Permit 74 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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COMMUNITY DEVELOPMENT Permit#: FPS2019-00078
Date Issued: 06/20/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE# 10
Project: Oregon Academy of General Dentistry Subdivision: VARNS ACRES Lot: 9
Project Description: Fire Alarm.Adding(6)devices for TI.
Contractor: POINT MONITOR CORPORATION Owner: TRIANGLE POINTE TWO LLC
5863 LAKEVIEW BLVD STE 100 901 NE GLISAN ST, STE 100
LAKE OSWEGO, OR 97035 PORTLAND, OR 97232
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 06/20/2019 $123.72
12%State Surcharge-Building 06/20/2019 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 06/20/2019 $49.49
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 06/20/2019 $4.00
Occupancy Grp: B Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 06/20/2019 $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 Calcs Provided: Yes Cut Sheets Required: Yes
Total $199.56
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,603.00
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 r s
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signat re:
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
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Fire protection System -,,ri�Ka� FOR OFFICE LSE oM.v
Received
City of Tigard �� y: ti t r,I t� Permit No.:F; -� -1W
Date/ByTAit
:
SW Hall Blvd.,Tigard,OR 97223 JUN ® 5 Plan Review �y
Phone: 503.718.2439 Fax: 503.598.1960 .ringo Date/By: Other Permit (St ;i-�
T I G A R D Inspection Line: 503.639.4175 GIii QF D to Ready/By: ' r�C / � Juris ® See Page 2 for
Internet: www.tigard-or.gov BUILDING D v1S10 tified Metho `jam' / Supplemental Information
0 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
®Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
, , """ i ��=` r� `. work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
ElAccessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
7.i " 408 sat 444t%Il ;" 4 Total number of floors:
v . „.,, ,.. a .:°. Er 4 .., ION .., a..ATIUIV,,y ,.. ,;
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Job site address:13333 SW 68th Parkway New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:010 Project name:OAGD Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
U , ATA t OMMERRIAI.T II 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
x , ,,, , „ > 11 RIPTIO I flf 'e work indicated on this application.
FIRE ALARM C, : 'i��itCXy� Valuation: $$4,603.00
Existing building area: square feet
New building area: square feet
,,,,4,..t,„,,,„. p
:?. :1447,4V, ',.i.',.'i. O.1,�.,,a'2;ii ..; w.,,x '" ' °` `,4",' �",1 ' '.,S:x ..„ w' r«,a 1''''a Number of stories:
Name:OAGD Type of construction:
Address:13333 SW 68th Parkway,Suite 010 Occupancy groups:
City/State/ZIP:Tigard,OR 97223
Existing:
Phone:( ) Fax:( ) New:
#,
�1 9< LICANT A.:4".1'... :„ 40 NOTICE
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$�
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
:,,,17,::: :;14.:: ;4,,`:1'' ,.ham ..v - RA ,,,,:: 4�_ # B tot ,`..04,"1! Il .,i
Business name:Point Monitor Corp.
':i.., referrolee, /4bikj ..
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 ,(3 v Ar Total permit fees:
Authorized signature:
Amount received:
r--- This permitapplication expires if a permit is not obtained
Print name:Ben Breit Date:6/4/19 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 I/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
El New system Number of sprinkler heads: Number of alarm devices:
® Addition or ❑ 1-10 heads: Affidavit required and El 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
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44' ! ad s.. B =g 8 6 t ". ! �' k: ' y ', y, _; !" �,� y �,. `s
:. a4V
Q liiClercia Sp r�}yyy�� ,
Sprinkler Type ❑ Wet El Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
."ltd
ai
Hood Project Valuation: I $
' ax« $ s: yz.+!!»z? Jnwam e ira - ,x",e1 wear akz,y a „; s -zr rWafsn , a ss
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: I $ 4,603
,Ites ! ! Sprinkler
> ; kSta1u OdSys! ;� z
Square Permit Feer
sir z rr s
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
� ,�..mit.... _.. ..:.. . _
Sprinkler Project Square Footage: sq.ft.
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: $
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