Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
�'`'! COMMUNITY DEVELOPMENT Permit#: FPS2019 00144
Date Issued: 11/26/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 134BC00300
Jurisdiction: Tigard
Site address: 12264 SW SCHOLLS FERRY RD
Project: Restore Cryotherapy Tigard Subdivision: None Lot: None
Project Description: Fire sprinkler permit:Adding and relocating a total of(9)sprinkler heads for TI. Affidavit submitted.
Contractor: EXPRESS FIRE SYSTEMS INC Owner: FW OR-GREENWAY TOWN CENTER LLC
1913 41ST STREET PO BOX 790830
WASHOUGAL,WA 98671 SAN ANTONIO, TX 78279
PHONE: 360-953-8432 PHONE: 360-823-7223
FAX: 360-953-8394
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/26/2019 $123.72
12%State Surcharge-Building 11/26/2019 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 11/26/2019 $49.49
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 11/26/2019 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .1 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 $188.56
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $4,050.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
e
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Cods and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started/, ithin 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires yo o follow the rules/ado ed by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- 000. You may o ain' copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
r
Issued By: z, Permittee Signature:
Call 50 . 39.4175 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 pr ject.
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 Doris a it
rc
ci. 177i _ ,/0St )f '_tio/y
Permit No.:
" 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
IN a Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:/ ,i0e)/`l—C2.'
Inspection Line: 503.639.4175 J' q Date Ready/By: Juris: See Page 2 for
TIGARD P N0V' 2 6 2019 Y Y ��-•, S
Internet: www.tigard-or.gov Notified/Method: "G„ Supplemental Information
TYPE ' l t t '= REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction ❑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.
❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12264 SW Scholls Ferry Rd. New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Restore Oryotherapy 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.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
: $
Add/relocate sprinkler heads due to new walls - less than 10 Valuation
4,050.00
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Restore Hyper-Wellness Portland Metro Type of construction:
. Address4871 Meadow Rd., Ste 173 Occupancy groups:
City/State/ZIP:Tigard, OR 97035 Existing:
Phone:1360 )823-7223 Fax:( ) New:
❑✓ APPLICANT 0 CONTACT PERSON NOTICE
Business name:Express Fire Systems All contractors and subcontractors are required to be
Contact name:Tiffany Bell licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address670 S 28th St. jurisdiction in which work is being performed.If the
City/State/ZIP:WaShOU al WA 98671 applicant is exempt from licensing,the following reasons
apply:
Phone:(360)953-8432 I Fax: :( )
E-mail: Design@expressfiresystems.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: (Please refer to fee schedule
Express Fire Systems Permit fee:
Address:670 S 28th St.
•City/State/ZIiWashOu al, WA 98671 State surcharge(12%of permit fee):
g FLS plan review(40%of permit fee):
Phone:( 360 953-8432 Fax:( ) (Due upon application submittal.)
CCB lie.: 1 93272 Total permit fees:
Authorized signature: /
////// 1, �
�� ' ' Amount received:
This permit application expires if a permit is not obtained
Print name:Tiff n Bell Date:11 21 1 within 180 days after it has been accepted as complete.
any / / * Fee methodology set by Tri-County Building industry
Service Board.
I:\Building,Permits\FPS-PcrmitApp_031016.do,. 440-4613T(11/02/COM'WF.B)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done: I
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:
RI 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:
Type of System(Complete A, B,C or D as applicable):
A.) Commercial Sprinkler 14. ` :,.. K . v�
Sprinkler Type Wet El Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor 1� `?
Sprinkler Project2Valuation: $
B.) Type I- Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Mann
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
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: $
I:\Building\Permits\FPS_PermitApp_031016.doc 2
City of Tigard Permit No.: /``/"S 1,t y— (.rs?t'ht
13125 SW Hall Blvd.,Tigard,OR 97223
: 2 Phone: 503.718.2439 Fax: 503.598.1960 ,Lit Date Received: !l v(�/i d
,,, +'y'-.gem- /
Inspection Line: 503.639.4175 ���,�„ �' _
TIGARD Internet: www.tigard-or.gov By: Gr of 1 s .4
NfV 2 6 7nm:
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
•
Project Name: Restore Cryotherapy Occupancy:
Job Address: 12264 SW Scholls Ferry Rd. Type of Construction:
Suite:
Contractor: Express Fire Systems Phone: 360.953.8432
Number of Proposed or Altered Heads: 9
Type: Quick Response Hazard: Light Density: 0.1
1, Tiffany Bell Oregon Construction Contractors Board No. 193272
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.
0 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: I2,/ "'t Date: 11/21/19
Print Name: Tiffany Bell ,,
1:\Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1
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Job Number: S19-072 NOV 2 6 2019
Job Name: Restore Cryotherapy C Y O ` c 4--t
Job Address: 12264 SW Scholls Ferry Rd.,Tigard, OR 97223 1 €! 21'�, - ,:4\?' !'- 4'
Owner: Restore Hyper-Wellness Portland Metro
4871 Meadow Rd. Suite 173
Lake Oswego, OR 97035
Contact: Nate Fennell -nate@restorecryotherapy.com
Contact Phone: 360.823.7223
Contractor: Express Fire Systems, Inc.
Contractor Phone Number: 360.953.8432
Contact Person:Tiffany Bell—design@expressfiresystems.com