Permit Ni CITY OF TIGARD
FIRE PROTECTION SYSTEM PERMIT
t n
` COMMUNITY DEVELOPMENT Permit #: FPS2010 -00053
Date Issued: 05/25/2010
.ilti•GASEkti 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135A603400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Subdivision: LINCOLN TOWER Lot: 0
Project: Axiom EPM
Project Description: Fire alarm
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
Permit Fee COM 05/25/2010 $102.20
CALIFORNIA ST 49TH FL 12% State Surcharge - Building 05/25/2010 $12.26
PHONE: Plan Review - Fire Life Safety - COM 05/25/2010 $40.88
Houlry Building Rate 05/25/2010 $180.00
Contractor: Hourly Building 12% State Surcharge 05/25/2010 $21.60
SAFE TECHNOLOGY GROUP INC
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360 - 699 -2130
FAX: 360- 719 -1527
Type of Use: COM
Class of Work: ALT Type of Const: IIB
Occupancy Grp: B Height: ft
Stories: 12
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm Svstem:
Fire Alarm Required: Yes Alarm Type: Automatic
Pull Station Required: Yes Smoke Detectors Req: No
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Tota $356.94
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 2800
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 No • - . on Cen - . hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir- questions to OUNC • ing 503.246.6699 or 1.800.332.2344.
Iss ed By: / / , Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 FOR OI FICC USL Oi LY
i
u 9 ECEVED carved �
City of Tigard Dat B 6- /i / Permit No 131 25 SW Hall Bd. Tard P lan R 1W�®
Other Permit:
71
P hone: 503.639.4171 Fax: 503.598.196 D ateB : ` ��j e?O SS
�' ° NIAY 1 1 2010 � �O � �
T v R D I nspec ti on Line: 503 .639.4175 Date Reat : y: ® Page 2 for formation
IGA Notified/Method. • (0 Supplemental In
Internet: www.t or.gov Noti
CITY OF TIGARD 1.1/ ft
• TYPE OF WADING DIVISION REQUIRED DATA: 1- 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
® 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: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10260 SW Greenburg Rd New dwelling area: square feet
City /State /ZIP: Tigard OR Garage /carport area: square feet
Suite/bldg. /apt. no.: 710 Project name: Axiom Covered porch area: square feet
Cross street/directions to job site: Lincoln Tower 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.
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.
Fire alarm Valuation: $52,800.00
Existing building area: 9000 square feet
New building area: 0 square feet
❑, PROPERTY OWNER ❑' TENANT Number of stories: * g
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing: B
Phone: ( ) Fax: ( ) New: B
® APPLICANT 0 CONTACT PERSON NOTICE
Business name: Safe Technology Group Inc. All contractors and subcontractors are required to be
Contact name: Jason Sweet licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6400 NE Hwy 99 Suite G375 jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: Vancouver WA 98665
apply:
Phone: (360) 699 -2130 Fax: : (360) 719-1527
E -mail: sales @safetechnology.net
CONTRACTOR - BUILDING PERMIT FEES*
(Please refer ro fee schedrrle)
Business name: Safe Technology Group Inc.
Permit fee:
Address: 6400 NE Hwy 99 Suite G375
State surcharge (12% of permit fee):
City /State /ZIP: Vancouver WA 98665 0
FLS plan review (40% of permit fee):
Phone: (360) 699 -2130 Fax: (360) 719 -1527 (Due upon application.)
CCB lic.: 173731 Total permit fees:
Authorized signature:
'I ‘T/' Q� Amount received: �.---"---
ff This permit application expires if a permit is not obtained
Print name: Jason Sweet Date: 5 -6 -10 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.doc 10/01/09 440- 4613T(1l /02/COM/WEB) *5:3-9-
FPS.2010 uous3
FUNDAMENTALS OF FIRE ALARM SYSTEMS 72 -
FIRE ALARM SYSTEM
RECORD OF COMPLETION
Name of protected property: kl (�
Address: it. cZ• • ,
•
Representative of protected property (naine /phone):
Authority having jurisdiction:
Address /telephone number:
j Organization name/phone Representative name !phone
Installer n l• • • •1.
Supplier 1 _ r +��
Service organization 1
Location of record (as- built) drawings: S i
Location of operation and mai tenancemanuals: S
Location of test reports: -
A contract for test and inspection in accordance with NFPA standard(s)
Contract No(s): Effective date: Expiration date:
System Software
(a) Operating system (executive) software- revision level(s):
(b) Site-specific software revision date:
(c) Revision completed by:
(name) (firm)
1. Type(s) of System or Service
NFPA 72, Chapter 6 — Local
If alarm' is transmitted to location(s) off premises, list where received:,
NFPA 72, Chapter 8 Remote. Station
Telephone numbers of the organization receiving alarm:
Alarm:
Supervisory:
Trouble:
If alarms are retransmitted to public fire service communications centers or others, indicate location and telephone
numbers of the organization.receiving alarm:
Indicate how alarm is retransmitted:
NFPA 72, Chapter 8— Proprietary
Telephone numbers of the organization receiving alarm:
Alarm:
Supervisory:
Trouble:
If alarms are retransmitted to public fire service communications centers or others, indicate location and telephone
numbers of the organization receiving alarm:
Indicate how alarm is retransmitted:
__,NFPA '72, Chapter 8 — Centra Station
Prime: contractor: S '...n _ i
Central station location:
(NFPA 72, 1 of 4)
FIGURE 4.5.2.1 Record of Completion.
2002 Edition
72 - NATIONAL FIRE ALARM CODE
Means of transmission of signals from the protected premises to the central station:
McCull'oh Multiplex One -way radio
Digital alarm communicator Two -way radio Others
Means of transmission of alarms to the public fire service communications center:
(a)
(b)
System location:
NFPA 72, Chapter 9 — Auxillary
Indicate type of connection: Local energy Shunt Parallel telephone
Location of telephone number for receipt of signals:
2. Record of. System Installation
(Fill out after installation; is complete and.wiring is checked for opens, shorts, ground faults, and improper branching,
but prior to conducting operational acceptance tests.)
This sy m as been installed in accordance with the NFPA standards as shown below, was inspected by
P ry on 5 -,2 l /b , includes the devices shown •
in 5 and 6, and has been in service since 6 " ? -/0 .
NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 10 11 (circle all that apply)
NFPA 70, National Electrical Code, Article 760
"Manufacturer's instructions
Other (specify):
Signed: Date: 2Y-
Organization:
3. Record of System I peration
Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3, is attached
All operational features and functions of this system were tested by date
and found to be operating properly in accordance with the requirements of:
NFPA 72, Chapters 1 2 3 4 5 6 7 8 10 11\ (circle all that apply)
Y NFPA 70, National Electrical Code, Article 760
Y Manufacturer's instructions
Othe ecif ):
Signed: -S vGt w� -� . Date: ,� - 2 I -y
'1 b
• Organization: _ r
4. Signaling Line Circuits
Quantity and•class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
Quantity: Style: Class:
(NFPA 72, 2 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
FUNDAMENTALS OF FIRE ALARM SYSTEMS 72 -
5. Alarm- Initiating Devices and Circuits.
Quantity and ,class initiating device circuits (see NFPA 72, Table 6.5):
Quantity: Style: Class:
MANUAL
(a) Manual stations Noncoded Transmitters C oded Addressable
(b) Combination manual fire.alarm and guard's tour coded stations
AUTOMATIC
Coverage: Complete - . Partial
Selective Nonrequired
(a) Smoke detectors Ion Photo Addressable
(b) Duct detectors Ion Photo Addressable
(c) Heat detectors FT RR FT/RR RC Addressable
(d) Sprinkler waterflow'indicators: Transmitters Noncoded. Coded Addressable
(e) The alarm verification feature is disabled or enabled , changed from . seconds to seconds.
(f) Other (list):
6., Supervisory Signal- Initiating Devices and Circuits (use blanks to indicate quantity of devices)
GUARD'S TOUR
(a) Coded stations
(b) Noncoded stations
(c) Compulsory guard's tour system comprised of transmitter stations and intermediate stations
Note: Combination devices are recorded under 5(b), Manual, and 6(a), Guard's Tour.
SPRINKLER SYSTEM
Check if provided
(a) Valve supervisory switches
(b) Building temperature points
(c) Site water temperature points
(d) Site water supply level points
Electric fire pump:
(e) Fire pump power
(f) Fire pump running
(g) Phase reversal
Engine - driven fire pump:
(h) Selector in auto position
(i) Engine or control panel`trouble
(j) Fire pump running
ENGINE - DRIVEN GENERATOR:
(a) Selector in auto position
(b) Control panel trouble
(c) Transfer switches
(d) Engine running
Other supervisory function(s) (specify):.
(NFPA 72, 3 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
-r.
72 -34 NATIONAL FIRE ALARM CODE
7. Annunciator(s)
Number: Type: Location:
8. Alarm Notification Appliances and Circuits
NFPA 72, Chapter 6 — Emergency Voice /Alarm Service
Quantity, of voice /alarm channels: Single: Multiple:
Quantity of speakers installed: Quantity of speaker zones:
Quantity of telephones or telephone jacks included in system:
Quantity and the class of notification appliance circuits connected to system (see NFPA 72, Table 6.7):
' Quantity: _ ,Style: Class:
Types and quantities of notification appliances installed:
(a) Bells With Visible
(b) Speakers With Visible
(c) Horns With Visible
(d) Chimes. With Visible /
(e) Other: S With Visible
(f) Visible appliances without audible: .
' 9. System Power Supplies
(a) Fire Alarm Control Panel: Nominal voltage: Current rating:
Overcurrent protection: Type: Current rating:
Location:
(b) Secondary (standby):
Storage battery: Amp -hour rating:
Calculated capacity to drive system, iri hours:
Engine- driven generator dedicated to fire alarm system:
Location of fuel storage:
(c) Emergenc•system used as backup to!primarypower supply:
Emergency system described in NFPA 70, Article 700:
10. Comments
Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s):
System deviations from the referenced NFPA standard(s) are:
-.2 7 -/
(signed) for inst., lation on /supplier (title) (date)
(signed) for alarm ervi e co pany (title) (date) '
(signed) for central station (title) (date)
Upon completion of the system(s) satisfactory test(s) witnessed (if required by -the authority having' jurisdiction):
(signed) representative of the authority having jurisdiction (title) (date)
(NFPA 72, 4 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
4 -
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe:work to be done _
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
® Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of. System (Complete A; B, C or D as applicable): .
•
A.) Commercial Sprinkler •
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I Hood. Fire Suppression System .
Hood Project Valuation: $
•
C:) FireAlarm
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 2800
•
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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
\ \ Safcservcr \dS \ SAFE \ Forms \Use these forms \Permit Apps \ Tigard \FPS- PcrmitApp.cbe 10/01/09