Permit (125) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
'1111COMMUNITY DEVELOPMENT Permit;Y: FPS2017-00026
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2017
T[ g Parcel: 2S 112 DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 200
Project: NuScale Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Relocating(3)fire alarm notification appliances. Affidavit submitted.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/07/2017 $102.20
12%State Surcharge-Building 03/07/2017 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 03/07/2017 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 03/07/2017 $0.50
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 $155.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $2,400.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Ab.
Building Permit Application
Fire Protection ;
System .,,
y 7; iot
rz ore ric �sl:ONLY
City of Tigard b ReceivedAl, ,'
13125 SW Hall Blvd.,Tigard,OR 972 Plan :
f{er Plan Review WNW
I
Phone: 503.718.2439 Fax: 503.5989S ;c �Qw �'°� pa{etg : •t er'mut.
1 1 O A R l Inspection Line: 503.639.4175 �s,t Date Ready BY: -, Page 2 for
Internet: www.tigard-or.gov (2;t:), Notified/Method: Supplemental Information
t k=6
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TYPE OF WORK REQIJIREp DATA,1 AND 2-FAMILY DWELLING
0 New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 Other equipment,materials,labor,overhead,and the profit for the
f' work indicated on this application.
C;ATEGUYYY�` 1<1 'tO1V
. ter_
❑ 1-and 2-family dwelling ®Commerciallindustrial Valuation: S
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JU$ SITE liNb`'(,?KNI411d)!I„AND&LOBATION
Total number of floors:
Job site address:6650 SW Redwood Lane New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.:200 Project name:NuScale Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
d1t �,cssl6yt
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
' > e e work indicated on this application.
Fire Alarm-notification devices Valuation: 332,400.00
Existing building area: square feet
New building area: square feet
24"t1 46,A '_ " Jl VV g` Number of stories:
Name:NuScale Type of construction:
Address:6650 SW Redwood Lane#200 Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:( ) Fax:( ) New:
a
Business name:Point Monitor Corp. All contractors and subcontractors are required to be
Contact name:Brooke Williams licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:5863 Lakeview Blvd.Suite 100 jurisdiction in which work is being performed.If the
City/State/ZIP:Lake Oswego,OR 97035 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)627-0100 Fax::( )
E-mail:bwilliams@pointmonitor,com
CONTRACTOR BUILDING PEFEE
Business name:Point Monitor Corp. lPlaaserelsrYarsesebeirdei"
Permit fee:
Address:5863 Lakeview Blvd.,Suite 100
State surcharge(12%of permit fee):
City/State/ZIP:Lake Oswego,OR 97035 FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( ) (Due upon application submittal.)
CCB lic.:135901 Total permit fees: [t $i
Authorized signature:
Amount received:
This permit application expires if a permit is not obtained
Print name:Ben Breit Date:3/1/17 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board,
I.Building Permit FPS-PermitApp_031016.doc 440.4613T(I 102COM 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:X 3
® Addition or 0 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
0 11+ heads: Plan review requited and 0 6+devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Tie of Sy, nompiete 74 ,B,Cot D as applicable):
A) cornmei � r {
. `#
Sprinkler Type ❑ Wet . P _
❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes ❑ No
Hazard Group
Density
Design Area
K Factor
Sprinkler Project Valuation: I $
) Type, B 14"� w�3 ® Syst
r.
w`= F
Hood Project Valuation: $
/'a v 11
C) Fire
<
Submittal shall Battery Calculations 0 Yes - r
include: Individual Component ❑ Yes
Cut Sheets
.;. .. .. ,,
D.) Residential Sprihkleir(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: $
(::\Users\bwilliams\IJe'sktop\ IgURhIS\II>s_PermitApp-'1'igard.doc 2
City of Tigard Permit No.: 7,?clr 7--L .C13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.196 � i 4 Date Received: 1 7
Inspection Line: 503.639.4175
'A ` Internet: www.tigard-or.gov 49/01 '4 `T r4—
fa R s 21J By:
1 1( /G ttt//r��///
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
fi af f.
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Nuscale Occupancy: Same
Job Address: 650 SW Redwood Lane#200,Tigard 97224 Suite:
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $1,108
Type of System: (check one) ❑Required ['Non-required
(check one) ['Automatic ❑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(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) 3
I, Ben Breit Oregon Construction Contractors Board No. 135901
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.
jurisdiction. g
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: 3/1/17
Print Name: Ben Breit
L1BuildinglForms\FireAlarmAffidavit_071514.docx Page 1 of 1
Debbie Adamski
From: Brooke Williams <bwilliams@pointmonitor.com>
Sent: Wednesday, March 01, 2017 10:31 AM
To: #Building Permit Technicians
Subject: Affidavit and Electrical Permit Applications -NuScale TI
Attachments: SKMBTC36017030111220.pdf
Good morning,
All permit applications atta s-•
**Please also note we will need to pay for an early morning, 6am, inspection ahead of time. Date is unknown at
this time.****
Thank you for your e a,
Brooke Williams
Project Coordinator—TI Dept.
� �- ►4 '
Point Monitor Corp. 114503-627-0100
From: PMC_Docs /iLS2--- laj} "
Sent Wednesday, March 1, 2017 10:23 AM
To: Brooke Williams<bwilliams@pointmonitor.com>
Subject: Message from KMBT_C360
1