Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2017-00056
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/04/2017
T t O�'� Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9336 SW WASHINGTON SQUARE RD W13
Project: White House Black Market Subdivision: None Lot: None
Project Description: Relocate(5)heads as required for TI.
Contractor: WYATT FIRE PROTECTION INC. Owner: PPR WASHINGTON SQUARE LLC
9095 SW BURNHAM PO BOX 847
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/04/2017 $72.61
12%State Surcharge-Building 05/04/2017 $8.71
Type of Use: COM Plan Review-Fire Life Safety-COM 05/04/2017 $29.04
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 05/04/2017 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: ORD1
Density: .15 Design Area: 1500
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $110.86
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,214.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
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 • ::: . .2344.
Issued By: PermitteeSignature:Aol .
Call 03.639.4175 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 u it completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection SystemRECEh! FOR OFFICE L SE O LI'
- Received w //
City of Tigard ��AAIt '
1 2017 Date/By: 7 / I Permit No.: / a7� 0
•
13125 SW Hall Blvd.,Tigard,OR 97231 AV1 Plan Review �^
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit/64/06017..6 ey1�.
T I G A R D Inspection Line: 503.639.4175 CITY OF TIGAiiJ Date Ready/By: Jar's. ® SSeePage 2 for --'4
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method:---2 / Supplemental Information
e-Al
Sy j�` c %"{Y h.'xk "?u '�' A+'S= r9 fL Y.r N fi
TYPE OF WOR ',r x a ,
n. likt i"y% REQUIRED'DATe 1-AND 2-FAMILY DWELLING
❑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 ❑Other: equipment,materials,labor,overhead,and the profit for the
`/ ''' CATEGORY OF CONSTRUCTION dM= •
work indicated on this application.
ID1-and 2-family dwelling ®Commercial/industrial Valuation: $
1:1Accessory 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:9336 SW Washington Square Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:W13 Project name:White House Black Market 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.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
x• 4)'"' ' DESCRIPTION OF"WORK " " work indicated on this application.
Reloca heads as required for TI Valuation: $$1,214.00
Existing building area: square feet
New building area: 0 square feet
", 0 PROPERTY OWNER 0 TENANT h w:i ' Number of stories: 1
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing: Ordinary 1
Phone:( ) Fax:( ) New:
II APPLICANT 0 CONTACT PERSON NOTICE "=4
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Max Colley licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham Rd jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)684-2928 Fax::( )
E-mail:m.colley@wyattfire.com
440 4 ,.r . CONTRACTOR - .: • .:: " BUILDING PERMIT FEES*
Business name:Wyatt Fire Protection (Please refer toJee schedule)
Permit fee:
Address:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.)
CCB lic.:64077 Total permit fees: //0 ,,p-‘.,
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name:Max Colley Date:4/27/17 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp.doc Rev 01/05/2012 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
• ~�: ��� ��.� �- sed;r .4.:
1.) ❑ New 2.) Modification to sprinkler heads only:
® Addition ® 1-10 heads: No plan review required.
® Alteration ❑ 11+ heads: Plan review required.
El Repair
Number of sprinkler heads: 5
Additional description of work:
Type of Systein(Complete A B,.0,pr,D as applicable):
Wit.
A:) CO i ercial Sprinkler
'-..* x-u, .... 1,.^ ,..r4..4"q
® Wet ❑ Dry
Additional Standpipes 0
Information: Hazard Group Ordinary 1
Density 0.15
Design Area 1500
K.Factor 5.6
Sprinkler Project Valuation: $ 1214
B. FT e I- giLiOd Fire Suppression System
Hood Project Valuation: •
$
C.) Pire Alain
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential prinkler(StandAlone stem
t
Square Footage: Permit Fee: A 4or'
0 to 2,000 $198.75 ��
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05 .43
7,201 and greater $404.39 .f£
Sprinkler Project Square Footage: sq. ft.
Fire ProtectionPernit 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: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
W:\Max\1112 PERMIT APPLICATIONS\Tigard App.doc Rev 01/05/2012 2
OFFICE COPY
City of Tigard Permit No.: / -7°--S- 2,67/7 "ma-5,,6
13125 SW Hall Blvd.,Tigard,OR 97223
= Phone: 503.718.2439 Fax: 503.598.1960 Date Received: ..5- ///7
TIGARD Inspection Line: 503.639.4175
Internet: www.tigand-or.gov By: --
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIOI'ECEIVED
OR TENANT IMPROVEMENTS MAY 1 2017
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) CITY OF TIGARD
BUILDING DIVISION
Project Name: White House Black Market WSq Occupancy: Ordinary 1
Job Address: 9336 SW Washington Square Rd Type of Construction:
Suite:
Contractor: Wyatt Fire Protection Phone: 503-684-2928
Number of Proposed or Altered Heads: 5
Type: SSP Hazard: Ordinary 1 Density: 0.15
I, Max Colley, Wyatt Fire Protection Oregon Construction Contractors Board No. 64077
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits,beams,partitions,walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop (exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads(see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
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.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature: Date: 4/27/2017
Print Name: ax Coll-.00111111111111111P.—
I:\Building\Forms\FireSprinklerAffidavit
ollI:\Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1