Permit s t CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
114
COMMUNITY DEVELOPMENT Permit#: FPS2020-00125
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/8/2020
Tito tFC1? g Parcel: 1S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 101
Project: Spec Space Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire alarm permit;installation 3 alarm devices.Affidavit submitted.
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-255-9488 PHONE:
FAX: 503-257-7121
FEES
Description Date Amount
Specifics: Permit Fee-COM 12/08/2020 $69.92
12%State Surcharge-Building 12/08/2020 $8.39
Type of Use: COM Plan Review-Fire Life Safety-COM 12/08/2020 $27.97
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 12/08/2020 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: No Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $106.78
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,200.00
This permit is issued subject to the regulations
1 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 calling 503.232.1987 or 1.800.332.2344.
Issued By: ; (a _n� (1 , �_ Permittee Signature: (� , ^ A1� AI l l
�J` xCfalll`50033.)639.4175 by 7:00 a.m.for the next available inspectionc 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 li C IV D
City of Tigard DEC 4 2020 Received y� Permit No
111 • 13125 SW Hall Blvd.,Tigard,OR 97223 pl tev/Z ���,�/ ��{ 21/� s
_ Phone: 503.718.2439 Fax: 503 598.1 X�'�/ {� .(� Date/ ' Other Permit:
Inspection Line: 503.6394175 OF ����� t�
TIGARD 1 N r ^ 1(, 1r h Date edjMeBO. ' ' stp
Juri1 S See supplage 2emental
Information
Internet: www_t1gard-Or.go -? 'NotifiedlMeiho .C/ '� supplemental Information
. ..i TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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
CATEGORY AF CONSTRUCTIONwork indicated on this application.
❑ 1-and 2-family dwelling ElCommercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ['Other: Number of bathrooms:
.[OB SITE.INFORMATION AND LOCATION Total number of floors:
Job site address: 10220 SW Greenburg Road (3Lincoln) New dwelling area. square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: 101 Project name:VSP Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
"REQUIRED DATA:COM M1IERCIAI-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
R equipment,materials,labor,overhead,and the profit for the
r " lt tl� WORK' work indicated on this application.
Install fire alarm devices per submitted plans. Valuation: $1,200
Existing building area: square feet
New building area: square feet
€F ,ie 15, -
-* Px,1{T cNER ❑ TENANT Number of stories:
Name: Shorenstein Realty Services Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
D APPLICANT ❑,CONI'ACI' IERSON 4 rjVaTICE- * .. 4.4gt,". .
Business name. All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply'
Phone:( ) Fax::( )
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee Acieedute)
Business name: Capitol Electric Company,Inc.
- Permit fee: 72.61
Address: 11401 NE Marx Street
City/State/ZIP:Portland,OR 97220 State surcharge(12%of permit fee): 8.71
FLS plan review(40%of permit fee): 29.04
Phone:(503)255-9488 Fax:(503)255-1966 (Due upon application submittal.)
CCB lie.:48748 Total permit fees: 110.36
Authorized signature: ,,a,�,__,—.(3� 7t..-� — ,SZJ Amount received:
v This permit application expires if a permit is not obtained
Print name:Shane Tercek Date: 12/3/20 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
013mIdinglPermas\FPS-PermitApp_031016.doc 440-4613T(1 I/02/COMAVEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:'
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: 3
® 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.)y Commercial Sprinkler
Sprinkler type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: 1$
C.) Fire Alarm
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1,200
:Residential Sprinkler (Stand Alone System) ~jJ
Square Footage: Permit Fee:
0 to 2,000 $198.75 r�jjr�;( ygc��ai a
2,001 to 3,600 $246.45 ��i�i ��tt � h,r of; 3a�rsiEiz � 4
3,601 to 7,200 $310.05 :wtrl'f l )p""7
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
ProtectionPermit Fees
Project valuation subtotal (see A,B & C above): $ 1,200
Permit fee based on project valuation (see fee schedule): $ 72.61
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $ 8.71
FLS Plan Review (40°%b of permit fee): $ 29.04
TOTAL: $ 110.36
Q.\Fire Alarm\FA Jobs\zz201729-45 VSP 101 @ 3Lincoln\job info\1 FPS_PermitApp2017.0126.doc
RECENED
City of Tigard CC 4 2020 Permit No.: r-IoS'201�-QO/Z j
III13125 SW Hall BlvdD
.,Tigard,OR 9QB3C /,, g/zro6
Phone: 503.718.2439 Fax: 5 g$,t9 Date Received: �/O
Inspection Line: 503.639.4175 ) I Y LI �' ��t ��
TIG,'1RD Intemet: www.tigard-or.go `(=' DIVISION B
B�l��DING o,v Y C/7V 074' Icy
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: VSP 101 Occupancy: B_
Job Address: 10220 SW Greenburg Road Suite: 101
Contractor: Capitol Electric Co., Inc. Phone: 503-255-9488
Valuation of work: $ 1,200
Type of System: (check one) ❑■Required [Non-required
(check one) ['Automatic [Manual *Both
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added(max s) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(ma<5) /To be Relocated (max 5)
Number of Proposed Notification Appliances: To be Added(max 5) 3 /To be Relocated(max 5)
I Shane Tercek Oregon Construction Contractors Board No. 48748
certify the following is true and 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.
g) Battery supplies are capable of supporting the system modifications.
h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications.
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.
• Electrical permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature: S� ` '-�' r" "�� Date: 12/3/20
Print Name: Shane Tercek
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