Permit � a{
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1 COMMUNITY DEVELOPMENT Permit#: FPS2017-00094
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/26/2017
8[f�t ]t.T�r g Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12262 SW SCHOLLS FERRY RD
Project: Advantis Greenway Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Fire alarm-Add AFS radio to Silent Knight 5700 system.
Contractor: PROTEC INC Owner: FW OR-GREENWAY TOWN CENTER LLC
720 NE FLANDERS ST PO BOX 790830
PORTLAND, OR 97232-2763 SAN ANTONIO, TX 78279
PHONE: 503-235-4000 PHONE:
FAX: 503-235-0363
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/26/2017 $51.09
12%State Surcharge-Building 06/26/2017 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 06/26/2017 $20.44
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 06/26/2017 $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: Yes Alarm Type: Automatic
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $78.16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $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 No' ':• 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 direr questions to •UNC by calling 503.232.1987 or 1.800.332.2344.
Iss •d By: Permittee Si nature:
411) L , 0
Call 503.639.4175 by 7:00 a.m.for the next available in. •ction 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 cEiv Received /_
. i� j Date By: �f /7 �j�k Permit No.:0590/7-6005y (�
,1114 13125 S50 Hall Blvd.,Tigard, Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: ?_aG�Qci
TI GAR D Inspection Line: 503.639.4175 I Date Ready By: Juris: ET See Page 2 for
Internet: www.tigard-or.gov JUN 2017 Notified/Method: Supplemental Information
4
ergotj
u ►_ , , �. Permit *are based on the value of.t I t;Aifik} t
1: r
El New construction � I ��'� � r�'r o1\t r fees* 1'1 �._ :� �.,_
!Jl 1t�ythe work performed.
Indicate the value(rounded to the nearest dollar)of all
Y.-Addition/alteration/replacement ❑Other:
,., equipment,materials,labor,overhead,and the profit for the
P tad
`` ;- � '. work indicated on this application.
�, j ` i� 'u � � R � PP
III1-and 2-familY dwellin Valuation: $
g (Commercial/industrial
ElAccessory building ElMulti-familyNumber of bedrooms:
111Master builder ❑Other: Number of bathrooms:
'i ! I if ° t•t.' 1 i Total number of floors:
Job site address: S ) sLA.,,o\vS O`/ s7\a' New dwelling area: square feet
City/State/ZIP: `I ,c..? o`"'� Ct'1 .2-13
Z Z 3 � Garage/carport area: square feet
Suite/bldg./apt.no.: y Project name: ioith VA 5elz;l-: Covered porch area: square feet
Cross street/directions to job site: aQF(4 Ltd,-?/ Deck area: square feet
Other structure area: square feet
A; 1 `, & i`1 4,.
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
P
1 ® i' :, work indicated on this application.
IN 6C) /-V5 R0.a ,C) Valuation: $ )¶00
51 \r"\-, kn�5 I\V 5--7 Do Existing building area: square feet
t
New building area: square feet
Number of stories:
Name: AOVA \V,',A- G6CO C 3r UN1%c \ Type of construction:
Address: t v\ S \-\\c1/4., r‘ 5 \ , Occupancy groups:
City/State/ZIP: \�\1\W 4„UtT,!� O`'L C`"1 -2:1 1- Existing:
Phone:( ) Fax ( )
New:
;. -- • "� iji w � .•
Business name:
4 V-\cC- ...1','lG All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
Gam'/1 �Nt\\
ec under ORS 701 and may be required to be licensed in the
Address: .7 lo N i� ^`U
cw�, e C S 5 \ jurisdiction in which work is being performed.If the
City/State/ZIP: 7(:)v 1\fid O cil Z3Z applicant is exempt from licensing,the following reasons
apply:
Phone:(Sp ) -L-.),---- '- cDc7 FFax::( )
E-mail: n e \ 0 BCD 't-C. CJrG LA t?y ( C.11
i i
A Business name: - g`
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 lic.: �'
��J {/4/ Total permit fees:
Authorized si gnature: Amount received:
This permit application expires if a permit is not obtained
Print name: (7_,,i--7 �\ 1 I e,-1 Date: ^Z Z,. -') within 180 days after it has been accepted as complete.
1 - * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describework 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: Num.-r of alarm devices:
❑ Addition or ❑ 1-10 heads: Affidavit required and ►1 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: $
) Typeod Fire Suppression System
Hood Project Valuation: $
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ '57)) -a7(
i S one Syme
Square Footage: Permit Fee: u
0 to 2,000 $198.75
2,001 to 3,600 $246.45 ?.`'.,
3,601 to 7,200 $310.05 ,
7,201 and greater $404.3944.
Sprinkler Project Square Footage: sq, ft.
tt w 4: Fire Protection Permit Pees ;
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: $
I:\Building\Permits\FPS_PemutApp_031016.doc 2
Building Permit Application
Fire Protection System FOR OFFICE USE OM\
INCity of Tigard Received Permit No.:
Date/B
� 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/B :
Inspection Line: 503.639.4175 Date Ready/By: Juris. FdSee Page 2 for
T I G A R D
Internet: www.tigard-or.gov Notified Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
Permit fees*are based on the value of the work performed.
❑New construction ❑Demolition Indicate the value(rounded to t earest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,.,erhead,and the profit for the
work indicated on this app ation.
CATEGORY OF CONSTRUCTION
Valuation: $
❑ 1-and 2-family dwelling 0 Commercial/industrial
Number of bedr.ems:
❑Accessory building 0 Multi-family
❑Master builder
0 Other: Number of b hrooms:
JOB SITE INFO' •TION AND LOCATION Total nu •er of floors:
Job site address: New d 'elling area: square feet
City/State/ZIP: Gar.l e/carport area: square feet
Suite/bldg./apt.no.: I Project nam.• C.vered porch area: square feet
Cross street/directions to job site: ;I•eck area: square feet
Other structure area: square feet
' `,REQ' DiTA COMMERiCIAL-USeIIEeKLIST
Subdivision: I 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
Y
DESCRIPTION OFj/ r y work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
❑ PROPERTY O1 NERC 0 . ), :, Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
§. _ t3,. 3' ` 1 s ,.t . wt 41 _ i %.,, w , ., r i ..
Business name: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: apply:
Phone:( ) 1 Fax::( )
E-mail:
. tt NT'RAC
w °v rr t (Please refer tek Sc ;ule ✓,
Business name: Permit fee:
Address:
State surcharge(12%of permit fee):
City/State/ZIP: F.S plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: Total permit fees:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Date: within 180 days after it has been accepted as complete.
Print name: * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard Permit No.: e/25c22-EC/7-e06 ,9/
13125 SW Hall Blvd.,Tigard,OR 97223:111 111 ( �/ 7
Phone: 503.7182439 Fax: 503.598.1960 Date Received:
Inspection Line: 501639.4175
T I G A R O Internet: www.tigard-or.gov By:
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: a . Occupancy: \--))c.A,\l
Job Address: 1 k1.5 4'e66 y 8. Suite:
Contractor: p b - C 1%NG , Phone: 6'5• - LIG0
�r-• i�
Valuation of work: $ ' d0
Type of System: (check one) [Required INon-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)
kG4 r N--1 e G Oregon Construction Contractors Board No. 53 kit-`
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 this doc •nt with a copy of the sketch attached shall be available for all inspections.
Signature: Date: 6 "LL'1?
Print Name: kc, )"n,//rG--
I:\Building\Forms\FireAlarmAffidavit 071514.docx Page 1 of 1