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(Submittal of form by fax or at over-the-counter (City of Beaverton)

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Form B70-1034 REV 2/14
(1 to 10 sprinkler heads without plans)
Building Permit No. ________________________ Plans Examiner ______________________
(Submittal of form by fax or at over-the-counter times.)
Project Name: __________________________________________ Occupancy: ____________________________
Job Address: ___________________________________________ Type of Construction: _____________________
Suite: _________________________________________________
Contractor: _____________________________________________ Phone: ________________________________ Phone:
Number of Proposed or Altered Heads: _______________
Type: WET Hazard: LIGHT Density: .10
I, ___________________________________, Oregon Construction Contractors Board No. ____________ certify that 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 the 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 NFPA 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:
A sketch attached to this document showing the area of work within the building’s structure, and
A copy of this document shall be available for all inspections.
A completed Building Permit Application.
Signature: _________________________________________________________ Date: _____________________
CITY OF BEAVERTON
Community Development Department
Building Division
12725 SW Millikan Way / PO Box 4755
Beaverton, OR 97076
Phone: (503) 526-2493 Fax: (503) 526-2550
General Information (503) 526-2222
BeavertonOregon.gov
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS OR TENANT IMPROVEMENTS
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(Submittal of form by fax or at over-the-counter (City of Beaverton)

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Completed 2 August 2020

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