Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
>s COMMUNITY DEVELOPMENT Permit #: FPS2012 -00107
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 1S135ACO2500 •
Jurisdiction: Tigard
Site address: 9304 SW MANDAMUS CT
Project: Longstaff Apartments Subdivision: ASHBROOK FARM Lot: 25
Project Description: Building 5 - Install 13R fire sprinkler system.
Contractor: WESTERN STATES FIRE PROTECTION Owner: J.T. SMITH CO
13896 FIR ST STE B 5285 MEADOWS RD SUITE 171
OREGON CITY, OR 97045 LAKE OSWEGO, OR 97035
PHONE: 503 - 657 -5155 PHONE: 503 - 975 -7639
FAX: 503 -657 -5182
FEES
Description Date Amount
Specifics: Permit Fee - MF 08/30/2012 $274.36
12% State Surcharge - Building 08/30/2012 $32.92
Type of Use: MF Plan Review - Fire Life Safety - MF 07/24/2012 $109.74
Class of Work: ALT Type of Const: VB Info Process /Archiving - Lg $2.00 (over 08/30/2012 $2.00
Occupancy Grp: R -2 Height: ft 11x17)
Stories: 2 Info Process /Archiving - Sm $0.50 (up to 08/30/2012 $14.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $433.52
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $18,229.00
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. 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. d,/)
Issued By: j4,(//tittl e Permittee Signature: . 1 4 n� - i /y 1 1 a . / J' Calll b 50 � 3.639.4175 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.
s
Building Permit Application ,
Commercial
`J Tigard 2 F012 orrlcl, USE ONLY
City of Tigard JUL • eceived t OM Permit No.: ��p/,2 -410/0 0
ate 7 �/I
:� ° 13125 SW Hail Blvd., Tigard, OR 97223 C D t - a _ ,/,- ,f,a , [/
lIl Phone: 503.718.2439 Fax: 503.598.1960 0 ` OFI � •ther Permit: ifosv - %
r. ca I �ti
f I G A R D Inspection Line: 503.639.4175 psillgE s, Ai • ' .. :y: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Er7Ho Notified /Method: o Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
® 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.
❑ I - and 2- family dwelling ❑ Commercial /industrial
Valuation: $
❑ Accessory building ® Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9304 - 9342 SW L.ongstaff-Street New dwelling area: square feet
City/State /ZIP: Tigard, Oregon H4ub E45 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: The Reserve - Building #5 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST ,
Subdivision: 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.
install 13R fire sprinkler system Valuation: $$18,229.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name: Western States Fire Protection Co. (Please refer to fee schedule
Structural plan review fee (or deposit):
Contact name: Darrell Fluit
FLS plan review fee (if applicable):
Address: 13896 Fir Street, Suite B
City /State /ZIP: Oregon City, OR 97045 Total fees due upon application:
Phone: (503) 657 -5155 Fax: : (503) 657 -5182 Amount received:
E -mail: darrell.fluit @wsfp.us PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted PhotoVoltaic Solar Panel System.
Business name: Western States Fire Protection Co. Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: 13896 Fir Street, Suite B Solar Installation Specially Code checklist.
City /State /ZIP: Oregon City, OR 97045 Permit fee (includes plan review $180.00
and administrative fees):
Phone: (503) 657 -5155 Fax: (503) 657 -5182 State surcharge (12% of permit fee): $21.60
CCB lic.: 104570
/J Total fee due upon application: $201.60 s
Authorized signature: / y l This permit application expires if a permit is not obtained
"t within 180 days after it has been accepted as complete.
Print name: Darrell Fluit Date: 07 -20 -12 * Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building \Pennits \BUP -COM PennitApp.doc 02/24/2011 440- 4613T(1 I /02 /COM /WEB)
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
>s COMMUNITY DEVELOPMENT Permit #: FPS2012 -00107
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 1S135ACO2500 •
Jurisdiction: Tigard
Site address: 9304 SW MANDAMUS CT
Project: Longstaff Apartments Subdivision: ASHBROOK FARM Lot: 25
Project Description: Building 5 - Install 13R fire sprinkler system.
Contractor: WESTERN STATES FIRE PROTECTION Owner: J.T. SMITH CO
13896 FIR ST STE B 5285 MEADOWS RD SUITE 171
OREGON CITY, OR 97045 LAKE OSWEGO, OR 97035
PHONE: 503 - 657 -5155 PHONE: 503 - 975 -7639
FAX: 503 -657 -5182
FEES
Description Date Amount
Specifics: Permit Fee - MF 08/30/2012 $274.36
12% State Surcharge - Building 08/30/2012 $32.92
Type of Use: MF Plan Review - Fire Life Safety - MF 07/24/2012 $109.74
Class of Work: ALT Type of Const: VB Info Process /Archiving - Lg $2.00 (over 08/30/2012 $2.00
Occupancy Grp: R -2 Height: ft 11x17)
Stories: 2 Info Process /Archiving - Sm $0.50 (up to 08/30/2012 $14.50
11x17)
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $433.52
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $18,229.00
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. 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. d,/)
Issued By: j4,(//tittl e Permittee Signature: . 1 4 n� - i /y 1 1 a . / J' Calll b 50 � 3.639.4175 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.
EFSZo - ao►io 7
CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR A BOVEGROUND PIPING
-4:h15
PROCEDURE
Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service
before contractor's personnel finally leave the job.
A certificate shall be filled out and signed 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 daim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances.
PROPERTY NAME Date
V
PROPERTY ADDRESS %&A c _ ` MA.4...1 -.Ts
ACCEPTED BY APPROVING AUTHORITY('S) NAMES
ADDRESS
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS El YES ❑ NO
EQUIPMENT USED IS APPROVED ® YES ❑ NO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ® YES ❑ NO
OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES:
1. SYSTEM COMPONENTS INSTRUCTIONS ® YES ❑ NO
2. CARE AND MAINTENANCE INSTRUCTIONS ® YES ❑ NO
3. NFPA 13A ® YES ❑ NO
LOCATION SUPPLIES BUILDING:
OF SYSTEM
YEAR OF ORIFICE TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QUANTITY RATING
` - e 1--cr C _ 4 -V1 Zo'Z t i'Z- AG t('
`Z i t-6 Fs 4 Su., 249f, L `/z 1 -1 ?eo
SPRINKLERS S1 TA1°..t. F3 CI `7ge-1.31 ,tZ V Z 16 ?O v
PIPE AND Type of Pipe: Sch. 10 black, Sch. 40 black, CPVC
FITTINGS Type of Fittings: Cast Iron threaded, grooved, CPVC •
MAXIMUM TIME TO OPERATE
ALARM DEVICE THRU TEST CONNECTION
ALARM VALVE TYPE MAKE MODEL MIN. SEC.
OR FLOW 7=-1t31.+3 SYSTtIvi Sa'S uz Li d
INDICATOR
DRY VALVE O.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
TIME TO TRIP TRIP POINT TIME WATER ALARM
THRU TEST WATER PRESSURE AIR PRESSURE AIR REACHED OPERATED
CONNECTION' PRESSURE TEST OUTLET* PROPERLY
DRY PIPE MIN. SEC. PSI PSI PSI MIN. SEC. YES NO
OPERATING Without ❑ d
TEST 0.0.D.
With ❑ ❑
O.O.D.
IF NO, EXPLAIN:
'MEASURED FROM TIME INSPECTOR'S TEST CONNECTION OPENED. (OVER)
•
OPERATION
A ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC
PIPING SUPERVISED ❑ YES ❑ NO I DETECTING MEDIA SUPERVISED ❑ YES ❑ NO
DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE CONTROL STATIONS ❑ YES ❑ NO
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO, EXPLAIN
DELUGE &
PREACTION ❑ YES ❑ NO
VALVES
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE VALVE MAXIMUM TIME TO
MAKE MODEL SUPERVISION LOSS ALARM? RELEASE? OPERATE RELEASE
YES NO YES NO MIN. SEC.
❑ ❑ ❑ ❑
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess of 150 psi (10.2 bars) for two hours.
TEST Differential dry -pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped.
DESCRIPTION
PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours. Test pressure tanks at normal water level and air pressure and
measure air pressure drop which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours.
ALL PIPING PNEUMATICALLY TESTED AT 40 PSI FOR _24_ HRS. IF NO, STATE REASON:
DRY PIPING PNEUMATICALLY TESTED ❑ YES ❑ NO
EQUIPMENT OPERATES PROPERLY ❑ YES ❑ NO
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR
OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS?
TESTS ® YES ❑ NO
DRAM READING OF GAGE LOCATED NEAR WATER SUPPLY TEST RESIDUAL PRESSURE WITH VALVE IN TEST
TEST J CONNECTION: PSI I CONNECTION OPEN WIDE PSI
UNDERGROUND MAIN AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING
OTHER EXPLAIN
VERIFIED BY COPY OF THE U FORM NO. 85B ❑ YES ❑ NO
FLUSHED BY INSTALLER OF UNDER-
GROUND SPRINKLER PIPING ❑ YES ❑ NO
BLANK NUMBER USED LOCATIONS: NUMBER REMOVED
TESTING
GASKETS
WELDED PIPING ® YES ❑ NO
IF YES...
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? ® YES ❑ NO
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN
COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR -3? ® YES ❑ NO
WELDING DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED
QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS
IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT
THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? ® YES ❑ NO
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
(DISCS) CUTOUTS (DISCS) ARE RETRIEVED? ® YES ❑ NO
HYDRAULIC NAME PLATE PROVIDED IF NO, EXPLAIN:
DATA ® YES ❑ NO
NAMEPLATE
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
REMARKS
NAME OF SPRINKLER CONTRACTOR: dl.J Western States Fire Protection Company
TESTS WITNESSED BY
FOR PROPERTY OWNER (SIGNED) TITLE DATE
SIGNATURES I 1
FOR RINKLER C RACTOR ( IG D) TITLE DATE
� � tti - ■h,�� I -�� — I 1Zr'j ' —
F L AL FIRE MAR : NED) TITLE .` , L ) ' DATE
lr
FIIR RESPONSIBLE GI ��PLOYEE (SIGNED) [Sr T ( � vrc-L � 1 N S � DATE
7.- 17_ ���-
I I
ADDITIONAL EXPLANATION AND NOTES