Permit (22) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2017-00083
Ta AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/29/2017
Parcel: 2S112DD01601
Jurisdiction: Tigard
Site address: 15755 SW SEQUOIA PKWY
Project: Orthopedics Northwest Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Fire sprinklers-Adding(10)and relocating(22)sprinkler heads for TI.
Contractor: CENTURION FIRE PROTECTION LLC
Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 1705
OREGON CITY, OR 97045 ATTN: N PIVEN
15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-593-9791 PHONE: 503-324-6300
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM
06/29/2017 $188.28
Type of Use: COM 12%State Surcharge-Building 06/29/2017 $22.59
Class of Work: ALT Plan Review-Fire Life Safety-COM 06/29/2017 $75.31
Type of Const: VB Info Process/Archiving-Sm$0.50(up to 06/29/2017
Occupancy Grp: B Height: ft 11x17) $17.50
Stories: Info Process/Archiving-Lg$2.00(over 06/29/2017
11 x 17) $2.00
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .10 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 $305.68
Valuations:
Sprinkler Valuation: Required Items and Reports(Conditions)
$10,500.00
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 or 1.800.332.2344.
Issued By: /10111119r Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection ate.
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
'°*`Protection System �.., : ;-11---,! POR OFFICE LISE ONLY
�t ,
f , a`art 1.a Received- Permit No.: /y ;` {
City of Tigard 1• Date By: 117'J 1 r'00,o 7 t.2..x✓�✓
a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie .� p
g �� Other Permit:/��//�� /7- V
I' Phone: 503.718.2439 Fax: 503.598.1960 �1 Y Date By: a`' "( �� /�y'� ()co
Inspection Line: 503.639.4175 Date Ready By: I 1 Juris: ® See Page 2 for
r„r+nr� Notified/MethodU i/ Supplemental Information
Internet: www.tigard-or.gov b
� _ iREQU D UATM E. 1 i nW NG
Permit fees*are based on the value of the work performed.
❑New construction L)Demolition
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
AT SOII il lel TRiJCUON
Valuation: $
❑ 1-and 2-family dwelling ®Commercial/industrial
Number of bedrooms:
ElAccessory building
I:3 Multi-family
❑Master builder 0 Other: Number of bathrooms:
3 s1,.1 ,II9i J10N;AN13 ATION Total number of floors:
Job site address,5755 SW Sequoia Parkway New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.:200 Project name:Orthopedics NW Remodel Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
R tk0:11ATA COlt11I 3J OIAL4J
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
c ` T� '�T1A-t* 13'O�
workindicated on this ppl
icat
ion.
F . „_
Valuation: $$10,500.00
Add(10)new fire sprinklers
Existing building area: square feet
Relocate(22)fire sprinklers
New building area: square feet
1 R 2 . T''O NE- kJ TENANT Number of stories: 1
Name:Orthopedics NW Type of construction:
Address:5755 SW Sequoia Parkway#200 Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:( ) Fax:( ) New:
AitkU AN ai cT 1 .< ,
Business name:Centurion Fire Protection All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:Brent Barker under ORS 701 and may be required to be licensed in the
Address:PO Box 1705 jurisdiction in which work is being performed.If the
applicant is-exempt-frontlieensing,the-following reasons
City/State/ZIP:Oregon City,OR 97045 apply:
Phone:(503)593-9791 Fax::( )
E-mail:brentbarker@centurionfirepro.com
oNr2AcT R BI.11 11N 1 T)1
r;
Business name:Centurion Fire Protection Permit fee:
Address:PO Box 1705
State surcharge(12%of permit fee):
City/State/ZIP:Oregon City,OR 97045 FLS plan review(40%of permit fee):
Phone:(503)5934791 Fax:( ) (Due upon application submittal)
CCB lic.:204812 /aA//' Total permit fees:
` � Amount received:
Authorized signature: ./`"`�'� "� This permit application expires if a permit is not obtained
u -- --
Date:5/25/2017 within 180 days after it has been accepted as complete.
Print name:Brent Barker * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building'Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
Ill.'
F
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
I suite bar 'tt r a i
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 32 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: Add (10) new sprinklers and relocate (22) existing sprinklers.
if re =Coin i tem A il, cor-f as a 'i i ab1
. ) Cr ercial S} i*ier
Sprinkler Type ® Wet ❑ Dry
Additional- -Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group Light
Density .10
Design Area 1500
K. Factor 5.6
Sprinkler Project Valuation: $ $10,500
Type I f Hood Fire i�res Syste
Hood Project Valuation: $
,
Submittal shall Battery Calculations E=1Yes
include: Individual Component ❑ Yes
Cut-Sheets-
Fire Alarm Project Valuation: $
f) Itesid ,t> :S x ler Mand Ai4ine y telco)
Square Footage:q g 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 P te.c pii Pe t P`te
Project valuation subtotal (see A,B &C above): $ 10,500.00
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\DeadElk12\Dropbox\Centurion Fire Team Folder\JOBS 2017\17-023 Ortho2edics NW\AUTHORIZATION-PURCHASE ORDER\FPS_PermitApp.doc
SUBMITTAL PACKAGE
CENTURION FIRE PROTECTION Portland Orthopedics NW p 4.
PO Box 1705 5755 SW Sequoia Parkway#200 a
.t.,
Oregon City, OR 97045 Portland, OR 97224
503-593-9791 JUN 1 2017
www.centurionfirepro.com CITY;Of„-'I A
RD
BUILDING DIVISION
SECTION A: PIPE Pages 1,2
SECTION B: FITTINGS Pages 3-10
SECTION C: VALVES& BACKFLOW DEVICES Pages N/A
SECTION D: HANGERS Pages 3-17
SECTION E: ELECTRICAL Pages N/A
SECTION F: FIRE SPRINKKERS Pages 18-29
SECTION G: SIESMIC BRACING Pages N/A
SECTION H: MISCELLANEOUS Pages 30-48
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15755 SW SEQUOIA PKWY, LAKE November 15, 2017 at
OSWEGO, OR 11 :32:21 AM
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00083
Inspection Type: Inspector:
999 Sprinkler final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor