Permit ' CITY OF TIGARD BUILDING PERMIT
: �'� PERMIT #: BUP2007 -00634
COMMUNITY DEVELOPMENT DATE ISSUED: 1/3/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S101AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY ' /2X ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT: JURISDICTION: TIG
PROJECT: BENEFICIAL LIFE INSURANCE
Project Description: Fire alarm for TI
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 30 BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : Y HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 3,000.00
Owner: Contractor:
PACIFIC REALTY ASSOCIATES STEELHEAD TECHNOLOGIES INC.
15350 SW SEQUOIA PKWY #300 -WMI 11600 SW HAWTHORN ST
PORTLAND, OR 97224 PORTLAND, OR 97216
Contact #: PRI 503 - 910 -9440
Phone: FAX 503 - 585 -4474
Reg #: LIC 168965
FEES
REQUIRED ITEMS AND REPORTS
Description Date Amount
[BUILD] Permit Fee 12/13/2007 $69.65
[TAX] 8% State Surchart 12/13/2007 $5.57
[FLS] FLS Pin Rv 12/13/2007 $27.86
Total $103.08
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 than 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 -0100. You may obtain a ••py of these rules or direct questions to OUNC by
calling5. ••• or 1.81 e .332.2344.
\ /
7
Issu d By: k 0 / 4 ��9� PermitteeSignature: Al � 0r
7
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.
. aaJE C LIFE 1 -°t' &S
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Fire Protection. System AD*
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Bit'>t�c ing Permit Application OFFICE USE ONLY •
/� �� � Received �� � i
II city of Tigard ECM! ' �" DateB : ,/"� 61 ;Mr
Permi tNo.: // I mot/" MY
13125 S W Era11 Blvd:; Tigard, OR 9722 c � Plan Review
3.. Phone: 503:639.4171 Fax: 503:598.1960 DEC 3 LOO? DateBy. ,ilk} t / 11 Other P• it:
T f G,t'� D Inspection Line: 503.639 t �® Date ReaddyBy: 3 hJ See Page 2 for
Internet: www.tigard- or.gov C1TV Or 1 l' � N otifi .,, thod: , a Supplemental Information
glli:�lct�i�h /S1° ' / � /u 1i�'•
TYPE OF WORK / IIEQUI' DDATA: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: 12909 SW 68 Parkway New dwelling area: square feet
City /State/ZIP' Tigarg; OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no .9010 } Project name: Benefical Life Ins. Co. 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: I 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.
Relocation -of notification devices) as per print due to Tl Valuation $ 3 0
Existing building area: square feet
New building area: square feet
❑ PROPERTY. OWNER - • • - C} TENANT Number of stories:
Name: PacTrust Properties Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
Q 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: ( ) I Fax:: ( )
E -mail•
CONTRACTOR' BUILDING PERMIT FEES*
(Please refer to fee acherlule)
Business name: Steal-lead Technoligies Inc
Permit fee:
Address: 11600 SE.11awthorn -St
State surcharge (8% of permit fee):
City /State /ZIP: Portland; OR97216 °
FLS plan review (40% of permit fee):
Phone: (503) 910 -9440 I Fax: (503) 585 -4484 (Due upon application.)
CCB lic.: 168965 Total permit fees: � f
Authorized signature: Amount received: / D 2 j e Q b
This permit.applicatio .ezpires if a perms is - not obtained
111'Z within 18Odays after ithas been accepted as complete.
Print name: Robert•Binkley. Date:.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: I31JP2007- 00634
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 113/2008
Phone: (503) q39-4171 , d iI1 A k
Inspection Requests (24 Hrs.): (503) 639 - 4175 ,,-.I.) - F''!±
INSPECTION WORKSHEET FOR DATE: 1/1 008 TIME: 7:O2AM PAGE: 8
SITE ADDRESS: 12909 SW 69TH PK1Wi CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: BENEFICIAL LIFE INSURANCE
DESCRIPTION: Fire alarm tor TI
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: STEELHEAD TECHNOLOGIES INC. PHONE #: 503. 910.9440
Inspection Request Scheduled For: Date: 1/18/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Messa. -
M1
993 Alarm final 063539.01 603- 956-6290
Corrections /Comments/ Instructions:
a
1
S , 'i APPRO IF ❑ CANCEL ❑ NO ACCESS
❑ FAIL /4 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ( /eq 647 Phone #: (503) 718- Z" y
LI
FIRE ALARM INSTALLATION CERTIFICATE 3
After completion of an installation, modification, or addition of a system or single station detector (excluding a one
or two family residence) the licensee shall complete and present this certificate to the owner or their representative Iv
or post the certificate near the main control panel according to the Fire Alarm Rules 28TAC §34.817 CO
DISTRIBUTION: Original to owner or posted on site at control panel. Copy 1 to main authority having 0
jurisdiction. Copy 2 Certifying firm to retain in their office for access by AHJ m
Property Name: , `r ,i..7 (. C T 4 Type of installation: The system complies with the following codes and standards. O
CO
Bldg. or Floor No.: ti/r fe 00 - Rev Q � Z!> T New Code or Std Year/Edition Code or SW Year/Edition ••
Street: 7/4274." w' Modification NFPA 72 IBC / IFC J
City /Zip. IX... f ° dr r , , , Addition NFPA 70
Name of CERTIFYING Iirm: f / e --/-e.(� NFPA 101
City / Slate / Zip: k✓ t 110f je Name of nearest Fire Department:
Phone Number: .$Z 3 -- 7/c2 -V y yV X3
Fire Department (non - emergency) Phone: O
ACR-
Emergency Phone Number: tD
1
SYSTEM INFORMATION c*
Control Panel Manufacturer: /1 /vey U.do' Model 5 Ji•• /C Other: CO
ChecJ all the applicable system types below that were installed by the above certifying firm or the system types) In which the firm made modifications or additions. 7
�! Fire Alarm/Evacuation _Fire Detection _ Smoke Damper Control Sprinkler System Supervision — F
Voice Notification _ Elevator Control HVAC Control/Shutdown _
_ Magnetic Door Holder/Release N
INITIATING DEVICES INITIATING DEVICES NOTIFICATION APPLIANCES SUPERVISORY DEVICES CIRCUIT STYLE CIRCUIT STYLE/CLASS
T • ., Quantity Type Quantity Type Qua T1• = Quantity Quantity Quantity
Smoke Detectors UV/IR Bell, Horn or Chime - Valve Tamper Switches SLC 4 NAC Y or B
Heal Detectors i Isolation Modules Strobe High / Low Air Pressure SLC 6 NAC Z or A
Duct Smoke Detectors Kitchen Suppression Speaker Fire Pump - SLC 7
Beam Smoke Detectors Sprinkler Flow Switch Hom/Chime/Strobe ,l, IDC A
Fire Alarm Boxes Gas Fire Protection Syst. Speaker Strobe �f IDC B
Fire Phones JU
Annunciation Panel
m
RECORD DRAWINGS Record Drawings (One with original planner's signature.) 43
Company lAtT /dsf / /o, aril c .r Instructions describing, operation, test & maintenance /'� r
City / State ,e/0 r f/,..✓d � r? information to aid in establishing an Emergency Evacuation Plan R E! _ E I V E ® m
,Q r„
Planner's Name f,} /, re
( S ck The above required documents were supplied to: V ® m
License Num. PE or APS _ 7 /,.2 y Person's name:
Date on Plan / / (S`
O 7 _ Company's name: JAN 2 8 2008 - J
/ i
Revision number /date ` 7 t,7 Date:
trl
1 hereby certify, on behalf of the registered certifying firm, that this fire alarm system has been tested and complies CITY OF TIGARD
BUILDING DIVISION (j
with the requirements of NFPA -72 Fire Alarm Rules, the applicable codes and standards
and the manufacturer's Installation requirements. C.,)
Signature of Licensee: - License Number: '7 � S'( Fl --
Printed name of Licensee: -,l / > /. -4 Date signed :: / SFO35 Rev. 01/08 FML-009A W