Permit (10) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
IN i COMMUNITY DEVELOPMENT Permit#: FPS2018-00039
13125 SW Hall Blvd.,Ti Date Issued: 04/23/2018
TtCand OR 97223 503.718.2439�ARI: 9
Parcel: 2S 101 DA00101
Jurisdiction: Tigard
Site address: 13190 SW 68TH PKWY 130
Project: Kimsa Subdivision: VARNS ACRES Lot: 9
Project Description: Fire alarm:Adding/altering(1)devise.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC NW PROPERTIES LIMITED PA
5863 LAKEVIEW BLVD STE 100 STERN FAMILY LIMITED PARTNERSHIP
LAKE OSWEGO, OR 97035 STERN, HELEN R REVOCABLE TRUST
6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 04/23/2018 $53.78
12%State Surcharge-Building 04/23/2018 $6.45
Type of Use: COM Plan Review-Fire Life Safety-COM 04/23/2018 $21.51
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 04/23/2018 $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: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: No Cut Sheets Required: Yes
Total $82.24
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $568.00
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: ��c .�C/ Permittee Signature: r't' /I�G�ii (--,Call 503.639.4175 by 7:00 a.m.for the next available inspection date. �p
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.
c B
Building Permit Application
Fire Protection System (cm O I( 1 ‘)1 ON I.1
City of Tigard in r; '7, Received
a 13125 SW Hall Blvd.,Tigard,OR 97223 l ''' Plan Review / Permit No.:
_ Phone: 503.718.2439 Fax: 503.598.1960. Date/13 : other Permit: A , at,dip/00
1 1 c ,\1:1, Inspection Line: 503.639.4175 ` Date Ready By: hofs. See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
OF WORK. r REQ>�TIRF, DATA 1 AND FAM( Y' LLIr4G
0 New construction 0 Demolition Permit fees*are based on the value of the work performed.
INAddition/alteration/replacement 0 Other — Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
F CATEGORY i1F (1N� �Ojcy work indicated on this application.
s,.a
❑ I-and 2-family dwelling D Commercial/industrial Valuation: S
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other. Number of bathrooms:
JOB SITE INFORMATIONAND LOCATION Total number of floors:
Job site address:13190 SW 681"Ave. New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldgjapt.no.:130 I Project name:Kimsa Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQ, )ATA (COMMERCIAL-USE CHECKLIST
Subdivision: ( 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
DESCRIPTION,OF WOI work indicated on this application.
Fire Alarm Notification Devices Valuation: $568
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER El TENANT Number of stories:
Name:Kimsa Type of construction:
Address: 13190 SW 68"1 Ave.Suite 130 Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:( ) Fax:( ) New:
t� APPLICANT ,CONTACT PERSON' ;, .• . . �. �,. " NOTICES
Business name:Point Monitor Corp. All contractors and subcontractors are required to be
Contact name:Brooke Williams licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:5863 Lakeview Blvd#100 jurisdiction in which work is being performed.If the
City/State/ZIP:Lake Oswego,OR 97035 applicant is exempt from licensing,the following reasons
apply:
Phone:(503)627-0100 Fax::( )
E-mail:bwilliams@pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Point Monitor Corp. (Please eJer rofes schedule)
Permit fee:
Address:5863 Lakeview Blvd#100
State surcharge(12%of permit fee):
Cityr'State/ZIP:Lake Oswego,OR 97035 FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( ) (Due upon application submittal.)
CCB lic.:135901 Total permit fees:
Amount received:
Authorized signature: -**No mma. This permit application expires if a permit is not obtained
Print name:Ben Breit Date:4/19/18 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
F..Budding Permits FPS•PermitApp_031016.doe 440-46I3T(1102ICOM WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
Describew prl{ 2��..donew.®e u %, -_ a w a• r w w� a w ;,
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
▪ 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: Fire Alarm Notification Devices
T e°e4of S ,tem ,Co�aa lets. s ot.D KK ►mile . � . .,..:`F .:,
a%" r 't
�� l,on'ttn� a1 Jp"ttnkltl b''" m 't'a6 . ''
;"-x.,:r
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K.Factor
Sprinkler Project Valuation: I $
B.)
Typel4
Hood Suppi $ion System N x
Hood Project Valuation: I $
C) fre Aia m fi
r
Submittal shall Battery Calculations 0 Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: I $ 568
D.) Residential Sptnider(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: sq.ft.
Fire Protection Permit 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: $
(::\Users\bwilkams\I)esktop\1'ERM1'I'FORMS\I ire permit-cite of tigard.doc 2
City of Tigard j', rc: .::':2, Permit No.: FJ"5 1i-[.rivJ,
: I
13125 S50 Hall.2 39 Tigard,OR 98.19 61702-
Phone: 503.718.2439 Fax: 503.59gr1960 Date Received: 34,--.
Inspection Line: 503.639.4175 .
l :','./'[, Internet: www.tigard-or.gov r- By: ,,.t //' � ./
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Kimsa Occupancy: Same
Job Address: 13190 SW 68th Ave. Suite: 130
Contractor: Point Monitor Corp. phone: 503-627-0100
Valuation of work: $568
Type of System: (check one) D■Required DNon-required
(check one) DAutomatic ❑Manual ❑■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(n 5) /To be Relocated 0.5)
Number of Proposed Manual Alarm Stations: To be Added(mex5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max5) 1 /To be Relocated(max5)
I, Ben Breit Oregon Construction Contractors Board No. 135901
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: Date: 4/19/18
Print Name: Ben Breit
1:\BuildingWorms\FireAlarmAffidavit_071514.docx Page 1 of 1 E
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City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13190 SW 68TH PKWY 130, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00039
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor