Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I COMMUNITY DEVELOPMENT Permit#: FPS2022-00088
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/9/2022
Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 250
Project: CFG Subdivision: METZGER,TOWN OF
Lot: 9
Project Description: Fire alarm permit-install(3)new 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 06/08/2022 $69.92
12%State Surcharge-Building 06/08/2022 $8.39
Type of Use: COM Plan Review-Fire Life Safety-COM 06/08/2022 $27.97
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 06/08/2022 $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 $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 . : 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.
is 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.
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Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Tigard RECEIVEDDate/By:Received 4 r� 171.
PennitNo. 00088
13125 SW Hall Blvd.,Tigard,OR 97223 MAY y FPS20ZZ-
26 ��� Plan Review .I/ Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
ll/J/
t I It 1� Inspection Line: 503.639.4175 �I t l OF TIGARD Date Ready/ y: p/2g rj� Ions la See Page 2 for
Internet: www.tigard-or.govNotified t d: 6 LL- '/ �� Supplemental Information
lU1LQ1N.G_ 1.ISION � G c '
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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I-and 2-family dwelling ElCommercial/industrial Valuation: $
ElAccessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 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.:250 Project name:CFG 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: $$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:( ) 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:
Phone:( ) Fax::( )
E-mail: Sl'1411e Cepax . corn
CONTRACTOR BUILDING PERMIT FEES*
Business name:Capitol Electric Company,Inc. (Please refer to fee schedule)
Permit fee: 69.92
Address: 11401 NE Marx Street
City/State/ZIP:Portland,OR 97220 State surcharge(12%of permit fee): 8.39
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: 106.28
Authorized signature: ` — .
Amount received:
This permit application expires if a permit is not obtained
Print name:Shane Tercek Date:5/26/22 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS•PermitApp_031016.doc 440-4613T(11/02/COM/W EB)
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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 0 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 0 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)
sa
Square Footage: Permit lice:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
ij 7,201 and greater $404.39
`! Sprinkler Project Square Footage: I sq. ft.
fi
Fire Protection Permit Fees
Project valuation subtotal (see A, B& C above): $ 1200
Permit fee based on project valuation (see fee schedule): $ 69.92
,Ez Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $ 8.39
rl FLS Plan Review (40%of permit fee): $ 27.97
TOTAL: $ 106.28
Q:\Fire Alarm\FA Jobs\zz220920-45 CFG @ 21,250\job info\1 FPS_PermitApp 2017.2126.doc
' City of Tig13125 SW Hallard
vdaTigard,OR 97223 E C E I V E DPermit No.: FP/SZO22 8u
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 6/.26/.Z0�
Inspection Line: 503.639.4175 MAY 2 6 202? ! ,y��►
1 1 c'A R U Internet: www.tigard-or.gov By: G(/ ?7 i t
CITY OF TIGARD
FIRE ALARM SYSITENCIWEIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS) -
Project Name: CFG Occupancy: B
Job Address: 10220 SW Greenburg Road Suite: 250
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 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) 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: "
5 �"'�` Date: 5/26/22
Print Name: Shane Tercek
l:\Building\Forms\FireAlarmAffidavit_071514.docx Page 1 of 1