Permit BUILDING PERMIT
IN CITY OF TIGARD
PERMIT #: BUP2007 -00656
COMMUNITY DEVELOPMENT DATE ISSUED: 1/17/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102 BA - 02000
SITE ADDRESS: 12353 SW GRANT AVE ZONING: R -4.5
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT: 045 JURISDICTION: TIG
PROJECT: GRANT STREET ELITE CARE
Project Description: Fire alarm.
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: 5 - HR : sf N: S: E: W:
OCCUPANCY GRP: SR1 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 394 BASEMENT: sf AREA SEP. RATED:
STOR: 3 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: N MEZZ ?: N REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:Y
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : Y HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: Y PARKING:
VALUE: $ 10,000.00
Owner: Contractor:
ELITE CARE CASCADE LIFE & SAFETY SYSTEMS INC
2300 SW 103RD 2701 22ND ST NE
PORTLAND, OR 97225 SALEM, OR 97302
Phone: 971-506-0151 Contact #: PRI 503 - 315 -2204
FAX 503 - 315 -9925
Reg #: LIC 121899
FEES
• Description Date Amount
REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 1/17/2008 $119.70
[TAX] 8% State Surcha 1/17/2008 $9.58
[FL,S] FLS PIn Rv 12/28/2007 $47.88
Total $177.16
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 -01 . You may obtain a copy
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
,� I ? ,
Issued By�. � Permittee Signatur� -
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.
1
Building Permit Application
On System ECOVED
Fire Protecti
� FOR OFFICE USE ONLY
`J g
City of Tigard Received i
�j
DateB : . .l Eno I / (/ wr / Permit ' / �fy�
IN of
? / /
q 13125 SW Hall Blvd., Tigard, OR 97 2. •k `t00� Plan Review ►
'
Phone: 503.639.4171 Fax: 503.598. i ` DateB : ` r / l 4 m• therPermit:
T I G A R D Inspection Line: 503.639.4175 Gip B E OF ri GARU Date Ready t y: lu ' . ® See Page 2 for
Internet: www.tigard - or.gov dJ E � { Notified/Method: ice /pi ' i l./ Supplement:) Information
DUI@. ®iNG 1 F`+ LY AO if • . ;
• TYPE OF WORK , . REQUIRED' A'
DATA: 1- eri 2 -FAMIL DWELLING
pe 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: Q - k- S',,,) C Q fr o v'T A QE... New dwelling area: square feet
City /State /ZIP: -- ric c2 As tit b QQ 07 — 72. �3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: E up L (J f .o ►( 2) 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.
F ( (L2 �� Ne M n •t' �� e M Valuation: $ I e , e'
1� J •T Existing building area: square feet
New building area: square feet
&PROPERTY OWNER ❑ TENANT Number of stories:
Name: I L k 7 (?.._ (e Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
[APPLICANT ❑ CONTACT PERSON NOTICE
Business name: CAP.....j,,,p& I4f.. s .,44---k-7 All contractors and subcontractors are required to be
Contact name: (< Qty Lf 0 o ( licensed with the Oregon Construction Contractors Board
n under ORS 701 and may be required to be licensed in the
Address: OC 70 i 2 Z -0 g S i jurisdiction in which work is being performed. If the
City /State /ZIP: S k(�(� M . _( 1 / &Q 2 applicant is exempt from licensing, the following reasons
l apply:
Phone: (c.. ) .I S " 2 2 a LI Fax:: giS) l l s-- ( Q Q 7 Z '
E -mail: ) 6 rvk ie c 0 c hse f LtfiSik-fk"rt r r'M
CONTRACTOR BUILDING:PERMIT FEES*
(Please refer to fee schedule)
Business name: c kSc Achz L vcc K T
L ✓ Permit fee:
Address: S td 1.<-, t.sC A)
City/State/ZIP: State surcharge (8% of permit fee):
FLS plan review (40% of permit fee): 0 y7 co
Phone: ( ) Fax: ( ) (Due upon application.) /
CCB lic.: u - 2 _ p d Z I N:4 3 1 :: : : ?5 Total permit fees: r'
• Authorized signature: Amount received: I ' ' $ 6
This permit application expires if a permit.is not obtained
Print name: I4 d UZ L.6h b fL Date: 11 / 49/0 —) 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 03/23/06 440- 4613T(11/02/COM /\NEB)
• \ 1
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.
El 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 "A Yes
include: Individual Component w4 Yes
Cut Sheets
Fire Alarm Project Valuation: $ j 000
.
,D.) R esidential 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 (8% 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.
I: \ Building \ Permits \FPS- PermitApp. doc 2
CITY OF TIGARD 4 . v,� ., B� X67- ® C)6S 6
1
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: .Ci
Phone: (503) 639 -4171 he Ilia
Inspection Requests (24 Hrs.): (503) 639 -4175 :_..
INSPECTION WORKSHEET FOR DATE: 7 "% ( /a e TIME: PAGE:
SITE ADDRESS: I - 2,.- j 1 3 (, f� CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: •
DESCRIPTION: •
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspectio eq�i t Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
(;.,. /3 vv.\ s
Corrections /Comments/ Instructions:
I \AI : ...), 3 \\
/ 7 -7-
PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
I FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
7/ moo
Inspector: �� Date: Phone #: (503) 718-
y
CITY OF TIGARD , 4
BUILDING DIVISION a PERMIT #: 1 B,)P2007 - 00656
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/17/2008
Phone: (503) 639- 4171 °� °��ii I
Inspection Requests (24 Hrs.): (503) 639 -4175 ' :_.. -'
INSPECTION WORKSHEET FOR DATE: 5/8/2008 TIME: 7:01AM PAGE: 53
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE E=XTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: Fire alarm. 5/7/08: Phase I West, Phase II East
OWNER: ELITE CARE, PHONE #: 971- 506-0151
CONTRACTOR: CASCADE LIFE & SAFETY SYSTEMS INC PHONE #: 603- 315 -2204
Inspection Request Scheduled For: Date: 502008 Pour Ti e:
ny
Code # Inspection Description Confirm # Contact # Mes• .. - I
998 Alarm final 069537-01 503 - 209.8850 S
c
Corrections /Comments /Instructions: 41'
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I I PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \✓ t Date:' / V 1 0 V Phone #: (503) 718 - f
CITY OF TIGARD
BUILDING DIVISION ... -. ( 1
PERMIT #: 5UP2007-00656
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/17/2008
Phone: (503) 639-4171 &84111101It
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 7/1512008 TIME: 7:00Afyl PAGE: .5
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE:
PROJECT NAME: GRANT STREET ELITE CARE
DESCRIPTION: Fir 6 alarm. 5/7/08: Phase I West, Phase II East
OWNER: ELITE CARE, PHONE #: 971-506-0151
CONTRACTOR: CASCADE LIFE & SAFETY SYSTEMS INC PHONE #: 503-315-2204
Inspection Request Scheduled For: Date: 7/150008 \1)41t/ Pour Time: 1 . 0
1 4 a
Code # Inspection Description Confirm # Contact # Mes : ge
299 Final inspection 072657-01 503-209-8850 N
_______-----..
Corrections/Commenj Instructions:
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El PASS f irA "' eTIAL APPROVAL n CANCEL fl NO ACCESS
fl FAIL CALL FOR INSPECTION 0 ADDITIONAL FEE ASSESSED
—
._,: 1 1 i 0 A A
Inspector: Date: 1 Phone #: (503) 718-
CITY OFTIGARD �,„„ Od
BUILDING DIVISION PERMIT #: BUP2007 -00666
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/17/2008
Phone: (503) 639 -4171 � uI�� I
Inspection Requests (24 Hrs.): (503) 639 -4175 �' °�
INSPECTION WORKSHEET FOR DATE: 5/7/2008 TIME: 7:00AM PAGE: 32
SITE ADDRESS: 12353 SW GRANT AVE CLASS OF WORK:
SUBDIVISION: GRANT AVE ELITE CARE EXTEND RE LOT #: 045 TYPE OF USE: •
PROJECT NAME: GRANT STREET ELITE. CARE.
DESCRIPTION: Fire alarm.
OWNER: ELITE CARE, PHONE #: 971 - 506.0151
CONTRACTOR: CASCADE LIFE & SAFETY SYSTEMS INC PHONE #: 603- 315 -2204
Inspection Request Scheduled For: Date: 5/712006 Pour Ti e: V'
Code # Inspection Description Confirm # Contact # Mes e
998 Alarm final 069481-01 503- 209.8850 Y
Corrections /Comments /Instructions:
❑ PASS n PARTIAL APPROVAL CANCEL n NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
bt,0 7- 6065
Fire
Record of Completion
Name of protected property:Elite Care at Fanno Creek
Address: 3''SW Grant Ave. 1 -353
City:Tigard State:OR Zip: 97223
Representative of protected property (name): Bill Reed (phone): 971 - 506 -9338
Authority having jurisdiction: City of Tigard (phone): 503 - 639 -4171
Address: 13125 SW Hall Blvd.
City: Tigard State: OR Zip: 97223
Organization name /phone Representative name /phone
Installer: Cascade Life Safety Systems, Inc. Ken Rutledge 503 315 -2204
Supplier: Silent Knight Customer Svc 800 - 446 -6444
Service organization: Cascade Life Safety Systems, Inc. Ken Rutledge 503 315 -2204
Location of record (as- built) drawings: Fire Alarm Room
Location of operation and maintenance manuals: Fire Alarm Room
A contract for test and inspection in accordance with NFPA standard (s)
Contract No(s): Effective date: Mit Expiration dater
System Software
(a) Operating system (executive) software revision level(s): N/A
(b) Site - specific software revision date:
(c) Revision completed by:
(Name) (Company)
L Type(s) of Systems or Service
NFPA 72, Chapter 6 — Local
If alarm is transmitted to location(s) off premises, list where received:
Target Alarm Center
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 center or others, indicate location
and telephone numbers of the organization receiving alarm:
❑ NFPA 72, Chapter 8 — Proprietary
Telephone numbers of the organization receiving alarm:
Alarm:
Supervisory:
Trouble:
If alarms are retransmitted to public fire service communications center or others, indicate location
and telephone numbers of the organization receiving alarm:
Indicate how alarm is retransmitted:
(NFPA 72, 2002 edition 1 of 6)
Fire'Alarm `ystem
Record of Completion
® NFPA 72, Chapter 8 — Central Station
Prime contractor:
Central station location:
Means of transmission of signals from the protected premises to the central station:
❑ McCulloh ❑ Multiplex ❑ One -way radio
® Digital alarm communicator ❑ Two -way radio El Others
Means of transmission of alarms to the public fire service communications center:
(a)
(b)
System location:
❑ NFPA 72, Chapter 9 — Auxiliary
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 system has been installed in accordance with the NFPA standards as shown below, it was inspected
by Ken Rutledge on 5 -7 -08, and this includes the devices shown in sections 5 and 6. This system has
been in service since
® NFPA 72, Chapters 1020 3111 4❑ 5 ❑ 6® 711I 8E1 9 ❑ 10 ❑ 11111 (check all that apply)
® NFPA 70, National Electrical Code, Article 760
® Manufacturer's recommendations
® Other (specify):
Signed: Date:
Organization:
3. Record of System Operation
Documentation in accordance with NFPA 72 Inspection and Testing Form, Figure 10.6.2.3 (2002 edition)
is included on page _ .
All operational features and functions of this system were tested by Ken Rutledge on 5 -7 -08, and
were found to be operating properly in accordance with the requirements of:
• NFPA 72, Chapters 10 2 ❑ 3111 4❑ 5 ❑ 6® 7❑ 8Z 9 ❑ io ❑ 11❑ (check all that apply)
NFPA 70, National Electrical Code, Article 760
® Manufacturer's recommendations
❑ Other (specify):
Signed: Date:
(NFPA 72, 2002 edition 2 of 6)
Fire' Ala rm'System
Record of Completion
Organization:
4. Signaling Line Circuits
Quantity and class of signaling line circuits connected to the system (see NFPA 72, table 6.6.1):
Quantity: 6 Style: Y Class: B
5. Alarm- initiating Devices and Circuits
Quantity and class of initiating device circuits (see NFPA 72, table 6.5):
Quantity: 2 Style: Y Class: B
MANUAL
(a) Manual stations Non -coded _ Transmitters Coded Addressable 8
(b) Combination manual fire alarm and guard's tour coded stations
AUTOMATIC
Coverage: ® Complete ❑ Partial ❑ Selective ❑ Non - required
(a) Smoke detectors _ Ion_ Photo _ Addressable 75
(b) Duct detectors _ Ion_ Photo Addressable
(c) Heat detectors FT RR _ FT /RR _ RC Addressable 7
(d) Sprinkler waterflow indicators: Transmitters _ Non -code _ Coded
Addressable 3
(e) The alarm verification feature is ® disabled ❑ enabled, and has been changed from _ seconds
to _ seconds.
(f) Other (list):
6. Supervisory Signal- Initiating Devices and Circuits ( useblanlstoindicatequanhityofdevioes)
GUARD'S TOUR
(a) _ Coded stations
(b) _ Non -coded 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:
(NFPA 72, 2002 edition 3 of 6)
Fire System
Record of Completion
h. ['Selector in auto position
i. ❑ Engine or control panel trouble
j. ❑ Fire pump running
6. Supervisory Signal- Initiating Devices and Circuits (continued)
ENGINE - DRIVEN GENERATOR:
(a) ❑ Selector in auto position
(b) ❑ Control panel trouble
(c) ❑ Transfer switches
(d) ❑ Engine running
Other supervisory function(s) (specify):
7. Annunciator(s)
Number: 2 Type: Alpha Numeric
Location(s): Main Entry both Sides
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 the system:
Quantity and the class of notification appliance circuits connected to the system (seeNFPA72, Tatb6.7j
Quantity: 6 Style: Y Class: B
Types and quantities of notification appliances installed:
(a) Bells _ With Visible
(b) Speakers _ With Visible
(c) Horns _ With Visible 24
(d) Chimes _ With Visible
(e) Others _ With Visible
(f) Visible appliances without audible: 12
9. Power Supplies
(a) Fire Alarm Control Panel: Nominal voltage: 120VAC Current rating: 3a
Overcurrent protection: Type: Breaker Current rating: 20a
Location: Garage
(b) Secondary (standby):
Storage battery type: Gel Cell Storage battery voltage: 12VDC
Total amp -hour rating: 18ah Calculated capacity to drive system, in hours: 24
Engine- driven generator dedicated to fire alarm system: N/A
Location of fuel storage: N/A
(c) Emergency system used as backup to primary power supply:
Emergency system described in NFPA 70, Article 700:
(NFPA 72, 2002 edition 4 of 6)
Fire Alarm System
Record of Completion
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: None
i)) 1‘-11 — 7/ IS
(Signed) fur installation cont ctor /supplier (title) (date)
"7 in 10,y
(Signed) .r alarm service company (title) (date)
(Signed) for central sta •on (title) (date)
Upon completio - he system(s) satisfactory test(s) witnessed (if required by the authority having
jurisdiction):
7// �v k"
(Signed) representative of the authority having jurisdiction (title) (date)
(NFP.4 72, 2002 edition 6 of 6)
,p.