Permit •
CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2009 -00095
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/02/2009
Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD, STE# 750
Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
Project: Western Architectural
Project Description: TI
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Permit Fee - COM 06/02/2009 $176.90
CALIFORNIA ST 49TH FL 12% State Surcharge - Building 06/02/2009 $21.23
PHONE: Plan Review 06/02/2009 $114.99
Plan Review - Fire Life Safety 06/02/2009 $70.76
Contractor:
RUSSELL CONSTRUCTION INC
20915 SW 105TH AVE
TUALATIN, OR 97062
PHONE: 503 - 228 -4898
FAX: 503 - 228 -2770
Specifics:
Type of Use: COM
Class of Work: ALT
Dwelling Units: 0
Stories: 7 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $18,000
Floor Areas:
Total Area: 0
. Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $383.88
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors: No
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other ap•licable law. All work will
be done ' ccor•a • - with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is su %ended for more the 188
days. TTENTION: Ore• •n law 'quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules e - t forth in OAR
952 01 -0010 through OA' : 2 -0.1 • •0. You may obtain a copy of the rules or direct questions to OUNC by calling 503 4:.6• •9 or 1.8(4 2344.
. mirk
lssu d By: / oi Pe rmittee Signature: ,
• Call 503.639.4175 by 7:00 a.m. for an inspection that bu Mess da
This permit card shall be kept in a conspicuous place on the job site until comple o, of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial FOR OFFICE USE ONLY
City Of Tigard Date / / PermtNO 9 ECE R IE I SW Hall Blvd., Tigard, OR 9 3 "� Plan Revie �!• k
• Phone: : 503.639.4171 Fax: 503.598.19f v f Date/B : ,1
• Other Permit:
TIGARD Inspection Line: 503.639.4175 N o LUU Date Ready :y: Juris: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
:- z :. h ^ ` xm.;�t�� -..�;; -� ... ^o.�IS � "� " � '�':$
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..... 4._.. e._: 44'4% 4.44. ., '4 ' . ...,4__..3. _ ... ..._ _ _R EQUI R ED DATA. t . AND 2 A 4 D , W
❑ 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
6 ' TEGORX� F CONSTRLIGT-ION g t work indicated on this application.
CA
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $
❑ Accessory building Li Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
number of T t 1 b
J,OB SITE = FORMATIONn=AiVD ` l OCATIOIV o a o floors:
Job site address: 5 Lincoln-18100-SW Greenburg Rd New dwelling area: square feet
City/State /ZIP: Portland, OR 97223 . ' Garage /carport area: square feet
Suite/bldg. /apt. no.: 750 • Project name: Western Architectural Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
- REQ7IRED :DATA: COMMERCIAL- USE CHECKLIST`
�. - IS .
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, overhead, and the profit for the
ipment, matena s, labor, overhe d a e o
r
DESCRIP'I70N�OF& WORKS '�' ��. ' work indicated on this application.
Interior Tenant Improvement Valuation: $18,000
Work to include minor demolition, new walls. new doors and relites Existing building area: 7,630 square feet
•
New building area: square feet
PROPERTY 'OWNER � W R T•,ENF 1 Number of stories: 7
Name: Shorenstein Type of construction: I -B
Address: One SW Columbia Street, Suite 300 Occupancy groups:
City /State /ZIP: Portland, OR 97258 Existing: B
Phone: (503)412 -4906 Fax: (503)412 -4848 New:
