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Permit N CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 7,1 - COMMUNITY DEVELOPMENT Permit #: FPS2010 -00151 , TiQARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2010 Parcel: 2S112DC00500 Jurisdiction: TIGARD Site address: 15895 SW 72ND AVE 250 Project: Diagnostic Male Medical Subdivision: OREGON BUSINESS PARK 111 Lot: 40 Project Description: Fire alarm modification, install (1) strobe and (2) additional horn strobes. Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS IN( Owner: PACIFIC REALTY ASSOCIATES 15495 SW SEQUOIA PKWY STE 100 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 PORTLAND, OR 97224 PHONE: 503 - 968 -3353 PHONE: 503 - 624 -6300 FAX: 503 - 968 -3398 FEES 1 Description Date Amount Specifics: Permit Fee - COM 12/03/2010 $69.92 12% State Surcharge - Building 12/03/2010 $8.39 Type of Use: COM Plan Review - Fire Life Safety - COM 12/03/2010 $27.97 Class of Work: ALT Type of Const: Occupancy Grp: Height: ft 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: Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $106.28 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 No' tenter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or dir questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ) Is ued By: , :):‘, Al , - /� Permittee Signatur ! Cali 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 ECEVE , • Fire Protection System .,-FOR OFFICEEUSE City of Tigard DEC 2010 Received � � PennitNo.: 1 �- '', 13125 S50 Hall Blvd., Tigard, OR 97223 Plan Review , � P� �Q A, Phone: 503.639.4171 Fax: 503.598.196� OF TIGARD Plan R : pint Other Permit I Inspection L ine: 503.639.4175 BUILDING DIVISION Date Ready /A •. Juris: El See Paget for TIGA Internet www.tigard or.gov Notified/Method: Supplemental Information '- Ft' ° TYPE OF WORK REQUIRED5DATA 1 A1VD FAMILY DWELLING ' ❑ 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. Valuation: $ ❑ I- and 2- family dwelling ® Commercial /industrial Number of bedrooms: ❑ Accessory building ❑ Multi- family ❑ Master builder ❑ Other: Number of bathrooms: ~ JOB SITE INFORMATION AND LOCATION a, ' -. Total number of floors: Job site address: 15895 SW 72ND New dwelling area: square feet City /State /ZIP: PORTLAND, OR 97224 Garage /carport area: square feet Suite/bldg. /apt. no.: 250 Project name: DIAGNOSTIC MALE MEDICAL C Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet ... QU RCIA ST ,REIIiED: DATA : USECHECKLIST 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. INSTALL ONE STROBE AND TWO ADDITIONAL HORN STROBES TO EXISTING Valuation: $ / I aoe FIRE SYSTEM Existing building area: square feet — New building area: square feet ® y:TENANT' Number of stories: -- r ®. PROPERTY OWNER . ? , a . .; . 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 , ,^ F� CON'I'ACT PERSON'::: < .: � 1 ; ` ° � , • . APPLICANT:.4 "° "` ,. .,: � e • Business name: STANLEY SECURITY SOLUTIONS All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Contact name: GARY TAUSCHER 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 applicant is exempt from licensing, the following reasons City /State /ZIP: PORTLAND, OR 97224 apply: Phone: (503) 968 -3355 Fax: : (503) 969-3398 E -mail: :. d v § �� 2 �. 'lots Y L rBULLDING PERMIT FEES* `. , • CONTRACTOR - `; �. z > ... - - (Ple ase r t o fee schedule1, Business name: STANLEY SECURITY SOLUTIONS Permit fee: Address: 15495 SW SEQUOIA PARKWAY, SUITE 100 State surcharge (12% of permit fee): City /State /ZIP: PORTLAND, OR 97224 FLS plan review (40% of permit fee): Phone: (503) 968 -3355 Fax: (503) 968 -3398 (Due upon application) Total permit fees: CCB lic.: 161567 / Amount received: (D .c? Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: STEVE MOREHOUSE Date: 12/03 /2010 * Fee methodology set by Tri -County Building Industry Service Board. I: \Building\Permits \FPS- PermitApp.doc 03/23/06 440- 4613T(1I/02 /COM/WEB) City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Des'c ' wor o be .done { .x: " .. , 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 Sy "stem (Complete`A, B, C or Dias applicable) , ' rr A) Commercial Sprinkler �' a _ « Wet ❑ Dry Additional Standpipes Information: Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B') Type I - .I= Iood`rFire S "uppressigri System _ , . " Hood Project Valuation: $ v ., P 'a. xj tr Fire Alarm - R Submittal shall Battery Calculations ® Yes include: Individual Component ® Yes Cut Sheets Fire Alarm Project Valuation: $ - . �� . d 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 . a r" 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: \Documents and Settings \gnnt1026 \My Documents \TIGARD FPS- PennitApp 158952)1 AGNOSTIC MAIL; MEDICAL CTR.doc Building Division Over- The - Counter (OTC) Building Permit TIGARD Check List Description of Project: T1 GENERAL INFORMATION Class of Work:* tT Floor Areas (sq. ft.): Exterior Wall Construction: Type of Use:* ' First floor: N: S: Type of Construction: Second floor: E: W: Occupancy Group: � Third floor: Openings Protected Y /N ?: Occupancy Load: -- Total sq ft.: N: S: Stories: Note: Combine total floor area for E: E: Height: — all floors above third floor and Roof Construction: Floor Load: add to the third floor sq. ft. Fire Retardant: Basement: Basement: Area Separation Rated: Mezzanine: Garage: Occu. Separation Rated: REQUIRED ITEMS Fire sprinkler: Handicap access: Smoke detector: Protected corridors: Fire alarm: Parking spaces ( #): Notes: Total Valuation: $ FCC, C - INSPECTIONS FEES DUE Footing /foundation Firewall $ Permit Fee Post /beam structural Smoke detector $ State Surcharge Shear wall l\lisc. inspection $ 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: $ /06 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 r[�S / o en /S 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: Oregon Business Park III Address: 15895 SW 72 Ave, Suite 250 Description of property: Diagnostic Male Center 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 © 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 4' , 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 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: 4 /A' Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired ((( 'partial area lit-N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter qN /A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: k Type of coverage: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ TransmitteeN /A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelect is 5.2.3 Heat Detectors Number of heat detectors: q A' Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequire partial area ll1 /A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter '.Al( 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: /1- Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter 11N 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: / /1 Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter di NFPA 72, Fig. 4.5.2.1 (p. 2 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. 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: o Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.2 Annunciator 2 ❑ Local ❑ Remote Type: 0 Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.3 Annunciator 3 ❑ Local ❑ Remote Type: o 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: 3 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 ® 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 ❑ 1 -told -open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking El 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 ratio 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: - - - - - -- -- - - - - -- - - ----- L/� -- - � � - - - - -- --- - - - - -- - - - -- - - -- Signed: � ���' - ' Printed name: , 6 • C Date: 12/29/2010 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* El 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 NEPA 72 *) is attached Signed. ,• r . Printed name: X r� � t •�C.ek Date: 12/29/2010 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 specified herein has been installed and tested according to all NFPA standards cited herein. Signed: [l /I r�Jr►ri ' �/ Printed name:4 4 66 - ,9 L 4L4cR. Date: 12/29/2010 Organization: S anley CSS Title: Fiels Service Technician Phone: 503 - 968 -3300 13.2 System Service Contractor This system .s s.ecified her i has been installed and tested according to all NFPA standards cited herein. Signe f)►pi///t , Printed name: / G , ei,cci Date: 12/29/2010 Organization: Stanley CSS Title: Field Servi e Technician Phone: 503 - 968 -3300 13.3 Central Station This sy4 as spe i fed herein wi monitored according to all NFPA standards cited herein. Signe* i Printed name: Gary Tauscher Date: 12/29/2010 Organization: Stanley CSS Title: Operations Manager Phone: 503-968-3355 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: _ Title: Phone: 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