Permit (142) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
III • COMMUNITY DEVELOPMENT Permit#: FPS2018-00159
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/01/2018
T"r� A V.Dg Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 250
Project: The Filkins Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Fire alarm. Adding(2)devices and relocating(2)devises.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/01/2018 $88.75
12%State Surcharge-Building 11/01/2018 $10.65
Type of Use: COM Plan Review-Fire Life Safety-COM 11/01/2018 $35.50
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 11/01/2018 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 11/01/2018 $0.50
11x17)
Building Misc Fund(copies/prints) 11/01/2018 $1.00
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: Cut Sheets Required:
Total $138.40
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,885.00
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
oror1.800.332.2344. ,bIssued By: .Z%,0i2/�/ Permittee Signature: CYC71i c G .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 SystemRECEIVE
yI wiz OF RI- GtiG O\L1
City of Tigard OCT 3 0 2018 DE!iew
Rec13125 SWHallBlvd,Tigard,OR 97223 `iI�' /4` I i/ice/
`
1 Phone: 503.718.2439 Fax: 503.598.19 CITY op Ti DaB : s
T 16:�I:D Inspection Line: 503.639.4175 UIL.QING G'ARD Date Ready By: Juris: H See Page 2 fo
Internet: www.tiganl-or.gov DIVISION Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY`OF CONSTRUCTION ..` ` work indicated on this application.
ID1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION,.AND"LOCATION Ty,' Total number of floors:
Job site address:12909 SW 681h Parkway New dwelling area: square feet
City/State/ZIP:Portland,OR 97223 Garage/carport area: square feet
Suite/bldgJapt.no.:250 Project name:Filkinsl 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: 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 Valuation: $$1,885.00
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER TENANT Number of stories:
Name:The Filkins Group Type of construction:
Address:12909 SW 68th Parkway Suite 250 Occupancy groups:
City/State/ZIP:Portland,OR 97223 Existing:
Phone:( ) Fax:( )
New:
LO APPLICANT 0 CONTACT PERSON
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 refer Yo jeeychedxlel
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:
Authorized signature: '+ /
Amount received:
..• This permit application expires if a permit is not obtained
Print name:Ben Breit Date:10/30/18 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:BuildingPemHssFPS-PermiiApp_031016.doc 440-4613T(I 1,02COM'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:
0 New system Number of sprinkler heads: Number of alarm devices: 4
® Addition or 0 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
0 11+heads: Plan review required and 0 6+devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work: Fire Mann Notification Devices
T A' of tem Com•lete A,B •
C or.D;as a; iicab � ' `.t � .
,
Commercial Sprinkler n �
Sprinkler Type 0 Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes 0 No
Hazard Group
Density
Design Area
K.Factor
Sprinkler Project Valuation: 1 $
B.) Type I Hood Fire Suppression System
Hood Project Valuation: 1 $
C.) Fire Alarm
Submittal shall Battery Calculations 0 Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Mann Project Valuation: $ 1,885
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 R)RMS\Fire permit-city of tigard.doc 2
CityTigard Permit No.:
13]255SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: `/
Inspection Line: 503.639.4175
T I ;,ti a.[) Internet: www.tigard-or.gov By: A‘s,i&Q,;(4/zog—
FIRE
ALARM SYSTEM AFFIDAVIT FOR ALTERATIOr E C E l V E D
OR TENANT IMPROVEMENTS OCT 3 0 2018
(MAXIMUM OF 5 DEVICES WITHOUT PLANS) CITY OF TIGARD
BUILD/NG DIVISION
Project Name: THe Filkins Group Occupancy: Pacific Parkway Center
Job Address: 12909 SW 68th Parkway Suite: 250
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $1,885
Type of System: (check one) DRequired QNon-required
(check one) DAutomatic DManual tBoth I�
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 tmex 51
Number of Proposed Notification Appliances: To be Added(max 5) 2 /To be Relocated(max 5) 2
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: 10/30/18
Print Name: Ben Breit
I:1BuildingWormslFireAlarmAffidavit 071514.docx Page 1 of I
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12909 SW 68TH PKWY 250, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00159
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor