Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
' `• COMMUNITY DEVELOPMENT Permit #: FPS2011 00106
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 09/22/2011
Parcel: 25101AB00100
Jurisdiction: Tigard
Site address: 12023 SW 70TH AVE
Project: Red Rock Center, Phase II Subdivision: Lot: 0
Project Description: Fire sprinkler system for shell
Contractor: FIRESTOP CO Owner: FRY, DOUGLAS
3203 NE 65TH ST #2 23077 SW NEWLAND RD
VANCOUVER, WA 98663 WILSONVILLE, OR 97070
PHONE 360- 718 -8604 PHONE:
FAX 360- 718 -8603
FEES
•
Description Date Amount
Specifics: Permit Fee - COM 09/09/2011 $306.64
12% State Surcharge - Building 09/09/2011 $36.80
Type of Use: COM Plan Review - Fire Life Safety - COM 09/09/2011 $122 66
Class of Work: FPS Type of Const: VB Info Process /Archiving - Lg Sheet (over 09/22/2011 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm Sheet (up to 09/22/2011 $15.00
11x17)
Commercial Sprinkler System:
Sprinkler Required. Yes Sprinkler Type: Wet
Standpipe Required Hazard ORD1
Density. .2 Design Area 1062
K Factor. 8
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required. Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required'
Total $483.10
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation $22,000.00
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 ot1 ication er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090. You ma obtain a copy of the rules
or d' ect questions to OU b -II g •3.232.1987 or 1.800.332 2344.
Is ued By: / / / r Permittee Signature: s
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.
Building Permit Application
Fire Protection System RECEIVED FOR OFFICE USE ONLY
C g
Cl of Tigard ' ;war No Z
° 13125 R eceived C
Tigard, Hall Blvd , Ti , OR 97223 Date /B � 3 � /V��� // DO /ewe) S E P 0 9 2011 Plan Review W/ Other Permi
Phone 503 639 4171 Fax 503 598.1960 Date /B Mat �i I :50620//— A/ U/ 7
T . ■ Inspection Line 503 639 4175 Date Ready /By ,. Juns 0 See Page 2 for
Internet: www.tigard -or gov CITY OF TIGARD Notified/Method L f w i- 71 upplemental Information
'BUILDING DIVISION , elle 11) A. - .... ; ';. i a
TYPE OF WORK REQUIRE) DATA: 1- AND 2- FAMILY DWELLING
L�9 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
CI 1- and 2- family dwelling Commercial /industrial Valuation: $
111 Accessory building El Multi-family Number of bedrooms:
ID Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 Z O 2-, 3 5t,4 - MTh AVE, New dwelling area: square feet
City /State /ZIP: "f 1 6 A g_ Q ` in R 9 1 2_2. 3 Garage /carport area: square feet
Suite/bldg /apt. no.: Project name: IY b 12...ock A EG N'T`E — Covered porch area: square feet
A Cross street/directions to job site: .L- 1) 6 . 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
DESCRIPTION OF WORK �j M work indicated on this application.
5 S i lr N 4 I N S l A Li- F( C S/ n p) /Vi< cep_ Valuation. $ 221 eCro
S i/ S TE M .� O p _ ' r ski IA _ t Existing building area: square feet
! (f"� New building area: i I 1 ov 17 square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories I
Name: N f A Type of construction: N/A
Address: [ Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
[APPLICANT , E " ONTACT PERSON NOTICE . .
Business name: k F i Ice silo ! o L L_ C... All contractors and subcontractors are required to be
Contact name: e,,, Cz E� licensed with the Oregon Construction Contractors Board
/ _ under ORS 701 and may be required to be licensed in the
Address: 3 6 3 N c S 7=` S l q sp. . jam jurisdiction in which work is being performed. If the
'
City /State /ZIP: VA 0 C t1 VG7L7 INVA • J 1 $'O S3 applicant is exempt from licensing, the following reasons
T ^f 4 apply:
Phone: (760) l /Cl - 9�0a4- rr F ax: : ( %V) -7 - 6 60 3
E -mail: /C 6 r c' ire e H -F -edhp c o o , 4oY,,
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule) •
Business name. Ylk M E A_ S A pjd v
Permit fee:
Address:
State surcharge (12% of permit fee):
City /State /ZIP:
FLS plan review (40% of permit fee):
Phone: ( ) Fax ( ) (Due upon application.)
.;CB lie.: 1 8 3 2_ 'i 9 Total permit fees:
Authorized signature: 7 4 /- 4 .a-y__ Amount received:
//I This permit application expires if a permit is not obtained
Print name: /2„-66.p... T b, { ,-E J J Date: 9 / 7 / 1 Y / within 180 days after it has been accepted as complete.
* Fee methodology set by Trt- County Building Industry
Service Board.
I \Budding\Permits \FPS- PermuApp doe 10/01/09 440- 4613T(I1/02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) [r New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration El 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
["Wet El Dry
Additional Standpipes 0
Information: Hazard Group d (LC), 2..
Density a LO
Design Area j Sen O
K. Factor S O
Sprinkler Project Valuation: $ 0 07 , °.
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): $
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: $
Plan review requires a completed apphcation and 2 sets of plans at submittal. Plan review fees are required at submittal.
I. \Buildin \Pcmvts \PPS -Pet mitApp doc 10/01/09 2
RECEIVED
FIRESTOP COMPANY SEP 09 2011
AUTOMATIC FIRE PROTECTION CITY OF TIGARD
3203 NE 65 Street, Space 2 3614 NE 65 St. OR / 1832' U1LV1NG DIVISION
Vancouver, WA 98663 Marysville, Wa. 98271 WA / FIRESCL922OH
P 360- 718 -8604
F 360- 718 -8603
LETTER OF TRANSMITTAL
To: City of Tigard Building Department
Attention: Fire Sprinkler Plans Examiner
Address: 13125 SW Hall Blvd.,
Tigard, Or. 97223
Regarding: Red Rock Center, Building A
From: Bob Green
Date: September 8, 2011
Subject Address
Red Rock Center, Building A
12023 SW 70 Ave.
Tigard, Or. 97223
Attached:
1. 3 sets of Shop Drawings (Sheet 1 of 1), hydraulic and seismic
calculations stamped by FPE
2. 3 sets of sprinkler head cut sheets.
3. Building Permit Application and check for $466.60 for total fees
based on $22,000.00 valuation.
If you have any questions, please call.
Copy to: File
Sincerely,
tie.g-j 1 4- -
Robert D. Green, CET 3
bob.green(a�firestopco.com
360- 718 -8604
Fps Z� 1
ao p
FIRESTOP COMPANY
AUTOMATIC FIRE PROTECTION
3203 NE 65" Street, Space 2 3614 152" St. NE, #4 OR / 183279
Vancouver, WA 98663 Marysville, Wa: 98271 WA / FIRESCL922OH
P 360 - 7184604
F 360- 718 -8603
FAX
Attention: Fire Sprinkler Inspector •
Company or Government Office: City of Tigard Community Development
Regarding: Red Rock Center Building A
FAX: 503- 624 -3681
E -mail:
From: Bob Green
Date: April 26, 2012
Subject Project and Address # of pages sent
including this cover
sheet is 3.
Red Rock Center�n A
12023 SW 70 Ave.
Tigard, Or. 97223
. I
Please see attached for Contractor's Material and Test Certificate for
Aboveground Piping as requested. Please confirm receipt,
Copy to file
Thank you
44 9
Bob Green
bob.green(rfirestopco.com
360 -718 -8604
£/I d I89£429£O6 «CO9881LO9£ 03 dOlSMIA OZ :bI 9Z-bO -ZIOZ
L.
Contractor's Material and Teat Certificate for aboveground Piping
PROCEDUR
representative Upon completion of work, Inspection and tests shall be made by the contractor's ��
representative. All defects shall be corrected and system left In service before contracto sr peere en4 twin rsonnel finally le by h e owner s
y eve the lob.
A certificate shall be filled out and etgned by both representatives. Copies shall be prepared for approving authorities, owners, and
contractor. It Is understood the owner's representative's Signature In no way prejudices any delm against contractor for faulty material, poor
workmanship, or failur comply with approving authorities requirements or local onfinancee.
Property name �c CC r ~� — [Date Property address I / i '-
I iZo � te/ 0 vE. `tI 6Art -0 4R-• `i ?u3
Accepted by approving authorities (names) L , T Y d (`
Address
1 3) 2 -r HA l.Lr B Lv b .
Pins Ti &A s-O _ o fL , 7z.z".3
Installation conforms to accepted plans
Equipment used Is approved al Yes ❑ No
If no, explain deviations Yea �'] No
I
Has person In charge of fire equipment been instructed as _
KI to location of control valves and tare and maintenance Yes �] No
01 this new equipment?
If no, explain
Instructions
Have copies of the following been left on the premises? I ❑ Yes El No
1. System components Instruction ® Yes
2. Care end maintenance Instructions ❑ No
Yea []No
_ 3. NFPA 25 fir,
Location of — r J Yes El No
system Supplies buildings 4 A N) /q I '
upe'� �
Year of Orifice Temperature
Make Model manufacture size
74 .B►7s _ FtFA.. 'LOt� t74-07-1 °. F
Sprinklers n ` _ FIFR - 56 t1 Y1J. 9.3 (SS" f
Pips and Type of pipe _ALA Oc- I/ 7 1 �! 4°
fittings Type of finings c . r • TFtQE R D E e �Lq4 v E CI
Alarm Maximum time to operate
valve or _ T Alarm device • through test connection
flow YPa _ .. Melee Model Minutes Seconds
Indicator W F S Pair €1 V$ fL - So
Dry valve O. O. D.
Make Model Serial no. Make Model Serial no.
I I Dry pipe Time to trip
water • Alarm
operating through test Water Air reached operated
test �,: neogpnt.2 re ..... , air pressure test outlet' P�
t p roperly
7M J � ~ Pei _ gel Minutes Seconds Yea No ,
O.O.D.
explain -T— W
2 NFPA 13 from � � opened sections ~_
•
� wtm perm lesion from NFPA 19, Irretefiptien of Speeder Systems, Copyright 02002, Netlor al Fire Protection Atw istic% Quincy, MA 02269-This reprinted =term '
Is complete end official poglon of the National Fire Protection Association, on me raMrsnpd Mild which Is npnyeerrfsd only h Y the standard in its cmireht
- Fire snkl r Association
pave Inman threat suite 200, halloo, u, Te 76219 AFSA Form SAF061
pri
(ZVI 9Z-trO-ZLOZ
£ /Zd t89£tiZ9£05 «£0988tLO9£ 09dO1S31f1d
•
£/£ d
Dees eadi aaym operate
supenision bee me m7
HrdmateOr Hydrostatic tests ahem ea male et ml tea men 200 pH ( 3.0 ear) for 2 hours or eO pa (3A ben
sewe.telo Oman in moan of 150 pet (102 bar) ter 2 haute. Dial 0401. vdra claws shad be lefa
open ailing 01e liM to prevent Pampa Al almegrmod plpep tee PM be supped,
Ewalt assails?' 40 psi (2.7 ban Mt prams and museum amp, wMeh giro. aW awed no psi (0.1 tier)
0
24 hem. t . 1e W
tanks at nom.etie 4 ek mimes end newe end measure Mr pressure 0. . dro witch ghee
Psi ( ban In 2a h um,
Contractor's Material and Test Certificate for Aboveground Piping
1,89£0Z9£0S (< £09881L09£ 03 d01S31113
( ZVI 9Z-vO-ZLOZ
NEW
BACKFLOW ASSEMBLY TEST REPORT 0 EXISTING
REMOVED
PROPERTY fact C REPLACED
OWNER:
MAILING ? ('1 a 3 Sop 7674 ,q
ADDRESS: /�/11(��Jl'
CITY 7/ r (I STATE V i ZIP •
ASSEMBLY •
ADDRESS f7 h1 e
DR.P.B.A.b.C.V.A DR.P.D.A. DD.C.D.A. DP.V.B.A. DS.V.B.A. DA.V.B. DAIR GAP
SIZE: n . MAKE: W, / /4 4i M ODEL: 75'6 Xe_ •
PURVEYOR 5 of e (I NUMBER: j ( 1 / _j ? 5-94
ASSEMBLY /
LOCATION:
REDUCED PRESSURE ASSEMBLY P.V.I3.A. / S.V.B.A. INITIAL TE T ( .
hi Check DOUBLE CHECK AIR CHECK PASSED
Press. Drop Check # INLET
INITIAL RelieNahre min 5 psi Tight `J�'� R' . e Opened at: Press. Drop FAILED D
TEST Opened at: Date:
RESULTS min. 2 psi Leaked n paid L /7/M-
A UB = Check # 2 psid psid t
Tight
RELIEF VALVE S� , DID NOT FAILED SYSTEM !fL
PASS n FAIL n L eaked D OPEN n n /
Comments y�,
Repairs _ r fi f /"� /4/ / ( (tom r
and/or
Parts
Reduced Pressure Assembit Double Check. P.V.B.A. / S.V.B.A. AFTER REPAIRS
Check # 1 !Check # 1
TEST AFTER rsress. Drop
min. 3 psi 'Tight D 1:, Opened at: Press. Drop Date:
REPAIRS
Relief d
min. 2 psi # 2
Buffer ' Tight D psis psid paid PASSED D
A - B= I -r
In completing and submitting this test report, the tester certifiOs that the assembly
has been tested and maintained in accordance with all applicable rules and
regulations of the water system. and state regulations.
GAUGE CALIBRATI DATE 02 -16"12 DETECTOR METER READING
TESTER SIGNDURE CERT a 0823 8, 1129
17
TESTER NAM€ RNrEO ENE HIGGINS GAUGE a 1189
TESTER ADDRESS BRUSH PRAIRIE WA cce a NA
COMPANY MOE AM Drilling, Clackamas OR PNDNE o 503-284-3701
28„ SERVICE RESTORED
REPORT RECEIVED BY: (REPRESENTATIVE OF OWNER)
w'a1E- wan, sya.m copy Paac . cuaa.nr Copy YELLOW •Test. Page 1 oft
BACKFLOW ASSEMBLY TEST REPORT ' EXISTING
0 REMOVED
PROPER O REPLACED
OWN R TM R e l Po C 4 C e PHONE:
MAILING (� Apt t
ADDRESS: / 2 0 ? 3 fill - 0' pt
CITY / / 7 Chi' d STATE 0 P ZIP •
ASSEMBLY
ADDRESS s q kb, t
OR.P.B.A. ❑D.C.V.A OR.P.D.A.1 D.C.D.A. [11 P.V.B.A. Ell S.V.B.A. DA.V.B. DAIR GAP •
SIZE: 4 MAKE: j4), / 14/ 14 J MODEL: _75 .
PURVEYOR Ti ? dJ r ci NUMBER: f J .Z ? / /i •
ASSEMBLY /� �
LOCATION: V6( /.4 (- JY 14 r d rr.coi-- r, ve' w4y •
1 (
REDUCED PRESSURE ASSEMBLY P.V.B.A. / S.V.B.A. INITIAL TEST .
#1 Check DOUBLE CHECK AIR CHECK PASSED N
Press. Drop Check # 1 INLET
min 5 p FAILED
INITIAL Opened Tight W-4 Opened at: Press. Drop ID
TEST Opened at: Date:
RESULTS min 2 psi Leaked n psid a 1 f /
BUFFER
- B ER # a
Check 2 psid psid / // 7/
/
Tight 42 7 SYSTEM ���
RELIEF VALVE eaked psid DID NOT FAILED PSI
PASS n FAIL n L ❑ OPEN n n
r r
Comments f �a / I r C / ,
Repairs n J
and/or
Parts
r I i
Reduced Pressure Assemblt • bouble.Check P.V.B.A. / S.V.B.A. AFTER REPAIRS
Check # 1 !Check # 1
TEST
AFTER Press. Drop min. 3 psi Tight LI p Opened at: Press. Drop Date:
Relief p
REPAIRS Opened I
min. 2 psi ( C heck # 2
Buff Tight ❑ paid psid paid PASSED ❑
A - B= -I -r
In completing and submitting this test report, the tester certifies that the assembly
has been tested and maintained in accordance with all applicable rules and
regulations of the water system. and state regulations.
GAUGE CALIBRATION DATE 02 -16-12 DETECTOR METER READING
TESTER SIGMNRE + 'I CERT a 0823 & 1129
TEAR / ` lCCCCi'' "'�/ GENE HIGGINS GAUGE a 1189
TESTER ADDRESS BRUSH PRAIRIE WA cce a NA
COAIPANAAME ASA Drilling, Clackamas OR PHONE a 503 284 - 3701
SERVICE RESTORED
REPORT RECEIVED BY: (REPRESENTATIVE OF OWNER)
WHITE - Water systao copy NW - amp copy YELLOW - Test. copy • Page 1 of 1