Permit (109) CITY OF TIGARD14
FIRE PROTECTION SYSTEM PERMIT
'' Permit#: FPS2018-00098
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/16/2018
T f � Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 500
Project: Health Net Subdivision: None Lot: None
Project Description: Fire alarm:Adding and altering(21)devices for TI.
Contractor: POINT MONITOR CORPORATION Owner: GK TRIANGLE CORPORATE PARK III L
5863 LAKEVIEW BLVD STE 100 ATTN KBS REALTY ADVISORS
LAKE OSWEGO, OR 97035 P 0 BOX 28270
SANTA ANA, CA 92709
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/16/2018 $166.76
12%State Surcharge-Building 08/16/2018 $20.01
Type of Use: COM Plan Review-Fire Life Safety-COM 08/16/2018 $66.70
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 08/16/2018 $4.00
Occupancy Grp: B Height: ft 11x17)
Stories: 5 Info Process/Archiving-Sm$0.50(up to 08/16/2018 $7.50
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: Yes Smoke Detectors Req: Yes
Battery Gales Provided: Yes Cut Sheets Required: Yes
Total $264.97
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $8,340.00
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: Permittee Signature:
J _ / // /ij
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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 FOR OFFICE USE ONLY
City of Tigard AUG 1 3 2013 eceived
RDate/By: no a Ift permi.,frs,40g--,...a.,,F
11113125 SW Hall Blvd.,Tigard,OR 97223 I Phone: 503.718.2439 Fax: 503.598.100 , Plan Review.
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Other Permit:
TIGARD Inspection Line: 503.639.4175 ;:': , , .,:j Date Ready/By:
Internet: www.tigard-or.gov Notified/Method: Juris: I 0 See Page 2 for
ii, /6 t t 1375.--- Supplemental Information
pLi ;,. ". . 1 4Se /Iv jfrife".r
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction El Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
[E]Addition/alteration/replacement El Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
CATEGORY OF CONSTRUCTION
Valuation: $
I=1 1-and 2-family dwelling 0 Commercial/industrial
El Accessory building El Multi-family Number of bedrooms:
Number of bathrooms:
1:1 Master builder El Other:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:13221 SW 68th Parkway New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:500 Project name....Calatemeahase11.AleaX Ake Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
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
DESCRIPTION OF WORK work indicated on this application.
Fire Alarm-Notification Devices 621) Valuation: $8,340
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER eil TENANT Number of stories:
Name:Centene Phase II Type of construction:
Address: 13221 SW 68th Parkway Suite 500 Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:( ) Fax:( ) New:
El APPLICANT 0 CONTACT PERSON NOTICE
Business name:Point Monitor Corp. All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name:Brooke Williams
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
applicant is exempt from licensing,the following reasons
City/State/ZIP:Lake Oswego,OR 97035
apply:
Phone:(503)627-0100 Fax:
E-mail:bwilliams@pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Point Monitor Corp.
Permit fee:
Address:5863 Lakeview Blvd#100
State surcharge(12%of permit fee):
City/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:
lir
Amount received:
Authorized signature: _
410, _ -
----- -----......_-
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Ben Breit Date:8/10/18
* Fee methodology set by Tri-County Building Industry
Service Board.
I.\Building\PermitsTPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work 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: Number of alarm devices: 21
►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
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: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ 8,340
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: 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: $
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:
13221 SW 68TH PKWY 500, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00098
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor