Permit (42) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111 4 ' COMMUNITY DEVELOPMENT Permit#: FPS2019-00036
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/19/2019
T f( ,4 I [, 9 Parcel: 1S134AD06202
Jurisdiction: Tigard
Site address: 10500 SW NIMBUS AVE T
Project: Westside A Jesus Church Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: A
Project Description: Fire sprinkler. Adding(4)sprinkler heads for TI.
Contractor: WYATT FIRE PROTECTION INC. Owner: DIETRICH, NANCY BISHOP
9095 SW BURNHAM ROBINSON,JERRY CHRISTOPHER TRUST
TIGARD, OR 97223 ROBINSON, LYNN ET AL
9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: 503-684-2928 PHONE:
FAX: 503-684-9657
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/19/2019 $67.23
12%State Surcharge-Building 03/19/2019 $8.07
Type of Use: COM Plan Review-Fire Life Safety-MF 03/19/2019 $26.89
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 03/19/2019 $1.00
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: Cut Sheets Required:
Total $103.19
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,083.00
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 callinga503.232.1987 or 1.800.332.2344.
Issued By: _. 7. l / ., ` Permittee Signature: ,;" ' },n c/'-
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
g of Tigard Receiate/B � �ved /
� � ��� ii.
41 13125 SW Hall Blvd.,Tigard,OR 97223 5 :,,, 3 t t-l' B Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : %' / F (/R-_
T 1 G A K D Inspection Line: 503.639.4175 Date Ready/By: 11.11 H See Page 2 for
Internet: www.tigard-or.gov otified/Method: Supplemental Information
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑■ Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
r = s work indicated on this application.
/-t, ff )4901,1AktatiMitNWMA4.45.24k` /k,
El1-and 2-family dwelling El Commercial/industrial
Valuation: $
❑Accessory building ElMulti-familyNumber of bedrooms:
0 Master builder ElOther: Number of bathrooms:
# ' Total number of floors:
Job site address:10500 SW Nimbus Ave New dwelling area: square feet
City/State/ZIP:Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:T Project name:Westside Jesus Church Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
of i i
Subdivision: 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
t • ° > #r w s # work indicated on this application.
Add fire sprinkler heads for new TI Valuation: $1083
Existing building area: square feet
New building area: 0 square feet
t ' - Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
Business name:Wyatt Fire Protection All contractors and subcontractors are required to be
Contact name:Ronin Campbell licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:9095 SW Burnham jurisdiction in which work is being performed.If the
City/State/ZIP:Tigard,OR 97223 applicant is exempt from licensing,the following reasons
apply:
Phone:( )503.684.2928 Fax: :( )503.684.9657
E-mail:r.campbell@wyattfire.com
Y
Business name:Wyatt Fire Protection
Permit fee:
Address:9095 SW Burnham —
State surcharge(12%of permit fee):
City/State/ZIP:Tigard, OR 97223 FLS plan review(40%of permit fee):
Phone:( )503.684.2928 Fax:( )503.684.9657 (Due upon application submittal.)
CCB lic.:64077 Total permit fees:
Amount received:
Authorized signature:
di This permit application expires if a permit is not obtained
Print name:Ronin Campbell Date:3/18/19 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doc 440-4613T(1 1/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
' E ..+># t D ld as .,, - s. .
gyp,..: sy - r . �'—' s., =�
1.) Type of Work: 2) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 4 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 EI(36)+s devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
."`. aa- ig. - , := w .. +�
Sprinkler Type SSP-QR • Wet 111 Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density 0.05
Design Area 1500
K.Factor 5.6
Sprinkler Project Valuation: $1083
Hood Project Valuation: $
i.
Submittal shall Btry Calculati ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
#�$ r. .74 t _
•
Square Footage:
Permit Fee. 4 .' ..* ,, § E :, "1
0 to 2,000 $198.75 � �
2 001 to 3 600 $246.45 '
3,601 to 7,200 $310.05
7,201 and greater .; - Y. -. s ,`
$404.39
Sprinkler Project Square Footage: sq. ft.
d -.`352'^T�""'°`°' 4 c # 3 f 3 $ k1 i 9 +:. 's... s.;t .. `t ,'` k,="
'^, :,. ,1•.' ,.t .:u-,.;:. ..: =tn:ds.w -.....affi:a, „ 5 '.r xb ,i`3v' ,. .. z .e. u ..};•
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: $
W:\Permits\Permit Application Forms(Updated July 2017)\Tigard Fire Permit App.doc2
Cityof Tigard ` '
. -Permit No.: -tPPSA/l (Ge, ,
11 13125 SW Hall Blvd.,Tigard,OR 97223
* Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 5 AT
Inspection Line: 503.639.4175-or.go //�� j/J /r4
TR;ARD Internet: www.tigard-or.gov ov
g g By: ,L .� � i�LL�L��tet.
f
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Westside Jesus Church TI Occupancy:
Job Address: 10500 SW Nimbus Ave Bldg T Type of Construction:
Suite:
Contractor: Wyatt Fire Protection Phone: 503.684.2928
Number of Proposed or Altered Heads: 4
Type: SSP-QR Hazard: Light Density: 0.05
I Wyatt Fire Protection Oregon Construction Contractors Board No. 64077
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits, beams,partitions,walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop (exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads (see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
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.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature: Date: 3/18/19
Print Name: Ronin Campbell
I:\Building\Forms\FireSprinlderAffidavit_071514.docx Page 1 of 1
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
10500 SW NIMBUS AVE T, TIGARD, OR, 97223 June 20, 2019 at 11 :39:55 AM
Record Type: Record ID:
Commercial - Fire Protection System FPS2019-00036
Inspection Type: Inspector:
999 Sprinkler final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor