Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
11-1 2 COMMUNITY DEVELOPMENT Permit #: FPS2012 -00023
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/22/2012
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 555
Project: West Coast Careers Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Relocating (2) horn strobes.
Contractor: COCHRAN INC Owner: LINCOLN CENTER LLC
7550 SW TECH CENTER DR. #220 BY SHORENSTEIN PROPERTIES LLC
TIGARD, OR 97223 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 -234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Permit Fee - COM 02/22/2012 $51.09
12% State Surcharge - Building 02/22/2012 $6.13
Type of Use: COM Plan Review - Fire Life Safety - COM 02/22/2012 $20.44
Class of Work: ALT Type of Const: Info Process /Archiving - Lg $2.00 (over 02/22/2012 $6.00
Occupancy Grp: Height: ft 11x17)
Stories: Houlry Building Rate 02/22/2012 $180.00
Hourly Building 12% State Surcharge 02/22/2012 $21.60
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 $285.26
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $500.00
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 wor. 's not starte. • in 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires . • w the ules adopt d b• the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 95 001 -0090. •u may opy o he rules
or direct questio by ca ' g 503.232.1987 or 1.800.332.2344. 4111111
Issued By: Permittee Signature:
AMO
Call 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
Fire Protection System RECEIVED FOR OFFICE USE ONLY
Received ` ^ ^ � /Li ,. /n
City of Tigard Dat : RA � Permit No.: /,"J /IO'
III 13125 SW Hall Blvd., Tigard,OR 97g D Plan Review
2 Phone: 503.718.2439 Fax: 503.59 .86
8119 2 2 2012 Date/B : i , � Other Permit:
TIGARD Inspection Line: 5013.639.4175 Date Ready/By. 63 See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
RI III DING DIVISION
TYPE OF WORK REQUIRED DATA: I- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees' are based on the value of the work performed.
Indicate the value (romded 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: $
ID Accessory building ❑ Multi- family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: ' 6 3 0 0 514 G' ^Q Fet.i. \1 Q CI V.2D New dwelling area: square feet
City/State /ZIP: l'A L� 0 ,4- #. 2..p b 9 _ � Garage /carport area: square feet
Suite/bldg. /apt. no.: ' Project name: a � — � � 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 (romded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
1. -I'S __) \f`..A 0 f,-, (Am Vic. Pzrt b f.� Valuation: $
1 ✓1Ld Existing building area square feet
1
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stones:
Name: .. t V 6-`,■ . Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( )
New:
❑ 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 lensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR BUILDING PERMIT FEES"
Business name: n N 2 '___1 � (2 ` (Please refer to fee schedule)
Address: ,' 1 rte. Permit fee: �
`^'� ‘2.1 Ve- State surcharge (12% of permit fee): ( 13
City/State/ZIP: --�, A 2r) ES f2--. FLS plan review (40% of permit fee):
Phone: (s r2 3 A 6. S .1.rr Fax: ( ) (Due upon application.) �d ' y �><��
S' 6
CCB lic.: 1 Z Total permit fees:
Authorized signature: r �
Amount received: �,
+mot 1 This permit application expires if a permit is not obtained
Print name: �C�� � �'� M (Z l I V �� I Date: � 1 9 ` \ M ithin 180 days alter it has been accepted as complete.
vv 11 d -L • Fee methodology set by Tri -County Building Industry
Service Board.
I:\ Building \Permits\FPS- PermitApp.doc 02/01/2011 440-4613T(11 /02/COM/WEB)
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.
❑ 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 - 1 "
Information: Hazard Group f •
Density . f . _ ,
Design Area
K. Factor
Sprinkler ProjectValuation: $
B.) Type I - 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 $ •
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 • • $246:45
3,601 to 7,200 $310.05
•_ 7,201 and greater - $404.39 •
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,(12% of permit fee): $
• FLS Plan Review (40 %'of.permit fee): $ ' •
TOTAL: $ • . •
Plan review requires -a completed application and three (3) sets of plans at submittal. -
Plan review fees are required at submittal. • ..
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I:\ Building \Permits \FPS - PermitApp.doc 02/01/2011 - •' i2
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FIRE ALARM SYSTEM RECORD OF COMPLETION
To be completed by the system installation contractor at the time of oetem acceptance and approval.
1. Protected Property Information
Name of property: lel un.
Address: L ()IC C r etr T...( s_7_22:3
. , Description of property:
Occupancy type: :13 ( i'vte 5 5 C lvid e
Name of property representative: . Sl 0 -c 5 l e, R.c gift( Sr ftli :T.. S
Address: _17.- C? .5 (A) 6- 62ee4412_14._t jf.1_20Affsate
Phone: Fax: E-mail:
Authority having jurisdiction over this property: __kJ 7 of
Phone: Fax: E
2. Fire Alarm System Installation, Service, and Testing Information
A bista dd l r l em ation fe contracto n r for (. t&opvio t4 i e. I . 06c 972 ,44 •
Phone: fn -205 -lac/ 2- Fax: E-mail:
Service organization for this equipment: 3
Address: 6___Irac 1.0 kl< ow C L.,.j eV( T I p4- 13- .1,0A t . c'. o4
Phone: 5 5143 -qa a 0 Fax: TO ' V 675 E-mail: q 703 5
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:
Address:
Phone: Fax: 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: C-e 4-vvx g #erini •
Name of organization receiving alarm signals with phone numbers a (applicable):
Alarm: Adve, , 3 9re i-ce,tvi Phone: • 5 2.. 55S - /3 1 3 -
Supervisory: ( Phone: I . _.. .. •
Trouble: t I 1 Phone: I 1
Entity to which alarms are retransmitted: Phone: •
Method of retransmission of alarms to that organization or location:
•
NH 72, Fig. 4.5.2.1 (p. 1 of 5)
Copyright 02009 National Fire Protection Assodalion. This Inn may be copied for InrivIdual use other than for resale. tt may not be meted for commercial sate or dtranbution.
