Permit (29) �, CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
'''. ' COMMUNITY DEVELOPMENT Permit#: FPS2016-00085
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/02/2016
TIGARD Parcel: 1S133AD02500
Jurisdiction: Tigard
Site address: 12658 SW NORTH DAKOTA ST
Project: Kindercare Subdivision: None Lot: None
Project Description: Fire alarm-Add(1)horn/strobe to restroom
Contractor: FIRE SYSTEMS WEST INC Owner: KCP RE LLC
600 SE MARITIME AVE#300 BY GREENSTREET PARTNERS LP
VANCOUVER,WA 98661 2601 BAYSHORE DR, 9TH FLOOR
COCONUT GROVE, FL 33133
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/02/2016 $77.99
12%State Surcharge-Building 05/02/2016 $9.36
Type of Use: COM Plan Review-Fire Life Safety-COM 05/02/2016 $31.20
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 05/02/2016 $3.00
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 $121.55
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,480.00
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. Yo ay 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:
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 FOR OFFICE USE ONLY
- City of Tigard Dale/BReceive:d
e./6 OW, / Permit No.:t a0th*Cev gs-
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: el See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 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
[ eAddition'alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 I-and 2-family dwelling 0 Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 'L New dwelling area: square feet
� G 5� s�.1 �� ��a{�
City/State/ZIP: Vi gPt-, Or" Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: (;Ag:tetcw.,Q 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(rounded 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.
04-g-4 I i-/u teg1- Poo
0--_ Valuation: $ 1 C/ ' D
Existing building area: square feet
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:( ) Fas:( 1 New:
•
APPLICANT 0 CONTACT PERSON NOTICE
Business name: 6/2_ S.f 5\4.,.„1 1.-1Q1/41-k- All contractors and subcontractors are required to be
Contact name: /Ls' S� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 60° 44Ate-/ eivc, )41t,/e 14 3 jurisdiction in which work is being performed. If the
City/State/ZIP: 04,0cou J (r o.JfN 6/616 a ( applicant is exempt from licensing,the following reasons
apply:
Phone:cy,o) 77( 7655 Fax: :( )
E-mail: "I 41,/k,c-- 'V r 2t _srTS ..)1A.S%.3 C^J'r. ccod"
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
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 lie.: L4 9 9 3 Z Total permit fees:
`��� / Amount received: A/42,/,S5
Authorized signature: i`�/,,�
This permit application expires if a permit is not obtained
Print name: Mkt_ L's,
/
Date: 5 Zia, within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-Permit App_03 I 0 16.dor 440.4613T(1 I/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:
0 New system Number of sprinkler heads: Number of alarm devices:
❑ Addition or 0 1-10 heads: Affidavit required and 0 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 ❑ 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
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Flood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations El 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 Pritction Petmit Fe
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: $
1:\Building\Permit.\1,PS_PennitApp_lI311116.doc 2
City of Tigard Permit No.: 110&—COO gs�
• 13125 SW Hall Blvd.,Tigard,OR 97223
1 Phone: 503.718.2439 Fax: 503.598.1960 Date Received: S/J-/0O
Inspection Line: 503.639.4175
T I c':�h f> Internet: www.tigard-or.gov By: 0-
0
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: lc l el 4,,e-rCxt Occupancy:
Job Address: 12,,co 5 S vJ rkl'• Suite:
Contractor: tri, c7 y c14,)S 1..)2S Phone: 3 b 7—7( 7 3 3 6
Valuation of work: $ C �j
Type of System: (check one) gliequired ❑Non-required
(check one) Automatic nManual ❑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(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) ( /To be Relocated(max 5)
I, 4i •-CK 4Oregon Construction Contractors Board No. c_(,9-7J
certify t e following is true and defines the scope of work for this project: r
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.
• Electric permit.
• A copy f this �ument with a copy of the sketch attached shall be available for all inspections.
Signature: Date: S.0 2- 2a (G
Print Name: M Pc t SLC.{-f Ad-
I:\Building\Foms\FireAlarrAffidavit 071514.docx Page 1 of 1
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12658 SW NORTH DAKOTA ST, TIGARD, OR,
97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2016-00085
Jeff Grove
Violation Summary:
Inspector Contractor