Permit II
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
`� = COMMUNITY DEVELOPMENT Permit#: FPS2021-00089
T t t.A R 013125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/29/2021
Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD S640
Project: Spec Space Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire alarm permit-install(2)fire alarm notification devices.AFFIDAVID SUBMITTED.
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX ST 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 08/03/2021 $59.16
12%State Surcharge-Building 08/03/2021 $7.10
Type of Use: COM Plan Review-Fire Life Safety-COM 08/03/2021 $23.66
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 08/03/2021 $0.50
Occupancy Grp: B 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 Req:
Battery Calcs Provided: Cut Sheets Required:
Total $90.42
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $800.00
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: Ho.l Ly v -De,Wege Permittee Signature: Qvt/Appkiza,tio-o.
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 Application _1 27/2
Fire Protection System R RECEIVED FOR OFFICE USE ONLY"
11111 City of Tigard r� Received h¢Q3 � �� Permit No.:F� �Q'j�f
JUL t 2011 Date/By: (/o' //
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie�yrp
Phone: 503.718.2439 Fax: 503.598.1 Date/By: 6l Other Permit:
Inspection Line: 503.639.4175 `mil t 1 �F -f�A�� Date Ready/By: Tuns:
Tl(;AR1� pEl See Page2for
Internet: www.tigard-or.gov 3UILDING DIVISION, NotiSewmethow 4`Cv IT& Supplemental Information
1,404.
TYPE OF WORK DIVISION ,_' ram_ q/ 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
®Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling ®Commercial/industrial Valuation: $
ElAccessory building ❑Multi-family Number of bedrooms:
El Master builder ID Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10220 SW Greenburg Road (2 Lincoln) New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:640 Project name:VSP 640 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.
Install fire alarm devices per submitted plans. Valuation: $800.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER 0 TENANT Number of stories:
Name:Shorenstein Realty Services Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON t
NOTICE
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::( )
Email:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Capitol Electric Company,Inc.
Permit fee: 59.16
Address: 11401 NE Marx Street
City/State/ZIP: Portland,OR 97220 State surcharge(12%of permit fee): 7.10
FLS plan review(40%of permit fee): 23.66
Phone:(503)255-9488 Fax:(503)255-1966 (Due upon application submittal.)
CCB lie.:48748 Total permit fees: 89.92
Authorized signature: �Q.
Amount received:
This permit application expires if a permit is not obtained
Print name:Shane Tercek Date:7/27/21 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1.\Building\Permits\FPS-PermitApp_031016.doc 4404613T(1 I/02/COM/WEB) 1
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: 2
® 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
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: $
C.) Fire Alarm
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 800
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): $ 800
Permit fee based on project valuation (see fee schedule): $ 59.16
Permit fee based on square footage(see D above): $
State Surcharge (12% of permit fee): $ 7.10
FLS Plan Review(40%of permit fee): $ 23.66
TOTAL: $ 89.92
Q:\Fire Alann\FA Jobs\zz211118-45 VSP 640 @ 2L\job info\1 FPS_PemvtApp 2017.126.doc
Capitol
Electric Co. Inc. RECEIVED
JUL. 2 7 2021
vITY OF TIGARO
July 27, 2021 'MOLDING DIVISION
Plans Examiner
City of Tigard
Building Services
13125 SW Hall Blvd.
Tigard, OR 97223
Re: Affidavit-Tenant Fire Alarm System Additions
VSP 640 @ 2 Lincoln
10220 SW Greenburg Road
Tigard, OR 97223
Please find attached a building permit application, a fire alarm affidavit, and an area of
work plan for the fire alarm tenant improvements at the address shown above.
Occupancy Group: B
The fire alarm system design includes the following:
1. Install (2) ADA synchronized fire alarm notification devices in the tenant space.
2. We will pre-test the fire alarm devices prior to requesting a final fire alarm
inspection.
Please contact me if you have questions or comments.
Respectfully,
Shane Tercek
Project Manager/Estimator
Fire/Life Safety Division
Capitol Electric Company, Inc.
(503) 262-0405 Direct
shane@cepdx.com
NICET Level III, Fire Alarm Systems #140599
11401 NE Marx Street- Portland, Oregon 97220-1041 - 503-255-9488 - Fax 503-257-7121
CCB#48748 -www.capitolelectricco.com
w
City of Tigard RECEIVED
q Permit No.: FPS202( 00089
13125 SW Hall Blvd.,Tigard,OR 97223 JUL 2 7 20[1
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 07/2 7/,202/
Inspection Line:Internet www.tigard-or.gov CITY OF TIGARD By: Cirri Of . )
tIG,1111)
3UILDING DIVISION
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS COfFICE
IPV
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: VSP 640 Occupancy: B
Job Address: 10220 SW Greenburg Road Suite: 640
Contractor: Capitol Electric Co., Inc. Phone: 503-255-9488
Valuation of work: $800
Type of System: (check one) (Required I—Non-required
(check one) FlAutomatic riManual RBoth
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 5)
Number of Proposed Manual Alarm Stations: To be Added (max5) /To be Relocated (max5)
Number of Proposed Notification Appliances: To be Added (max 5) 2 /To be Relocated (max 5)
1, 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: `t7 �`'""" � Date: 7/27/21
Print Name: Shane Tercek
1:\Building\Forms\FireAlarmAffidavit 071514.docx Page 1 of 1