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CITY OF WOODBURN Building Division [PHONE REDACTED] [EMAIL REDACTED] FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS OR TENANT IMPROVEMENTS (0-5 APPLIANCES WITHOUT PLAN REVIEW) Submit form via email [EMAIL REDACTED] or Over the Counter Project Name: Occupancy: Valuation: Permit Number 971 - Job Address: Suite: Contractor: Type of System: (check one) □ Required □Nonrequired (check one) □ Automatic □ Manual □ Both Note: Deleted Fire Alarm Panel option the replacement of a fire alarm panel requires a full review (full set of plans with associated manufacture specification sheets) for compliance with the current standard (ADA) and any compatibility. Fire Alarm Control be Replaced / To be Relocated (max 1) (max 1) No. of Proposed Notification Appliance Power Supplies: To be Added (max 1) No. of Proposed Smoke/Heat be Added / To be Relocated (max 5) (max 5) No. of Proposed Manual Alarm be Added / To be Relocated (max 5) (max 5) No. of Proposed Notification be Added / To be Relocated (max 5) (max 5) 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 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 and subject to field verification. g) Battery supplies are capable of supporting the system modifications. h) A statement of compliance, with the minimum information as specified in OFC Section 901.2.1, will be given to the building inspector prior to final approval. i) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications. In addition, I understand the following is required: * A sketch attached to this document and the building permit showing the area of work within the building's structure, and * A copy of this document shall be available for the authority having jurisdiction, and * An electrical permit. Signature: Date: 270 Montgomery St. Woodburn, OR 97071 SIGN