Permit (46) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
INCOMMUNITY DEVELOPMENT Permit#: FPS2016-00067
T!GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/04/2016
Parcel: 1S 126BC01500
Jurisdiction: Tigard
Site address: 9000 SW WASHINGTON SQUARE RD
Project: Embassy Suites Hotel Subdivision: 2005-035 PARTITION PLAT Lot: 3
Project Description: Fire alarm-Tie in new hood for omelet bar to existing fire zone.
Contractor: FIRE SYSTEMS WEST INC Owner: FO PORTLAND PROPERTY LLC
600 SE MARITIME AVE#300 BY WINSTON HARTON HOLDINGS LLC
VANCOUVER,WA 98661 745 FIFTH AVE 33RD FL
NEW YORK CITY, NY 10151
PHONE: 360-771-7835 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 04/04/2016 $102.20
12%State Surcharge-Building 04/04/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 04/04/2016 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 04/04/2016 $1.00
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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $156.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,500.00
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 Notific. - _- ter. 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..-stions to O C by - n. 503.232.1987 or 1.800.332.2344. A '
Issue. By: � � / J r Permittee Signature:
k
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 Received
City of Tigard DateBy: /(Q PermitNo.: P59.0/6,..0,00627
III . U 13125 SW HaII Blvd.,Tigard,OR 97223 A P R 0 4 2016 Plan Review v-`+
Phone: 503.718.2439 Fax: 503.598.196 Date/By: OtherPennit: M t Co1otS Geyycia
lit, RD l� Inspection Line: 503.639.4175 Date Ready/By: tuns: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
`mew construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
-skiAddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 1-and 2-family dwelling commercial/industrial Valuation: $
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: �9 boo S wAS h IA, Sbt,tal-e New dwelling area: square feet
City/State/ZIP: \ le a.aC�Q ck/22-1 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Sisk 10#,5 01-€.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: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rotnded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
,1_ Valuation: $ 250=3l t� id 0.4.4.,-.1kno6 owl O+^IC.ht sok r- t.}ti Tit"
Existing building area square feet
.. ,ft ZDu-C
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
CrAPPLICANT 0 CONTACT PERSON NOTICE
Business name: ct fly k.0.4,A,5 o--.\ All contractors and subcontractors are required to be
Contact name: ilet k Se f ) licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: raD 0 S(G etAh,L pt,I W E Ave 1:1---3-33 jurisdiction in which work is being performed.If the
City/State/ZIP: Vi4iV/ -0 u_/e/' W ik ct 8lo a.i applicant is exempt from licensing,the following reasons
C apply:
Phone:T 31.a )2?( 7$35 Fax: :( )
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee sckubr/e)
Business name: ,[`S U..) Permit fee:
Address: ` -
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: 4:9734.„, Total permit fees:
Authorized signature: Amount received:
kit_ This permit application expires if a permit is not obtained
Print name: Auk f e_m ' Date: ISMor within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PemtiGlpp_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: Number of alarm devices:
❑ Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required 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
❑ 11+ heads: Plan review required and El 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
El Wet El Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations El Yes
include: Individual Component El 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: $
I:\Building\Permits\FPS_PcrmitApp_071514.doc 2
I
City of Tigard R (�E��E� Permit No.: — P5„. , -to,Q Lo 7
:� 13125 SW Hall Blvd.,Tigard, 9
I Phone: 503.718.2439 Fax: 503.598.1960 Date Received: ii 6
Inspection Line: 503.639.4175 APR 0 4 2016 ��
1 i,:'' .f) Internet: www.tigard-or.gov By: •
CITY OF TIGARD
ALS YPAIV AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: e(tbnss`\ 5!:N-t-9 Occupancy: A i g, V—.
Job Address: Ci VW S U.1 ln1 Rs)1)rJ,A.<,iJ Si uv-k. Suite:
Contractor: 1 c t S' 5A4-"1g (VQ.st-- Phone:
Valuation of work: $ Z.50 3
Type of System: (check one) [tequired ❑Non-required
(check one) lErkutomatic .- cf anual a :oth
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 0.5) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) t /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) /To be Relocated(max 5)
I, Mikdc SC.,k1. \/ Oregon Construction Contractors Board No. (49 73 Z
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: Ro-lit51------ Date: 46/(e 4
Print Name: /14-pacK Sc.,(-1A'
I:\Building\Forms\FireAlarmAffidavit 071514.docx Page 1 of 1