01 17:49:41 03 -07 -2012 3/6
If Chapter 8, note the means of transmission from the protected premises to the central station:
[9Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2 -way radio ❑ 1 -way radio ❑ N/A
If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt
3.1 System Software
Operating system (executive) software revision Ievel: __ A _ -- __•- •-- . —... - - _ -- -.•
Site - specific software revision date: Revision completed by: __ — —_ _ _•__
4. Signaling Line Circuits
•
Characteristics ofsignaling line circuits connected to this system (see NFPA 72 Table 661):
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: A// _ Style: _ / Class: Aiff
5.1 Manual Initiating Devices
5.1.1 Manual Pull Stations Number of manual pull stations: A v /
I —
Type of devices: ❑ Addressable ❑ Conventional ❑• Coded ❑ Transmitter ❑ N/A
5.2 Automatic Initialing Devices Al' /
5.2.1 Area Smoke Detectors Number of smoke detectors: — /v
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: /
T 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 II Transmitter ❑ N /A ,, /
5.2.4 Sprinkler Waterllow Detectors Number of waterfiow detectors: / v k
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: r "
Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A
NFPA 72, Fig. 4.5.2.1 (p. 2 of 5)
Copyright 0 2009 National Fire Pretedlcn Association. This forth may be copied for individual use other Man for resale It may not be copied foreommerdal sale or diseaurtion.
01 17:49:55 03 -07 -2012 4 /6
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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 0 Fire pump phase reversal ❑ Selector switch not in auto
❑ Engine or control panel trouble ❑ Low fuel
Other.
63 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 7+
Type: D Addressable ❑ Directory ❑ Graphic ❑ N/A Location:
7.2 Annunciator 2 0 Local ❑ Remote '
Type: t7 Addressable ❑ Directory ❑ Graphic ❑ N/A Location:
7.3 Annunciator 3 ❑ Local ❑ Remote
Type: p Addressable ❑ Directory ❑ Graphic ❑ N/A Location: _ ` - - - - -� —�
8. Alarm Notification Devices and Circuits
8.1 Emergency Voice Alarm Service
fr
.
Number of single voice alarm channels: . Number of multiple voice alarm channels:
Number ofspealters: ..__....._....-- -_ ___.__..._..._... _.____ Number of speaker zones:
•
8.2 Telephone Jacks
Number of telephone jacks installed: A7/4 I 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 nottfrcation device circuits connected to this system (see NFPA 72® Table 6.5):
Quantity: _ ( Style: _ r Class: 5
8.4 Types and Quantities of Nonvoice Notification Appliances Installed
Bells: With visual device: Horns: _ With visual device: t
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 ProlesYon Assocfatlaa This form maybe copied for Individual use other than for resole. It may not be copied forcommerdal sale or distribution
01 17:50:07 03 -07 -2012 5/6
•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: /�� /
- ! ' 4 t Amps: — • __ • —_— •
Overcurrentprotection: Type: — _____ _ Amps: — _ - - - -- — __ —_ --
Location (of primary supply panelboard):
Disconnecting means location:
10.2 Secondary Power ow /
er
Location: 1 (5/- 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.
Fa The stem has been installed in accordance with thefo NFPA standards: (Note any or all that apply.)
PA 72 elm 4 70 Article 760 ,
tanufachuer's published instructions ❑ Other (please specify): — —�
System deviations from referenced NFPA standards: .
Signed -. Printed name: 1.7,/`ref v1 ( 1 - 3e4A" Date: 3 -7 -12
Organization: C , r.,.. .7_,,,e_ _ Title: r l er i ke Phone: q71 g
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 proper, in accordance with the requirements of:
®' rFPA 72 ZWATFPA 70® Article 760
['Manufacturer's published instructions ❑ Other (please specify):
❑ Documentation in acordance with Inspection and Testing Form ((Figure 10.6.2.3 of NFPA 72 is attached �7
Signed: e — _ Printed name: . 0 `'1 Date: 1 7 -/ ( •
Organization: •2( �1.,, c ., L Title: co + tt`Ght r - Phone: 9?/ ^27 ,225$
• • NFPA 72, FIg. 4.5.2.1 (p. 4 of 5)
Copt ® 2009 National Fire Protection Association. Th1e forth may bo copied for tote/Ideal use other than for resale. It may not be copied for commercial sale or dsblbution
01 17:50:20 03-07-2012 6 /6
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: Printed name: 17 .3 1 i' \ Ci c3-ea 4•1 Date:
Or ...e/t.L.oeva.114..- Title: phone: I -
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: Title: Phone:
133 Central Station
This system as specified herein will be monitored according to all NFPA standards cited herein.
Signed: Printed name: Date:
Organization: Title: Phone:
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:
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:
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NFPA 72, Fig. 4.5.2.1 (p. 5 of 5)
Copyright 02009 National Fire Protedon Associafion. This form may be copied for Individual use other than for resale. It may not be copied for commercial sale ibution
•