Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
Permit#: FPS2021-00104
3
COMMUNITY DEVELOPMENT
T[ AR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/9/2021
G L3
Parcel: 1 S135A601003
Jurisdiction: Tigard
Site address: 10330 SW GREENBURG RD
Project: Red Lobster Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Upgrade fire alarm system from phone lines to cell communicator.
Contractor: JOHNSON CONTROLS SECURITY SOLUTIONS LLC Owner: LINCOLN CENTER LLC
6305 ROSEWOOD ST SUITE A BY SHORENSTEIN PROPERTIES LLC
LAKE OSWEGO, OR 97035 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 855-201-1482 PHONE:
FAX: 503-675-4412
FEES
Description Dale Amount
Specifics: Permit Fee-COM 09/07/2021 $64.54
12% State Surcharge-Building 09/07/2021 $7.74
Type of Use: COM Plan Review-Fire Life Safety-COM 09/07/2021 $25.82
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 09/07/2021 $1.50
Occupancy Grp: A-2 Height: ft 11x17)
Stories:
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: Alarm Type:
Pull Station Required: Smoke Detectors Reg:
Battery Calcs Provided: Cut Sheets Required: Yes
Total $99.60
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,000.00
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 rules
Issued By: Permittee Signature:
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 Applicati ECEI V ED E cl 12121
Fire Protection System toil olrlCl, USE ONLY
SEP 2 t. Received/� /�) ry�.7/
City of Tigard Date/B : / L Z/ Adie Permit N. •S 20!A tip /,
i • 13125 SW Hall Blvd.,Tigard,OR 971ZA"('Y OF 71UHNV Plan Review
Phone: 503.718.2439 Fax: 503.598.�j�6b Date/B : Other Permit:
TIGARI) Inspection Line: 503.639.4175 3UILDING DIVISION Date ReadyBy: n ,s ® See Page 2tor
Internet: www.tigard-or.gov NotifiediMethod: `� �V-!� �� Suppkmental Information
' Jr
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction El 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 OF CONSTRUCTION indicated on this application.
;._m _ .... _.:.
❑ I-and 2-family dwelling Valuation: $
®Commercial/industrial
Number of bedrooms:
ElAccessory building ❑Multi-family
CI builder ❑Other
Number of bathrooms:
OB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10330 SW GREENBURG RD New dwelling area: square feet
City/State/ZIP: PORTLAND,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: 2�c , 1_0 6 S'7 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
ESCRIPTION OF WORK work indicated on this application.
Valuation: $ 1000
upgrade existing FA system from phone lines to Cell communicator
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ® TENANT Number of stories:
Name: RED LOBSTER 0457 Type of construction:
Address: 10330 SW GREENBURG RD Occupancy groups: A2
City/State/ZIP: PORTLAND,OR 97223 Existing:
Phone:( ) Fax: ( ) New:
IIIIL0 APPLICANT ElCONTACT PERSON NOTICE
Business name: Johnson Controls Security Solutions All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
Tjy Helms under ORS 701 and may be required to be licensed in the
Address: 6305 SW Rosewood St. 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:( ) 971-294-1320 Fax: :( )
E-mail: Tjy.HelmsCJCI.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: Johnson Controls Security Solutions (Please refer ro fee schedule)
Permit fee:
Address: 6305 SW Rosewood St.
State surcharge(12%of permit fee):
City/State/ZIP: Lake Oswego,OR.97035 FLS plan review(40%of permit fee):
Phone:( ) 971-294-1320 Fax: ( ) (Due upon application submittal.)
CCB lic.: 197010 Total permit fees:
r Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Tjy Helms Date: 9/2/21 *
Fee methodology set by Tri-County Building Industry
Service Board.
U\Building\Pamirs\FPS-PermnApp 031016.doc 440-4613T(I 1l02/COM/WEB)
tare-4- • 9 47/ 6o (-4)
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: 1
® 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 a6:
Sprinkler Type ❑ \vet ❑ 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: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1000
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: $
1:\Building\Permits\FPS_Permitdpp_031016.doc 2
COPY RECEIVED
CityofTigard SEP 2 Lut' pf$Zp z r - 0010 1
g Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97224,1
• Phone: 503.718.2439 Fax: 503.598.1 TY OF 1IGARD Date Received: q/a/Z
Inspection Line: 503.639.4175 3UILDING DIVISION B 1'' Internet: www.tigard-or.gov y /43 D
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: RED LOBSTER 0457 Occupancy: A-2
Job Address: 10330 SW GREENBURG RD Suite:
Contractor: Johnson Controls SS Phone: 971-294-1320
Valuation of work: $ 1000
Changing Phone lines for
Type of System: (check one) ['Required ❑Non-required cell communicator
(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 5) /To be Relocated (max 51
Number of Proposed Manual Alarm Stations: To be Added (max 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) /To be Relocated(max 5)
Tjy Helms Oregon Construction Contractors Board No. 197010
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.
Tjy Helms Digitally signed by Tjy Helms C1
Signature: Date:2021.09.0209:02:39-07'00 Date: 912/21
Print Name: Tjy Helms
I:\Building\Forms\FireAlannAffidavit_071514.docx Page 1 of I
Dianna Ornelas
From: #Building Permit Technicians
Sent: Monday, September 6, 2021 9:24 AM
To: tjy.helms@JCl.com
Subject: FPS2021-00104 - 10330 SW Greenburg Rd - Red Lobster
Attachments: FPS2021-00104.pdf
Hello Tjy,
This permit is ready to issue and the balance due is$99.60(see attached invoice).
The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record
number FPS2021-00104 under the Building tab. Payment can be made by'card' for a 3%service fee or select the 'check'
payment option and there is no service fee.
Please email the permit technicians at TigardBuildingPermits(a tgard-or.gov once the fees are paid so that we can issue
the permit and make it available for pick up.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
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