2114 LIC�ANT Mjele PERSO . N®TIGE = . Y .
Business name: Group Mackenzie All contractors and subcontractors are required to be
Contact name: Morgan Toth licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1515 SE Water Ave Suite 100 jurisdiction in which work is being performed. If the
City/State/ZIP: Portland, OR 97214 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9560 Fax: : (503) 228-1285
E -mail: mtoth @grpmack.com
..,r e01\T1ie1CTOK� :m���
,
Business name: Russell Construction - W iIN ' "`BI7IBDING PERMIT FEES* �
Address: 20915 SW 105th Ave I f , s �Q'1 ase -r ro (e schedirtrj . a . 1
Structural plan review fee (or deposit):
City/State /ZIP: Tualatin, OR 97062
FLS plan review fee (if applicable):
Phone: (503) 228 -4898 Fax: (503) 228 -2770
CCB lie.: 58918 Total fees due upon application:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
•
Print name: Kim Ford Date: 06/02/09 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
I: \Building\Permits\BUP -COM PermitApp.doc 2/23/07 440- 4613T(11/02/COM /WEB)
FUNDAMENTAIS OF FIRE ALARM SYSTEMS 72 -
FIRE ALARM SYSTEM
RECORD OF COMPLETION
Name of protected propert WESTERN ARCHITECTURAL - SUITE 750
Address: 10200 SW GR)'ENBURG ROAD
Representative of protected property (name /phone): SHORENSTEIN
Authority having jurisdiction: CITY OF TIGARD
Address /telephone number: 13125 SW HALL BLVD. 503- 718 -2424
Organization name/phone Representative name phone
bistaller SAFE TECHNOLOGY GR( 360 - 699 -2130
Supplier SAFE TECHNOLOGY GR( 360- 699 -2130
Service organization
Location of record (as- built) drawings: FACP
Location of operation and maintenance manuals: FACP
Location of test reports: CENTRAL STATION
A contract for test and inspection in accordance with NFPA standard(s)
Contract No(s): Effective date: _ Expiration date:
System Software
(a) Operating system (executive) software revision level(s):
(b) Site - specific software revision date:
(c) Revision completed by:
(name) (firm)
1. Type(s) of System or Service
x NFPA 72, Chapter 6 — Local
If alarm is transmitted to location(s) off premises, list where received:
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 centers or others, indicate location and telephone
numbers of the organization receiving alarm:
Indicate how alarm is retransmitted:
NFPA 72, Chapter 8 — Proprietary
Telephone numbers of the organization receiving alarm:
Alarm:
Supervisory:
Trouble:
If alarms are retransmitted to public fire service communications centers or others, indicate location and telephone
numbers of the organization receiving alarm:
Indicate how alarm is retransmitted:
X NFPA 72, Chapter 8 — Central Station
Prime contractor: SIMPLEX/GRINNELL
Central station location: 1- 888 - 746 -7539
(NFPA 72, 1 of 4)
FIGURE 4.5.2.1 Record of Completion.
2002 Edition
72 - NATIONAL FIRE ALARM CODE
Means of transmission of signals from the protected premises to the central station:
McCulloh Multiplex One -way radio
X Digital alarm communicator Two -way radio 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 i nstallation is complete and wiring is checked for opens, shorts, ground faults, and improper branching,
hut prior to conducting operational acceptance tests.)
This system has been installed in accordance with the NFPA standards as shown below, was inspected by
ADAM SWEET on 6 -26 -09 , includes the devices shown
in 5 and 6, and has been in service since 6 -26 -09
X N F P A 72, Chapters 1 2 ( 'X * 10 11 (circle all that apply)
X NFPA 70, National Electrical Code, Article 760
X Manuf'acturer's instructions
Other (specify):
Signed: ADAM SWEET Date: 6 -26 -09
Organization: SAFE TECHNOLOGY GROUP
3. Record of System Operation
Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3, is attached
All operational features and functions of this system were tested by ADAM SWEET date 6 -26 -09
and found to be operating properly in accordance with the requirements of:
X NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 g) 11 (circle all that apply)
X NFPA 70, National Electrical Code, Article 760
X Manufacturer's instructions
Other (specify):
Signed: ADAM SWEET Date: 6 -26 -09
Organization: SAFE TECHNOLOGY GROUP
4. Signaling Line Circuits
Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
Quantity: Style: Class:
(NFPA 72, 2 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
•
FUNDAMENTALS OF FIRE ALARM SYSTEMS 72 -
5. Alarm- Initiating Devices and Circuits
Quantity and class of initiating device circuits (see NFPA 72, Table 6.5):
Quantity: Style: Class:
MANUAL
(a) Manual stations Noncoded Transmitters Coded Addressable
(b) Combination manual fire alarm and guard's tour coded stations
AUTOMATIC
Coverage: Complete Partial
Selective Nonrequired
(a) Smoke detectors Ion Photo Addressable
(b) Duct detectors Ion Photo Addressable
(c) Heat detectors FT RR FT/RR RC Addressable
(d) Sprinkler waterflow indicators: Transmitters _ Noncoded Coded Addressable
(e) The alarm verification feature is disabled or enabled , changed from _ seconds to seconds.
(f) Other (list):
6. Supervisory Signal- Initiating Devices and Circuits (use blanks to indicate quantity of devices)
GUARD'S TOUR
(a) Coded stations
(b) Noncoded 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:
(el Fire pump power
(f) Fire pump running
(g) Phase reversal
Engine - driven fire pump:
(h) Selector in auto position
(ii Engine or control panel trouble
(j) Fire pump running
. ENGINE - DRIVEN GENERATOR:
(a) Selector in auto position
(b) Control panel trouble
)c) Transfer switches
(dl Engine running
Other supervisory function(s) (specify):
(NFPA 72, 3 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
72-34 NATIONAL FIRE ALARM CODE
7. Annunciator(s)
Number: Type: Location:
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 system:
Quantity and the class of notification appliance circuits connected to system (see NFPA 72, Table 6.7):
Quantity: 1 Style: Class: B
Types and quantities of notification appliances installed:
(a) Bells With Visible
(b) Speakers With Visible
(c) Horns 6 With Visible 6
(d) Chimes With Visible
(e) Other: With Visible
(f) Visible appliances without audible: 1
9. System Power Supplies
(a) Fire Alarm Control Panel: Nominal voltage: 120VAC Current rating: 6A
Overcurrent protection: Type: BREAKER Current rating: 20A
Location: ELECTRIC ROOM
(b) Secondary (standby):
Storage battery: 2 Amp -hour rating: 7 A
Calculated capacity to drive system, in hours: 24
Engine- driven generator dedicated to fire alarm system:
Location of fuel storage:
(c) Emergency system used as backup to primary power supply:
Emergency system described in NFPA 70, Article 700:
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:
ADAM SWEET VICE PRESIDENT 6 -26 -09
(signed) for installation contractor /supplier (title) (date)
(signed) for alarm service company (title) (date)
(signes or central station (title) (date)
U .impletion of the sy - . s) .atisfactory test( s) witnessed (if require by the authority havin: 'urisdic 'on):
G e,
r) representa r,(e the authority having jurisdiction date)
(NFPA 72, 4 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
'PI _ " Building Division
Over- The - Counter (OTC) Building Permit
TIGARD
Check List
Description of Project: TI
GENERAL INFORMATION
Class of Work:* : S7 1 Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* First floor: N: S:
Type of Construction: I Second floor: E: W:
Occupancy Group: S Third floor: Openings Protected Y /N ?:
Occupancy Load: - j Total sq ft.: N: ' S:
-7 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 s . ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
REQUIRED ITEMS
Fire sprinkler: YE- Handicap access:
Smoke detector: Protected corridors: on
Fire alarm: ` k S Parking spaces ( #):
Notes:
Total Valuation: $ , t ()CO
INSPECTIONS FEES DUE
Footing /foundation Firewall $ ' r Permit Fee
Post /beam structural Smoke detector $ , 2... State Surcharge
Shear wall Misc. inspection $ ' ,' Plan Review Fee
Masonry Approach /sidewalk $ 70 r . 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:
$ 3, es 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