Permit � q CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I a COMMUNITY DEVELOPMENT Permit#: FPS2022-00011
Date Issued: 1/20/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 304
Project: Variant Investments Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire alarm permit-relocate(3)fire alarm devices.AFFIDAVIT 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 01/20/2022 $69.92
12%State Surcharge-Building 01/20/2022 $8.39
Type of Use: COM Plan Review-Fire Life Safety-COM 01/20/2022 $27.97
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 01/20/2022 $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: Yes Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
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 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: Edgaroto-Ma-L4o .ado- Permittee Signature: ye,e- ar-p(,i,cc t ovi.
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
Fire Protection System ,'l fR I FOR OFFICE I NI.O\1,1
City of Tigard JAN Date/By: bl/10 202Z ��� Permit NoPP 2022'C V/f
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review I n
•
Phone: 503.718.2439 Fax: 503.598.196 ,,-- /(. �y, Date/By: /Vry Other Perr p,�2J—00293
Inspection Line: 503.639.4175 �' 4 dy y: Ions: ® See Page 2 for
'�I�i'DL Date Rea B jj�� qq��,,
TI G A R D Internet: www.tigard-or.gov ntfiLC *: ra ;�,iN Notified/Meth4V1/L.(//� Supplemental Information
Yt '
"� d
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 New construction 0 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.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
Number of bedrooms:
❑Accessory building 0 Multi-family
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10300 SW Greenburg Road (1 Lincoln) New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:304 Project name:Variant TI 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: l Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: 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: $1,200.00
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name:Shorenstein Realty Services Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:1 1 New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
y:
Phone:( ) Fax::( )
I/-mail:
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Capitol Electric Company,Inc.
Permit fee: 69.92
Address: 11401 NE Marx Street
State surcharge(12%of permit fee): 8.39
City/State/ZIP:Portland,OR 97220 0
FLS plan review(40%of permit fee): 27.97
Phone:(503)255-9488 Fax:(503)255-1966 (Due upon application submittal.)
CCB lie.:48748 Total permit fees: 10 7$
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name:Shane Tercek Date: 1/20/22 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
r.\Building\Permits\FPS-PermitApp_03t016.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 ® 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: $ 1,200
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): $ 1,200
Permit fee based on project valuation (see fee schedule): $ 69.92
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $ 8.39
FLS Plan Review (40%of permit fee): $ 27.97
TOTAL: $ 106.28
Q:\Fire Alarm\FA Jobs\zz220177-45 Variant TI @ 1I,302\job info\1 FPS_PemvtApp 2017.0126.doc
City of Tigard R I .. Permit No.: FPS O2- OW t I
1111 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960JAN 2 0 822 Date Received: 0( ZO/2O2 -
InspectionLine: 503.639.4175 OF �� �(j�
116 n RI) Internet: www.tigard-or.gov Cl i f TOM BY: / (20
BultDNG DIVIS C
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS CC)"
OF 5 DEVICES WITHOUT PLANS)
Project Name: Variant TI Occupancy: B
Job Address: 10300 SW Greenburg Road Suite: 304
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 IDBoth
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 (max 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) /To be Relocated(max 5) 3
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: "'`�' Date: 1/20/22
Print Name: Shane Tercek
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