Permit (45) CITY OF TIGARD71
FIRE PROTECTION SYSTEM PERMIT
a COMMUNITY DEVELOPMENT Permit#: FPS2017-00093
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/26/2017
Parcel: 2S101AA00100
Jurisdiction: Tigard
Site address: 12300 SW 68TH AVE
Project: Landmark Ford Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Fire Alarm-Adding(2)smoke detectors due to addition of elevator.
Contractor: PHILLIPS ELECTRONICS Owner: CORLISS, JAMES L&CORA K
3247 NW 29TH AVE PO BOX 23970
PORTLAND, OR 97210 TIGARD, OR 97281
PHONE: 503-222-5083 PHONE:
FAX: 503-227-4992
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/26/2017 $59.16
12%State Surcharge-Building 06/26/2017 $7.10
Type of Use: COM Plan Review-Fire Life Safety-COM 06/26/2017 $23.66
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 06/26/2017 $4.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 06/26/2017 $2.50
11x17)
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: Yes
Battery Calcs Provided: Cut Sheets Required:
Total $96.42
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $800.00
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
Utilit otification . enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or irect questions to eUN •' calling 503.232.1987 or 1.800.332.2344.
ssued By: 10 / / 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.
Building Permit Application
Fire Protection System
REcEivEDFOR Ol F[CE l Sl; OVLI
City of TigardReceived13125 SW Hall Blvd.,Tigard,OR 97223 DateB A�r ��I Permit No.: /056::: / Q2
111
Phone: 503.718.2439 Fax: 503.598.]U 0 plan Review !J
Inspection Line: 503.639.4175 f(J q Date/B : Other Permit:
TIGARD p 26 2017 Date ReadB
Internet: www.tigard-or.gov t y y Iuris: S page l for
Notified/Method: Supplemental Information
CITY Of TIGARn
REQ DATA:I-�2-FAMILY DWELLING
Permit fees*are
❑New construction tint
based on the value of the work performed.
Addition/alteration/replacement Demolition
Indicate the value(rounded to the nearest dollar)of all
0igi Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling 14 Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: '1 2. 5\k,/ �,s ,t-N._
Ave_ New dwelling area: square feet
City/State/ZIP: -1-,,,,s&,,,13‘ C recl CI-.
i J 7 ,)3 Garage/carport area: square feet
Suite/bldg./apt.no.: 1 Project name:
ivi,cir (7,-:,,,,,TA ( v;t e L I j) Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
Subdivision:
REQUIRED IRED DATA::COMMERCIAL-USE€+ E ;IST
I 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
AA �,, DESCRIPTIONWORK ` work indicated on this application.
rc1+h CaC � A'` �� $ J
`� �� �1S due , s Valuation:
c`eiNAor- Existing building area: square feet
New building area: square feet
❑ PROPERTY O'PE'NER , 0' TENANT
Number of stories:
Name:
Address:
Type of construction:
City/State/ZIP: Occupancy groups:
Phone:( ) Existing:
Fax:( )
Q AI'i?LICANTNew:
Q CON TACT PERSON
Business name: NOIC
Contact name: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Address: under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
Phone:( ) apply:
Fax::( )
E-mail:
CMoose reef Attlee Arita:Oki
OIRACTf) t
Business name: e lUI .T ING RMtI S*
Address: '.2;),y a� t�� �ve Permit fee:
City/State/ZIP: p State surcharge(12%oofpermit fee):
Phone:(50. )__ �_ .s.-.0 g3 Fax:( ) FLS plan review(40%of permit fee):
CCB lic.: 1 (Due upon application submittal.)
C t`
Z53 Total permit fees:
Authorized signature:#ii,
Amount received: -If
Print name: ��r� 1"G Date: This permit application expires if a permit is(no(tt obtained
vT O I 6�3�y I within 180 days after it has been accepted as complete.
` * Fee methodology set by Tri-County Building Industry
I:\BuildingTermits\FPS-PemUtApp_031016.doc Service Board.
440-4613 T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
scribc work to be dote:
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:
❑ Addition or ❑ 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
❑ 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 17 as appb(tab ):,
A.) Commercial"Spritzer
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
Hood Project Valuation: I $
C.)r Fire Alarm,
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: I $
D.) Residential Sprinkler(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: I sq. ft.
pine Prote tion.Permit p`e
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: $
C:\Users\Jono\Downloads\FPS_Pe, pp(3).doc 2
City of Tigard Permit No.: t-A 9e'17 Z'
13125 SW Hall Blvd.,T;i 1I'7t3i%E
Phone: 503.718.2439 3���44g4tf4� Date Received:
Inspection Line: 503.639.4175
T I G A R I) Internet: www.tigard-or.gov By:
JUN 2 6 2017 ///���//
FIRE Aoimf mow AFFIDAVIT FOR ALTERATIONS
BANWititSINT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: iv\(:), (--ick ( ve R ick Occupancy: 6
Job Address: \') CC SW g k\ Avp Suite:
Contractor: NI i`;P� �e �r ;�� Phone: 503- a-?-- SO g 3
Valuation of work: $ !kCr
Type of System: (check one) Required ONon-required
(check one) ]Automatic []Manual OBoth
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 c 5) 2, /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(m 5) /To be Relocated(.5)
Number of Proposed Notification Appliances: To be Added(m 5) /To be Relocated(m 5)
1, FC`` I I P-5 i`ieck-o ,6S Oregon Construction Contractors Board No. 1 a S36dy
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 document with a copy of the sketch attached shall be available for all inspections.
Signature: 1
Date: (� 20Z
Print Name: LT -c 14.0
I:\Building\FormsWireAlarmAffidavit 071514.docx
Page 1 of 1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12300 SW 68TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00093
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor