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n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
a COMMUNITY DEVELOPMENT Permit#: FPS2022-00007
Date Issued: 1/12/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 545
Project: Gallagher Bassett Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire alarm permit-install(2)smoke detectors&relocate another.AFFIDAVIT SUBMITTED.
Contractor: POINT MONITOR CORPORATION Owner: LINCOLN CENTER LLC
5863 LAKEVIEW BLVD STE 100 BY SHORENSTEIN PROPERTIES LLC
LAKE OSWEGO, OR 97035 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 01/12/2022 $123.72
12%State Surcharge-Building 01/12/2022 $14.85
Type of Use: COM Plan Review-Fire Life Safety-COM 01/12/2022 $49.49
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 01/12/2022 $0.50
Occupancy Grp: 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: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $188.56
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $4,820.00
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: Qw A
N0-Wd Va.w De,Wege,
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 g
Fire Protection System n `
RE '^'D
Received
City of Tigard 0I 12/201.. Permit No.:Fps2022. 7
ry Date/By: i
11 _ 13125 SW Hall Blvd.,Tigard,OR 97223 l hA l j 1 ( LC� Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
l I C,,It 1� Inspection Line: 503.639.4175 r� t r. or, Date Ready/By:/� ��//��� luris: ® See Page 2 for
Internet: www.tigard-or.gov �I l MARL)aARU Notified/Methe�t/�L)7' t/w Supplemental Information
ul_t::)'}( °NISI CIA , ST abh
TYPE OF WORK REQUIRED DATA:I-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
ElAddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
CI1-and 2-family dwelling ❑✓ Commercial/industrial Valuation: $
❑Accessory building El Multi-familyNumber of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION ANI) LOCATION Total number of floors:
Job site address: 10220 SW Greenburg Rd New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: 545 Project name: Gallagher Bassett Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW Washington Square Rd Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: l 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.
Parts and Smarts/Willamette Electric to do Install Valuation: $ 4820.00
Add 2 smoke detectors&relocate another Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER El TENANT Number of stories:
Name: Gallagher Bassett/Three Lincoln Center Type of construction:
Address: 10200 SW Greenburg Rd Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Suite 545 Existing:
Phone:( ) Fax:( ) New:
El APPLICANT 0 CONTACT PERSON NOTICE
Business name: Point Monitor All contractors and subcontractors are required to be
Contact name: Kristin Jones licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 5863 Lakeview Blvd Unit 100 jurisdiction in which work is being performed.If the
City/State/ZIP: Lake Oswego, Oregon 97035 applicant is exempt from licensing,the following reasons
g apply:
Phone:(503 )627.0100 Fax::( )
E-mail: KJones@Pointmonitor.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:Point Monitor (Please refer to fee schedule
Permit fee:
Address: 5863 Lakeview Blvd Unit 100
State surcharge(12%of permit fee):
City/State/ZIP: Lake Oswego, Oregon 97035 FLS plan review(40%of permit fee):
Phone:(503 )627.0100 Fax:( ) (Due upon application submittal.)
CCB lie.: 135901 Total permit fees:
oipitanysiy.eatvKris,in.ro.es Amount received:
Authorized signature: Kristin Jones hws uS,E•kpnw�pointmonflor corn,CN•Kris,in
o.,..xoss.m.,o,o:oz.e-oeov This permit application expires if a permit is not obtained
Print name: Kristin Jones Date: 01.10.22 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS-PermilApp fl031016.doc 440-4613T(11/02/COM/WEB)
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 0 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 0 Wet 0 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 0 Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
I Square Footage: Permit Fee:
0 to 2,000 $198.75
MN 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: $
I:A Building\Permits\FPSUPermitApp O31016.doc 2
City of Tigard EC !VC Permit No.: FPS2O22.-GX,O7
13125 SW Hall Blvd.,Tigard,OR 9722133
Phone: 503.718.2439 Fax: 503.598.1960 jpy .1 1 2522 Date Received: 'CN 11 I /2022-
Inspection Line: 503.639.4175 ,y-�
T I G A R D Internet: www.ti and-or. ov TIGARDBy:
Cl Y OF 71 C 4Rh
g g Gr cif
IIUUILCiNG DIVIS'O4.1
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS Ct ®"
(MAXIMUM OF 5 DEVICES WITHOUT PLANS) O'
Project Name: Gallagher Bassett Occupancy:
Job Address: 10220 SW Greenburg Rd Suite: 545
Contractor: Point Monitor Phone: 503.627.0100
Valuation of work: $4,820.00
Type of System: (check one) *Required [Non-required
(check one) nAutomatic ❑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) 2 /To be Relocated (max 5)
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) 2 /To be Relocated (max 5) 1
I Kristin Jones Oregon Construction Contractors Board No. 135901
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.
Digitally signed by Kristin Jones
Signature: Kristin Jones DNC=US,E=kjones@pointmonitor.com,CN=Kristin Jones 01.10.22
Date:2022.01.07 12:47:45-08'00' Date:
Print Name: Kristin Jones
I:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1