Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2004 -00410
�r� DEVELOPMENT SERVICES DATE ISSUED: 9/2/2004
'` '�I II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15575 SW SEQUOIA PKWY 100 PARCEL: 2S112DD -01600
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
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: 5N : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 4,400.00
Remarks: Fire sprinklers
Owner: Contractor:
PACIFIC REALTY ASSOCIATES WYATT FIRE PROTECTION INC.
15350 SW SEQUOIA PKWY #300 -WMI 9095 SW BURNHAM
PORTLAND, OR 97224 TIGARD, OR 97223
Phone:
Phone: 684 -2928
Reg #: LIC 64077
FEES REQUIRED INSPECTIONS
Description Date Amount Sprinkler Rough -In
[BUILD] Permit Fee 8/24/2004 $91.30 Sprinkler Final
[TAX] 8% State Surchari 8/24/2004 $7.30
[FLS] FLS Pin Rv 8/24/2004 $36.52
Total $135.12
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 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: iZet-tilt-c.-40t-
Permittee
Signature: a)"
Call 639 -4175 by 7 p.m. for an inspection the next business day
Fire Protection System
i Permit Application FOR oFH lcl USE ONLY Re 2��Q Building -y�L
RECEIVED Date/Ba��� �.]i� Permit No.: 1 �Qd•'^ DO y(
Plamm�: Appro al Other 1
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. AUG 2 4 tO4 Plan Other
Tigard, Oregon 97223 Date/By: 9 ' -O 7 /� , Permit No.:
Phone: 503- 639 -4171 Fax: 503- 598CM6PoF . '�'" 'fr 'tllii Post vi Lan Noe
Internet: www.ci.tigard.or.us BUILDIN r ^�' ' Contact � See Page 2 for
24 - hour Inspection Request: 503 - 639 - 4175 Name/Method: 014 Supplemental Information
TYPE OF WORK - . - REQUIRED DATA:
❑ New construction ❑ Demolition ` 1 & 2 FAMILY DWELLING '
❑ Addition/alteration/replacement ❑ Other:
• CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi - Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: 1%15 51■1 5etluoiCt. PlizAN 0 Total number of floors
Q New dwelling area (sq. ft.)
Suite #: /DO I Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name: 6A6-1) T)J 1 DA yL ) I Ny, • Covered porch area (sq. ft.)
Cross street/Directions to job site: vU Deck area (sq. ft.)
Other structure area (sq. ft.)
. +r4 --' s .14 RUIR
EQED DATA: . .
' +'CO11 VIERCIAI:-- USE CHECKLIST
I
Subdivision: Lot #: ;' - . •
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
' - DESCRIPTION OF WORK - the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
Valuation $ 44�"
Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
• ❑ • PROPERTY.. OWNER • . 1 ❑ ` TENANT 4 - ... . ;, Type of construction
Name: Occupancy group(s): Existing:
New:
Address: •
City /State /Zip:
NOTICE: All contractors and subcontractors are required to be
Phone: Fax: licensed with the Oregon Construction Contractors Board under
❑ APPLICANT • ❑ CONTACT PERSON i provisions of ORS 701 and may be required to be licensed in the
Business Name: jurisdiction where work is being performed. If the applicant is exempt
Contact Name: from licensing, the following reason applies:
Address:
City /State /Zip:
Phone: I Fax: ; ��• y, ,: , � .xt , , • . -
' .• FEES" '13':. F. - -.' .
•i
r.: g •,,,
III t e� r i. _'�1+tRMIT
E -mail: � °�`� � �� ��; � ,.. ,.. -s ; ' :.
i„s° =s +, P` ' ieaile' ' r:t -,. .
- CONTRACTOR _: r . , .. W ,., f - `- ;,:..- %-' ,,, ,-•. ,F .. -• ... „ . ...
Business Name: VII 0 'Fi ve-- ?YOke,C3YI, I .VY) • Fees due upon application $
Address: 610015 v\(. - 614w2a. (
City/State/Zip: 1 � ' rck. 012 411223 Amount received $
Phone: (o • 2G Z-t f Fax: (0854 • c14.) Date received:
CCB Lic. #: (4b'T1
Authorized ,, / Notice: Thls permit application expires if a permit is not obtained within
Signature: Date: � i (O 180 days after It has been accepted as complete.
terc117540 A . O *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \ Dsts\Permit Forms\BldgPermitApp.doc 01/03
•
Fire Protection Permit Check List
Describe work to be done:
A.) ❑ New B.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 4
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Wet a Dry ❑
Additional Standpipes
Information: Hazard Group •
Density
Design Area
K. Factor
Sprinkler Project Valuation: $ 4 � 400 . - •
B.) Type I - Hood Fire Suppression System . •
Hood Project Valuation: J $
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 • =s :' • -
3,601 to 7,200 $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Project Valuation Subtotal (A, B & C):, .$ • . -4 , 400 . -
Permit fee based on valuation (see attached chart): $ • q 1 . 3d
Permit fee based on square footage (D) (see fees above): $
State Surcharge 8% of Permit Fee: $ 1.30
FLS Plan Review 40% of Permit Fee: $ 3(0. S2
TOTAL: $ I35.
Plan review requires a completed application and 3 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.
is \dsts \forms \FPSchecklist.doc 02/28/03
AUG -13 -2004 14 45 HONEYWELL 503 968 3398 P.01/02
r.
• FUNDAMENTALS OF FIRE ALARM SYSTEMS 72 -31
i •
I FIRE ALARM SYSTEM
RECORD OF COMPLETION
Name of protected property: - 1 ) A t�I`. ► 5 } C o r #e a , A..r I . , 71%4. i pv
Address: _ • • Q.I. ,
Representative of protected property (nom ' h e) —
Authority having jurisdiction: Ti c a- g
Address/telephone number: t�
O onizotion narno /phone Represcraativc name /phone
Installer & e.
—
Supplier
Service organization ynr - . •
Location of record (as- built) drawing:. F AC`P t .r ar v.c,. FAA._
Location of operation and maintenance manuals; FAC.P
Location of test reports: F ACv
A contract for test and inspection in accordance with NPPA standard(s)
Contract No(s): J I Pt Effective date: Expiration date:
System Software
(a) Operating system (executive) software revision level(s): 14 I A
(b) Site- specific software revision date: _
(c) Revision completed by:
(name) (srm)
1. Type(s) of System or Service
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:
✓NFPA 72, Chapter 8 — Ceritral Station e !
Prime contractor: NA.
Central station location: 1,S `i9 S S Se r� -4w a. '' k�r 1 *too
a R U t
(NFPA 72,1 of 4)
FIGURE 4.5.2.1 Record of Completion. °
•
2002 Edition
•
AUG -13 -2004 14 38 HONEYWELL 503 968 3398 P.02/02
t •
72 -32 NATIONAL FIRE ALARM CODE
i
Means of transmission of signals from the protected premises to the central station
McCulloh Multiplex One -way radio
✓ Digital alarm communicator Two -way radio Others
Means of transmission of alarms to the public fire service corruzurdcations center:
(a) - .
(b) ..,._ -
System location: 7 --.._—____.- -
NFPA 72, Chapter 9 — Auxiliary
Indicate type of connection: .,- Local energy , Shunt x __�_ _ 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 by installed in accordance with the NFPA standards as shown below, was inspected by
—6 o ) TE ? tom o r 1 on a ,L 13 I oy , includes the devices shown
in 5 d 6, and has b n in servi since 8 ( i 0 - 1 a 4 .
_NFPA 72, Chapters 1 2 3 4 5 6 7 1 9 10 11 (circle all that apply)
_NFPA 70, National Electrical Code, Article 760
—,.-. Manufacturer's instructions
- Other (specify):
Signed: P -...-- _ !! — Date: g 1 0
_ 1
Organization:
3. Record of System Opera on
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 Lave L, < •• A 6._ date 'III I o y
and found to be operating properly in accordance with the requirements of:
— NFPA 72, Chapters 1 2 3 4 5 6 7 6 9 10 11 (circle all that apply)
NFPA 70, National Electrical Code, Article 760
Manufacturer's instructions
— Other (specify):
Signed: - -- �•, 1 Date: ei l 13 I 0 M
Organi2ati } .-.
4. Signaling Line Circuits
•
Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6..1.):
Quantity:_ _„•— Style: Class: B
(NFPA 72, 2 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
TOTAL P.02
AU6-13 -2004 14 :45 HONEYWELL 503 968 3398 P.02/02
• FUNOAMENTALS OF FIRE ALARM SYSTEMS
5. Alarm- Initiating Devices and Circuits
Quantity and class of initiating devioa circuits (see NFPA 72, 74ble 6.5):
Quantity: 3 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 x
Selective . _ Nonrequirod
(a) Smoke detectors Ion Photo ' Addressable
(b) Duct detectors Ion Photo Addressable
• (c) Heat detectors FT RR HC Addressable
(d) Sprinkler waterilow indicators: Transmitters Non coded Z. Coded , Addressable _
(e) The alarm verification feature is disabled 1 ,)( or enabled , changed from seconds to seconds.
(f) Other (list): E. x c a 1V s cc e .. l { I e
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) ■alve supervisory switches •
(b) 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:
(h) Selector in auto position
(i) Engine or control panel trouble
(j) Fire pump running
•
ENGINE - DRIVEN GENERATOR:
(a) Selector in auto position
(b) Control panel trouble
(c) __Transfer switches
(d) Engine running
Other supervisory functions) (specify):
•
(NFPA 72, of 4)
FIGURE 4.5.2.1 Continued
2002 EdliIon
TOTAL P.02
AUG -13 -2004 14 38 HONEYWELL 503 968 3398 P.01/02
• 72 -94
NATIONAL F'IRE ALARM CODE
7. Annunclator(s)
Number I Type: L El) Location: C A C V ^ S p c L,. M
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 ayatem: 1 • ""
Quantity and the ass of notification appliance circuits connected to system (see NFPA 72, Table 6.7):
Quantity: Style: Class:
Types and quantities of notification appliances installed:
(a) Bells With Visible
(h) Speakers . With Visible
(c) Horns 3 With Visible is - s
(d) Chimes With Visible
(e) Other. With Visible
(f) Visible appliances without audible; r n r.L
9. System Power Supplies
(a) Fire Alarm Control Panel: Nominal voltage: Ito \(A C current rating: 204
Overcurrent protection; Type: 1S.1•& k../' Current rating:
X ,Location: '1P0,.�...t. L I C•^ c ....,4- #1: 11 -- a .e.g. Ir.....,
(b) Secondary (standby): L
Storage battery: 2 - aloe Amp -hour rating: 1'1 Al{ 4. 0,1
I C Calculated capacity to drive system, in hours: G .3 Lo..r
Engine-driven generator dedicated to fire alarm system;
Location of fuel storage:
(c) Emergency system used as backup to primary power supply: +4A v :. j r 1 A •
Emergency system described in NFPA 70, Article 700:
' 10. Comments
Frequen of routine testa and inspections, if other than in accordance with the referenced NFPA standard(s):
System deviations from the referenced N'PA standards) are:
• for Insta lation contractor /supplier ( title) (date)
t
Get -13 -oy
(sign for alarm service company (title) (date)
� I( - 1 3 0
Is n for central station (title) (date)
Upon completion of the system(s) satisfactory test(s) witnessed (if required by the authority having jurisdiction):
Olgned) representative of the authority having jurisdiction (title) — (date)
(NFPA 72, 4 of 4)
FIGURE 4.5.2.1 Continued
•
2002 Edition
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP Od q-Od
Received Date Requested / '(' AM PM BUP
Location Suite /O MEC
Contact Person YYI_ __ Ph ( ) g� — ���g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner i�i ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
nn er
Fire arm �' ' Itt
Susp'd Ceiling I
Roof
Other:
4iro Orr 7
PART FAIL
= ING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call fo einspection RE: • Unable to inspect — no access
Fire Supply Line / ' ��
ADA Date l 0 G 1 ins �` Lop / ' J
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL