Permit (46) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
r Fri 11 COMMUNITY DEVELOPMENT Permit#: FPS2017-00082
13125 SW Hall Blvd.,Ti Date Issued: 06/14/2017
T[G.�tFt. and OR 97223 503.718.2439 9
Parcel: 2S112DD01601
Jurisdiction: Tigard
Site address: 15755 SW SEQUOIA PKWY
Project: Orthopedics Northwest Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Fire alarm for TI.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES LP
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: 503-324-6300
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/14/2017 $156.00
12%State Surcharge-Building 06/14/2017 $18.72
Type of Use: COM Plan Review-Fire Life Safety-COM 06/14/2017 $62.40
Class of Work: ALT Type of Const: IIIB Info Process/Archiving-Sm$0.50(up to 06/14/2017 $6.00
Occupancy Grp: B 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: Yes Alarm Type: Automatic
Pull Station Required: Yes Smoke Detectors Req: No
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $243.12
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $7,687.00
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 c py of the rules
or direct questions to OUNC by calling 503.232.1987 or '•1.332.2344.
Issued By: 1411, Permittee Signature.
AKA Jl
all 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
,ii �-,ii, lc 'r,' FOR OFFICE USE 01'1.1'
City of Tigard ' :.fie l '"l l ''t ceived
i 11 r 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : 1� permit No.: ��']r
Phone: 503.718.2439 Fax: 503.598.1960 Plan Revi>. .
Date/B : Other Permit4 Ahignilln
TI G n It D Inspection Line: 503.639.4175 M/V"t a el LW • for l C/v6
Internet: www.tigard-or.gov
Date Ready/:
Notified Method® �; n� see Page 2
2 ' "'V 3 a T1 GL �It �� /L y` Supplemental Information
tr4" =F e t I sir- t sy < � r
a �'it ', la k <, , , 11, 1.3e�,d l l &' p
:::14N'e:e:;r1':';n1:tio''''n*
.'' t -.f fr , s
❑Demolitione. Permit fees*are based on the value of the work performed.
®Addition/alteration/replacement Indicate the value(rounded to the nearest dollar)of all
t e ❑Other equipment,materials,labor,overhead,and the profit for the
e i work indicated on this application.
0 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
ElMaster builder ❑Other: Number of bathrooms:
'"
" ,; ,�,,. i ,zt .2. s '.( s Total numberoffloors:
Job site address 15755 SW Sequoia Parkway
New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224
Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Orthopedics NW
Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
a *• ,
9 1 i Se B Itl at�€ "a .r
Subdivision: ;,.. . �,'� , ,. ®t"
Lot no.: Permit fees*are based on the value of the work performed.
N
Tax map/parcel no Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
1 � f - a e 7 4' � a '" work indicated on this
a application.
Fire alarm notification devices Valuation:
$7,687.00
Existing building area: square feet
New building area:
,r a , ,_�� t : �. : square feet
` -" �.z ` <' ,_... Number of stories:
Name:Orthopedics NW
Type of construction:
Address:15755 SW Sequoia Parkway
City/State/ZIP:Tigard,OR 97224 Occupancy groups:
Phone:( ) Existing:
Fax:( )
New:
Business name:Point Monitor Corp. 'ar t
All contractors and subcontractors are required to be
Contact name:Brooke Williams licensed with the Oregon Construction Contractors Board
Address:5863 Lakeview Blvd#100 under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:Lake Oswego,OR 97035
Phone:(503)627-0100 apply:
Fax::( )
E-mail:bwilliams@pointmonitor.corn
Business name:Same as above s t l
Address: Permit fee:
City/State/ZIP: State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( )
(Due upon application submittal)
CCB lic.:135901
Total permit fees:
Authorized signature Amount received:
This permit application expires if a permit is not obtained
Print name:Ben Breit I Date:5/30/17 I within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
1.\Building\Permits\FPS-PermitApp_031016.doc Service Board.
440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental
Information&' �.- --
-..11=1,1%...11,.4.2. .,_ z£`L""=. ' 1;4 n art ',.' ,- ,...
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:
1-5 devices: Affidavit required and
® Addition or 0 1-10 heads: Affidavit required and ❑ (3) copies of sketch showing area
Alteration (3) copies of sketch showing area
to existin of work within building structure of work within building structure
g
system
0 11+ heads: Plan review required and 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
-T ' .4 -4,. ✓ a -
SawX t cet rreos r' d �a �. s' xrsf,* .. .; xs _
xW, � : ❑ Wet ❑ D
• A.
Additional Stand.i.es
Information: gmemzoin
I-1
Yes 0 No
Hazard Grou.
Densi
Desi: Area
K. Factor
S, i, , - ' o'ect Valuation: $
g,�� "` e;.+mss40 1 - ;° ,,.s
Hood Pro'ect Valuation: $
�' e '"Y"'. , '§ IttAil
- F ,,. S#�,''-" ` �',,e?ewe , a"' -, ,. '
�,.. ® Yes
Submittal shall Batte Calculations
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Pro'ect Valuation: $
rft174-'--:-V:,407,-k. Y#4 '''',.../.! ..t..1, ,.._. ',.,,-;',,f. :r. —4:1, ...'::'''' -.',, - :.: : -i 4',*,,,;''i‘!: .,,z1"n,e3,?: ..,-'.,,,::: - -...t4,1„ -ty,„ v.,,,,,
S•uare Foota:e: Permit Fee: • d.
0 to 2,000 - $198.75 r
$246.45 > ; , ,- v, !
2,001 to 3,600 1 , '
_ 3,601 to 7,200 $310.05 ,,, , ' -..w. ,,,„--4.--4,-,-.44
_ 7,201 and : eater $404.39 t, -iuu' , .: �„ ,.,
Sprinkler Project Square Footage: sq.ft.
� �` ,
'..��.. ,I^"�" l 1�"1�SLW '*;'s � x ' °i'w. x.4:41.117,-, .,,,....,..„..1.'it+Vk 'rA+um.. .
Pro'ect valuation subtotal see A,B &e C above . $
Permit fee based on .ro'ect valuation see fee schedule : $
Permit fee based on s•uare foota:e see D above : $
State Surchar•e 12% of sermit fee : $
FLS Plan Review 40% of sermit fee : $
TOTAL: $
C:\Users\bwilliams\Desktop\PERMIT FORMS\Fire permit-city of tigard.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15755 SW SEQUOIA PKWY, LAKE
OSWEGO, OR
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00082
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor