft.
Project valuation subtotal(see A,.B&C above): S
Permit fee based on project valuation.(see fee schedule}: $
Permit fcc based on square footage (see D above): $
State Surcharge (12%of permit fcc): $
FLS Plan Review(40%of permit fee): $
TOTAL $
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