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Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 11 11- COMMUNITY DEVELOPMENT Permit #: FPS2011 -00081 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06(28(2011 Parcel: 2S112DA01400 Jurisdiction: Tigard Site address: 6650 SW REDWOOD LN 220 Project: Archibald Subdivision: PACIFIC CORPORATE CENTER Lot: Project Description: Modification of (8) fire sprinkler heads for TI Contractor: DELTA FIRE INC Owner: PACIFIC REALTY ASSOCIATES 14795 SW 72ND AVE ATTN: N PIVEN PORTLAND, OR 97224 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 - 620 -4020 PHONE: FAX: 503 - 620 -1058 FEES Description Date Amount Specifics: Permit Fee - COM 06/28/2011 $64.54 12% State Surcharge - Building 06/28/2011 $7.74 Type of Use: COM Plan Review - Fire Life Safety - COM 06/28/2011 $25.82 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 $98.10 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $0.00 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 • if work is spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the 0 egon Utility Iotification Center. ' .:- les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtai a copy of th J rules or di ect questions to OUNC b, ailing 5e '32.1987 or 1.800.332.2344. / i Is ued By: Permittee Signature: ' Call 503.639.4175 by 7:00 a.m. for the next available inspe.' ion 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. r Building Permit Application ' Fire Protection System FOR OFFICE USE ONLY City of Tigard �,0 Received r' `� g Date /Bv: „ Permit No,: "* / 68/ • 13125 SW Hall Blvd., Tigard, OR !kl "*, + Plan Review Q�� r / �d Phone: 503.639.4171 Fax: 503.5' : 1? :1 6 DateBy: Other Permit: ( A !� TI G A R D Inspection Line: 503.639.4175 A Date Ready/By: Iuris: ® See Page t / for '/� Internet: w�w.ti d- or. gov \� f� t�^�� Notified/Method: Supplemental Information TYPE OF . e � ry � ? 1 . , . REQUIRED DAT4: 1= `AND.2 -F IILY DWELL ❑ New construction I iol t on Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all AAddition/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 I Commercial /industrial Valuation. S ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE LNFORMATION .AND. ` LOCATION . Total number of floors: Job site address: 6,( 50 ? 'v\E1 a 00e1 Lx New dwelling area: square feet ►, City /State /ZIP: MOAC t/\ - f M Of1 ), 1 � I la- ti Garage /carport area: square feet Idg. /apt. no.: 0 , l U'l Project name: to 0 6 i.L.- Covered porch area / square feet Cross street/directions to job site: ACCk 11001 T Q 1Q .},all Deck area: square feet t 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 ( rotnded 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. Valuation: s I VIA A 03 5 ' n r ,a � c T _. Existing building area square feet / New building area: square feet ❑ PROPERTY OWNER 0. TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New APPLICANT ❑ CONTACT PERSON . NOTICE,.• . • Business name:DetAt fi -roc. All contractors and subcontractors are required to be Contact name: rie4o c - - �� /��.� e; e � licensed with the Oregon Construction Contractors Board J 1J under ORS 701 and may be required to be lensed in the Address: , 4 7015 �` (, , 7 m t . . jurisdiction in which work is being performed. If the l V WW 1 n ^ applicant is exempt from reasons City /State/ZIP: OC'A _Vbild 09\. 93 Oman app licensing, g the following h. in Phone: (503 Gap 440 l (1 re Fax::( �503 l�it7 0 „ '05g E -mail: f (etoVi m f ^ r CONTRACTOR • BUILDPiG•PERO.IIT.FEES* Business name: -D f o s T,n e , (Ple6 e rejeiiofee schedn[e / ,,t� • Address: 1 �1 _l i J 1 vim► 'y ` . Permit fee: i ail 7 7 City /State/ "LIP: • � L � , ■ • � • State surcharge (12% of permit fee): '], 74 FLS plan review (40% of permit fee): A Phone: (5 r ' o p ,` - .111111110111M (Due upon application.) S '7 1 CCB lie.: go . Total permit fees: i 9,g , /0 t Authorized signature: / �� / l • nr Amount received: (0 - ( 0 � �a _� This permit application expires if a permit is not obtained Print name: a • ` ` •� ,Date: ,�� * within 180 days after it has been accepted as complete. Fee methodoloas set by Tri- County Buildine Industry Service Board. i/ Building \ Permits \FPS- PermitApp,doc 03/23/06 440- 4613T(11 /02 /COM1/WFB) City of - Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information , Describe work.to be done: i - 1.) ❑ New 2.) . Modification to. sprinkler heads only: ,tr' ddition X 1 -10 heads: No plan review required. K . Iteration ❑ 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 El Wet ❑ Dry . Additional Standpipes AVA Information: Hazard Group Lje- , i Density Design Area Gy(1O K. Factor j • Sprinkler'roject Valuation: $ B.) . Type - 1 - Hood Fire Suppression System Hood Project Valuation: $ I C.) Fire Alarm Submittal shall Battery Calculations ❑ Yes include: Individual Component ❑ Yes Cut Sheets Fire Alarm Project Valuation: $ 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): 1 $ . • . Permit fee based on project valuation (see fee schedule): $ Permit fee based on square footage (see D above): $ • State Surcharge (12% of permit fee): 1 $ . • FLS Plan Review (40% of permit fee): I $ 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 tire suppression engineer, or NICET level "3" technicians. i:\ B-uiiciing\ Permits\ FPS- PermicApp.doc 2 • FPs2o 11 .-o008 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 Parkway Center Address: 6650 SW Redwood Lane Description of property: PacTrust - Archibald Relocation LLC - Suite 220 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 arc 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. • I ta If Chapter 8, note the means of transmission from the protected premises to the central station: A Digital alarm communicator El McCulloh ❑ Multiplex ❑ 2 -way radio ❑ 1 -way radio El 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: 1 Style: / Class: 5 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 Watertlow 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 © 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 El 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 El 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 © 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 devi.tio rom refere ced NFPA standards: Signe �� Printed namer�1 fl � ( Date: --� 11 Organ i rn: 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): ❑ Documen atio in accordance with Inspection and Testing Form (Figure 10.6.2.3 of NFPA 72') is attached Sign • rt ! Printed name: C/e 0 C- 6€0... Date: 6 -ate II Organiz.ti' -n: 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 syste 3 as s ci fied herein has been installed and tested according to all NFPA standards cited herein. Sig i: I' (A��V Printed name k K.F�I 1 // Date: /9.0 / / • Organi.li 1 on: Stanley CSS Title: Field Service Technician Phone: 503 - 968 -3300 13.2 System Service Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Stanley CSS Title: Field Service Technician Phone: 503 - 968 -3300 • 13.3 Centr Station This sysi y i s specified htr in will be m' . • d according to all NFPA standards cited herein. Signed: �, ` Printed name: Gary Tauscher Date: 6/28/2011 Organization: St y 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.