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Permit
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT s COMMUNITY DEVELOPMENT Permit #: FPS2010 -00102 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010 Parcel: 2S112DA01400 Jurisdiction: Tigard Site address: 6650 SW REDWOOD LN 290 Subdivision: PACIFIC CORPORATE CENTER Lot: 0 Project: Fairway America Project Description: Add (3) horn strobes for TI Owner: FEES PACIFIC REALTY ASSOCIATES Description Date Amount 15350 SW SEQUOIA PKWY #300 Permit Fee - COM 09/14/2010 $77.99 PORTLAND, OR 97224 12% State Surcharge - Building 09/14/2010 $9.36 PHONE: 503 - 624 -6300 Plan Review - Fire Life Safety - COM 09/14/2010 $31.20 Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS INC 15495 SW SEQUOIA PKWY STE 100 PHONE: 503 - 968 -3353 FAX: 503- 968 -3398 Type of Use: COM Class of Work: ALT Type of Const: IIB Occupancy Grp: B Height: ft Stories: 3 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 $118.55 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: 0 Residential Square Footage: 0 Fire Alarm Valuation: 1500 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 - • o .ted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may ' bt- n a copy of the les or direct e . - ions o . - C by • 'n. 503.246.6699 or 1.800.332.2344. Issu :. By: , � � Permittee Signature: J _ CaII 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 R ECEIV EP FOR OFFICE USE ONLY 14 City of Tigard Dat Received • /4/ /O �� Permit No.: .. O/D --a) Pla Rev ° 13125 SW Hall Blvd. Ti ard OR 972. — .1. i� g 1 C Phone: 503.639.4171 Fax: 503.598.1 d c P 2010 Dat B : iew l� 11:M MA ether Permit: Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for T I G A It D Internet: www.tigard - or.gov CITY OF T Notified/Method: Supplemental Information BUII DING DI TYPE OF WORK 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: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 6650 SW REDWOOD LN New dwelling area: square feet City/State /ZIP: PORTLAND, OR 97224 Garage/carport area: square feet Suite/bldg. /apt. no.: 290 Project name: FAIRWAY AMERICA 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 THREE ADDITIONAL HORN STROBES TO EXISTING FIRE SYSTEM Valuation: $ / 500 Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: PACIFIC REALITY ASSOCIATES Type of construction: Address: 15350 SW SEQUOIA PARKWAY Occupancy groups: City /State/ZIP: PORTLAND, OR 97224 Existing: Phone: (503)624 -6300 Fax: (503)624 -7755 New: 0 APPLICANT ❑ CONTACT PERSON NOTICE Business name: STANLEY SECURITY SOLUTIONS All contractors and subcontractors are required to be Contact name: GARY TAUSCHER licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 15495 SW SEQUOIA PARKWAY, SUITE 100 jurisdiction in which work is being performed. If the City /State /ZIP: PORTLAND, OR 97224 applicant is exempt from licensing, the following reasons apply: Phone: (503) 968 -3355 Fax: : (503) 969 -3398 E -mail: . CONTRACTOR BUILDING PERMIT FEES* Business name: STANLEY SECURITY SOLUTIONS (Please refer to fee schedule) Permit fee: Address: 15495 SW SEQUOIA PARKWAY, SUITE 100 City /State /ZIP: PORTLAND, OR 97224 State surcharge (12% of permit fee): FLS plan review (40% of permit fee): Phone: (503) 968 -3355 Fax: (503) 968 -3398 (Due upon application.) CCB lic.: 161567 Total permit fees: Authorized signature: .g/.....„ , Amount received: This permit application expires if a permit is not obtained Print name: STEVE MOREHOUSE Date: 09 /14/2010 within 180 days after it has been accepted as complete. * Fee methodology set by Tri -County Building Industry Service Board. 11Building\Permits\FPS- PermitApp.doc 03/23/06 440- 4613T(1I /02/COM/WEB) 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.) Fire Alarm Submittal shall Battery Calculations ® Yes include: Individual Component ® Yes Cut Sheets Fire Alarm Project Valuation: $ / 500 • D.) Residential Sprinkler (Stand Alone System) Square Footage: Permit Fee: 0 to 2,000 $187.50 2,001 to 3,600 $232.50 3,601 to 7,200 $292.50 7,201 and greater $381.50 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. "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. C: \llocumcnts and Settings \gmt1026 \ My Documents \TIGARD FPS- PermitApp 6650 1 :DWOOD FAIRWAY AMERICA.doc • ° Building Division Over- The - Counter (OTC) Building Permit riGniiD Check List Description of Project: M—N1 _ GENERAL INFORMATION • Class of Work:* • t Floor Areas (sq. ft.): Exterior Wall Construction: Type of Use:* JO First floor: N: S: Type of Construction: ■ Second floor: E: W: Occupancy Group: Third floor: Openings Protected Y /N ?: Occupancy Load: G Total sq ft.: N: S: Stories: Note: Combine total floor area for E: E: Height: all floors above third floor and a Roof Construction: _ Floor Load: add to the third floor s . ft. Fire Retardant: Basement: Basement: Area Separation Rated: Mezzanine: Garage: Occu. Separation Rated: REQUIRED ITEMS Fire sprinkler: Y� Handicap access: f � j Smoke detector: Protected corridors: tl� -- Fire alarm: Parking spaces ( #): Notes: Total Valuation: $ 1 CO INSPECTIONS FEES DUE Footing /foundation Firewall $ , Permit Fee `'1 Post /beam structural Smoke detector $ . r1 State Surcharge Shear wall Misc. inspection $ -31, zp Plan Review Fee Masonry Approach /sidewalk $ FLS Plan Review Fee Framing $ Additional Permit Fee Insulation Sprinkler rough -in $ • Additional Plan Review Fee Gyp board Fire alarm $ Metro Construction Excise Tax Suspended ceiling Sprinkler final $ School Construction Excise Tax Final inspection $ Misc. Fee $ Hourly Rate Fee $ Hourly Rate State Surcharge $ Other: $ ( 0 , 5� Total Fees Due *OPTIONS: TYPE OF USE: COM = commercial; CMS = commercial manufactured structure. CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo; FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings or canopies); REP = repair. I: \Building \Forms \OTC- BUP.doc 08/19/08 IPSO (0 - 00( FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. 1. Protected Property Information Name of property: Pacific Corporation Center Address: 6650 SW Redwood Lane, Suite 290 Description of property: Fairway America Occupancy type: Name of property representative: Dennis Pagni Address: 15350 SW Sequoia Parkway #300 Phone: 503 -624 -6300 Fax: E -mail: Authority having jurisdiction over this property: City of Tigard Phone: 503 - 639 -4171 Fax: E -mail: 2. Fire Alarm System Installation, Service, and Testing Information Installation contractor for this equipment: _ Stanley Convergent Security Solutions Address: 15495 SW Sequoia Pkwy Ste. 100, Portland, OR 97224 • Phone: 5039683300 Fax: 5039683397 E -mail: Service organization for this equipment: Stanley Convergent Security Solutions Address: 15495 SW Sequoia Pkwy Ste. 100, Portland, OR 97224 Phone: _5039683300 Fax: 5039683397 E -mail: Location of as -built drawings: Location of Historical Test Reports: Location of system operation and maintenance manuals: A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Stanley Convergent Security Solutions Address: 15495 SW Sequoia Pkwy Ste. 100, Portland, OR 97224 Phone: 5039683300 Fax: 5039683397 E -mail: Contract expires: _ Contract number: • Frequency of routine inspections: — 3. Type of Fire Alarm System or Service NFPA 72 ® , Chapter Reference of System Type: Name of organization receiving alarm signals with phone numbers (if applicable): Alarm: Stanley CSS Phone: 8778990001 Supervisory: Stanley CSS Phone: 8778990001 Trouble: Stanley CSS Phone: 8778990001 Entity to which alarms are retransmitted: Phone: Method of retransmission of alarms to that organization or location: NFPA 72, Fig. 4.5.2.1 (p. 1 of 5) -Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. If Chapter 8, note the means of transmission from the protected premises to the central station: ❑ Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2 -way radio ❑ 1-way radio ❑ N/A If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system (executive) software revision level: - - - - Site - specific software revision date: - Revision completed by: 4. Signaling Line Circuits Characteristics of signaling line circuits connected to this system (see NFPA 72 Table 6.6.1): Quantity: Style: _ _ Class: 5. Alarm- Initiating Devices and Circuits Characteristics of initiating device circuits connected to this system (see NFPA 72 ® , Table 6.5): Quantity: _ _ Style: - _ Class: 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: - - Type of coverage: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.3 Heat Detectors Number of heat detectors: - - Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for seconds 6. Supervisory Signal- Initiating Devices and Circuits 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A NFPA 72, Fig. 4.5.2.1 (p. 2 of 5) Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 6.2 Fire Pump • Type of fire pump: ❑ Electric ❑ Diesel Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other:, 6.3 Engine - Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A ❑Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel Other: 7. Annunciators 7.1 Annunciator 1 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.2 Annunciator 2 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 8. Alarm Notification Devices and Circuits 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker zones: 8.2 Telephone Jacks Number of telephone jacks installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered ❑ N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system (see NFPA 72 ® , Table 6.5): Quantity: Style: Class: 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With visual device: Horns: With visual device: • Chimes: With visual device: Bells: With visual device: Visual devices without audible devices: Other (describe): • NFPA 72, Fig. 4.5.2.1 (p. 3 of 5) Copyright C 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 9. Emergency Control Functions Activated ❑ Hold -open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ❑ Elevator recall ❑ Other 10. System Power Supply 10.1 Primary Power Nominal voltage: Amps: _ Overcurrent protection: Type: Amps: Location (of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power Location: Type: Nominal voltage: Current rating: Number of standby batteries: Amp hour rating: Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: _ In alarm mode: 11. Record of System Installation Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.) NFPA 72 ® NFPA 70 ® , Article 760 ❑ Manufacturer's published instructions ❑ Other (please specify): System deviations from referenced NFPA standards: Signed: Printed name: Date: Organization: Stanley CSS Title: Fiels Service Technician Phone: 503 - 968 -3300 12. Record of System Operation All operational features and functions of this system were tested by or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of: ❑ NFPA 72 ❑ NFPA 70 ® , Article 760 ❑ Manufacturer's published instructions ❑ Other (please specify): ❑ Documentation in accordance with Inspection and Testing Form (Figure 10.6.2.3 of NFPA 72 ® ) is attached Signed: Printed name: Date: Organization: Stanley CSS Title: Field Service Technician Phone: 503 - 968 -3355 NFPA 72, Fig. 4.5.2.1 (p. 4 of 5) Copyright ® 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 13. Certifications and Approvals 13.1 System Installation Contractor This system as specif d herein has been installed and tested according to all NFPA standards cited herein. Signe Printed name: / 1 M, . c/�,,Qt — Date: /O- 6 0 Organization: Stanley CSS Title: Fiels Service Technician Phone: 503 - 968 -3300 13.2 System Service Contractor This s as specified erein h een installed and tested according to all NFPA standards cited herein. Signed: ' ( Printed name: -Th , ( 1 Ca"4 D a Date: /0' ( O Organization: Stanley CSS Title: Field Service Technician Phone: 503 - 968 -3300 13.3 Centr: Station This syst yes specified e in will be mo r d according to all NFPA standards cited herein. Signed: Ira L inted name: Gary Tauscher Date: Organization: St ey CSS Title: Operations Manager Phone: 503 - 968 -3355 13.4 Property Representative I accept thi system ash. ing been installed and tested to its specifications and all NFPA standards cited herein. Signed: 1 J�' Printed name: V ( . WILL' Date: I c9 2,0 1 U Organization: , A ,r Title: J��� Phone: (, 6 - 13.5 Authority Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, its approved sequence of operations, and with all NFPA standards cited herein. Signed: _ Printed name: _ Date: Organization: Title: Phone: NFPA 72, Fig. 4.5.2.1 (p. 5 of 5) Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.