Permit (38) •
11111 2 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2016-00138
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/16/2016
Parcel: 1 S 135 BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 400
Project: Everest Institute Subdivision: ASHBROOK FARM Lot: 5
Project Description: Fire alarm-adding(5)notification devices.
Contractor: CAPITOL ELECTRIC CO INC Owner: PLAZA WEST OWNER LLC
11401 NE MARX STREET BY CHIEF FINANCIAL OFFICER
PORTLAND, OR 97220 680 FIFTH AVE 20TH FL
NEW YORK, NY 10019
PHONE: 503-255-9488 PHONE:
FAX: 503-257-7121
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/16/2016 $77.99
12%State Surcharge-Building 08/16/2016 $9.36
Type of Use: COM Plan Review-Fire Life Safety-COM 08/16/2016 $31.20
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 08/16/2016 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 08/16/2016 $7.50
11x17)
Misc Administration Fee 08/16/2016 $5.00
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 $133.05
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,500.00
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 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 ques - o •UNC by c.Iling 503.232.1987 or 1.800.332.2344.
Issued / Permittee Sign: 4".',
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Call 503.639.4175 by 7:00 a.m.for the next available inspe 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 ApplicatioR ECEIVED
Fire Protection System AUGFOR OFFICE USE ONLY
City of Tigard G 1 5 2016 Received III
IN - q DateB g! Permit No.: `05 2j/6-CO/ i
13125 SW Hall Blvd.,Tigard,OR 912A, ,e sI I .< ,AR))gg
` s ,6 t a.X: P Plan Review
Phone: 503.718.2439 Fax: 503.59 .1190 Date/B : Other Permit: /3aP��tb 66.22
Inspection Line: 503.639.4175 'i �1
T I G AR D 1 .1"'''''''.w !S t Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.govNotified/Method: Supplemental Information
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❑New construction 0 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 0 Other:
7-'
ct ' , ® equipment,materials,labor,overhead,and the profit for the
i ,a`` -' work indicated on this application.
�7 o r e." y i�g '"
an �. ;,,, `
0 1-and 2-family dwelling g Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
li ' .- a , FO o 6,4 JO !ilk". T I I� ` �;r Total number of floors:
: moi. '' c ' .td . � . ,
Job site address:9600 SW Oak Street New dwelling area: square feet
City/State/ZIP:97223 Garage/carport area: square feet
Suite/bldg./apt.no.:Ste 400 I Project name:'l iga+ i-Dentat1-ai Covered porch area: square feet
Cross street/directions to job site: C`JEk.€57 t/-1TuTf-- Deck area: square feet
Other structure area: , square feet
i; y. wua w ,r r'" �c m� IST
Subdivision: �'� � �' �' "--"``>> �"m�
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 allq equipment,materials,labor,overhead,and the profit for the
>� ;:,,,,:„;:i:-..(7:-.76,,'
o " m as
! TO ! l rc �. work indicated on this application.
Install fire alarm devices in suite 400 per plats Valuation: $1500
Existing building area: square feet
New building area: square feet
i, '',';',-.--'31,',,,i':'71,':',-'1,,,',,,=:-1, Number of stories:''- . r� ;, .
Name: Type of construction:
Address:
Occupancy groups:
City/State/ZIP:
Existing:
Phone:( ) Fax ( )
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Business name: A ..E b ,� .,
All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and maybe required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:( ) I Fax: :( )
E-mail:
14 1
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f a t l iii � � D�DNGPEai F 1"� � � �: " j t [� � "'Be�d1.-4,,,,-Business name:Capitol Electric Company,Inc.
Address: 11401 NE Marx Street Permit fee:
City/State/ZIP:Portland,OR 97220 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(530)255-9488 Fax:(503)255-1966 (Due upon application.)
CCB lie.:48748 Total permit fees:
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Dan Wilson Date:8/5/2016
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp.doe Rev 01/05/2012 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 — Supplemental Information
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1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1-10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: _
Additional description of work:
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Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B T 'mac I fed- _ , ;u e oar... 1.e .� a. ,� � �
Hood Project Valuation: $
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Cut Sheets
1500
Fire Alarm Project Valuation: $
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tion
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ire P Alst 1dw ' mti t .! p4a�ft � e�� "u r ,, t _ ", �;Me ; .r ,d & Permit Fee: 1 4 i •Square Footage: ""f � ° fi$198.75 "0 to 2,000
2,001 to 3,600 $246.45
3,601to7200 " 6 ' j o a
$310.05
7,201 and greater $404.39 �h )? K" sir
Sprinkler Project Square Footage: sq. ft.
%ate. � ,'';e.� ,.s :.'��, �rv�-.� i +( I`a,":,P1'( P ,,,,1 1 .'..�.- -` .:esipkm.mo " +�„0- iii i, .x-- i�l
Project valuation subtotal (see A, B & C above): $
itillOPermit 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): $
U:YFA JobsYzz161601-45 Tigard DentalY1 FPS-PermitApp.doc Rev 01/05/2012 2
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City of Tigard Permit No.: f $ 7/(D—GAY 3
'4 13125 SW Hall Blvd.,Tigard,OR 97223 6
Phone: 503.718.2439 Fax: 5034131G91?5 2016
IN
Date Received: 965-4
TI #eo Inspection Line: 503.639.4175
Internet: www.tigard-or.gov ;:' (‘5_, _ ,A i By: 0 4
GI )FIRE AIS 4S 'E AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Tigard Dental Lab Occupancy:
Job Address: 9600 SW Oak St. Tigard, OR 97223 Suite: 400
Contractor: Capitol Electric Phone: 503-255-9488
Valuation of work: $ 1500
Type of System: (check one) [Required ❑Non-required
(check one) ❑Automatic ❑Manual nBoth.
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) 5 /To be Relocated(max 5)
I, Dan Wilson Oregon Construction Contractors Board No. 48748
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 th' document with a copy of the sketch attached shall be available for all inspections.
Signature: Date: 08/08/16
Print Name: Dan Wilson
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