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` City of Tigard Permit No.: S o;U/5'00/71/ ° 13125 S W HaII Blvd.,Tigard,OR 97223 ;. 3 Phone: 503.718.2439 Fax: 503.598.1960 Date Received: ///8/i S ,- c]A RD Inspection Line: 503.639.4175 Internet: www.tigard-or.gov By: CO.aeCtr-rn_a---r 40 74 FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERA h�' OR TENANT IMPROVEMENTS NOV 2 2 015 (MAXIMUM OF 5 DEVICES WITHOUT PLANS) OR OF MAKI) -''),, BUILDING DWVIS1U1 Project Name: J' 51 ca C i ktJf/ Occupancy: /� Job Address: 1 3 0 S/4 f 2- 4 0 14t Suite: /CS Contractor: reQ l f (/V(,O 4( `� Phone: i 5O 3-& o-7-aZ 0 0 Valuation of work: $ I "/ 0 Type of System: (check one) equired ❑Non-required (check one) 7IAutomatic :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 (i,.5) /To be Relocated(max 5) Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 5) Number of Proposed Notification Appliances: To be Added (max 5) I /To be Relocated(max 5) I I, 1r.i.,0, (1/1 ( 1 iq ed�-6 o Oregon Construction Contractors Board No. C 13 / 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: l O/300_5 VW Print Name: .4G 0 Y` \1-7110/tai -e ti I:Building\Forms\FireAlarmAffidavit 071514.docx Page 1 of 1 Fes A01 -- C(?y l c 3 CO Sw Sevi o«, ,%,y /Os 30'-0" -4 30'-0° J r 0 6 CD) w Q� nn 1 �PT-, fl •C�— •9- -%5.- PT-, 'I 'I qs qST PT-1 STORAGE PT-1 H© WORK AREA Pr-1 A OFFICE T 0 11031 11041 '` PT-3 105 O PT-, 1 PT-, LA CP A T PT-1 'I PT-1 0/ '� II. m 410 s — — . PT' Q�` — IHS� iI PT-2 e---- �3V IU Pr-, j .�:,...••• 'I PT-2 PT-2A If)? —..-.mss �:—�.s= 108 UP PT-1 OFFICE . S-0" O 1102 WAITING 1 OFFICE FT-2 Q O 101 PTA I1081 lo ti • I Pr-1 PT-, j C k —. ..._____ vd„ PT-3 i Fr — — — — — PT--,®C T.2 _ J ( r G -L I a tor? �� I' O °N 174 •� bil r o © e t�1