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Permit
y CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT COMMUNITY DEVELOPMENT Permit #: FPS2013 -00023 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/04/2013 Parcel: 1 S135AB01002 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 551 Project: Apex Systems Subdivision: METZGER, TOWN OF Lot: 9 Project Description: Fire alarm modification for TI Contractor: STONER ELECTRIC Owner: LINCOLN CENTER LLC 1904 SE OCHOCO BY SHORENSTEIN PROPERTIES LLC MILWAUKIE, OR 97222 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 - 462 -6500 PHONE: FAX: 503 - 659 -4968 FEES Description Date Amount Specifics: Permit Fee - COM 03/04/2013 $123.72 12% State Surcharge - Building 03/04/2013 $14.85 Type of Use: COM Plan Review - Fire Life Safety - COM 03/04/2013 $49.49 Class of Work: ALT Type of Const: IIB Info Process /Archiving - Lg $2.00 (over 03/04/2013 $10.00 Occupancy Grp: B Height: ft 11x17) Stories: 5 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: Yes Alarm Type: Automatic Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Yes Cut Sheets Required: Yes Total $198.06 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $4,529.00 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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifica ' • • - - • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You obtain a copy of the rules or direct • . -stions to OUN •y c- g 503.232.1987 or 1.800.332.2344. Iss d By: Permittee Signature: # L vim iL — 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 FOR OFFICE USE ONLY of Tigard gard RECEI DatBv a /3 �jQSa/3 `J b Date e Bed „ la Permit No.: 114 • 13125 SW Hall Blvd., Tigard, OR 9 7223 Plan Revie �/ . Phone: 503.718.2439 Fax: 503.598.19 1 2 2013 Date/By: l ) 21 Z7 (3 Other Pennit : kideg0 /3 d►GE T l G A R D Inspection Line: 503.639 Date Ready By ^� lmu el See Page 2 for Internet: www.tigard or.gov Notified 1 Method D"� 3 sr Supplemental Information II (( CITY OF TIGARD TYPE DIVISION REQUIRED DATA: 1 - AND 2- FAMILY DWELLING ❑ 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. Valuation: $ ❑ I- and 2- family dwelling ® Commercial /industrial El 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: 10220 SW Greenburg Rd. New dwelling area: square feet City/ State/ZIP: Tigard, OR 97223 Garage/carport area: square feet Suite/bldgJapt. no.: / I Project name: Apex Systems Covered porch area: square feet Cross street/directions to job site: Lincoln 3 Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE ('HECKLIST Subdivision: I Lot no.: Permit fees* are based on the value of the work pet 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. Install fire alarm notification as required to facilitate remodel of the space. Valuation: $54,529.00 Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone: ( ) Fax: ( ) New: ❑ APPLIC _ANT ❑ 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 licensed 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: ( ) I Fax:: ( E -mail: CONTRACTOR BUILDING PER1tIIT FEES* Business name: Stoner Electric, Inc. (Please refer to fee schedule) Permit fee: Address: 1904 SE Ochoco Street City/ State/ZIP: Milwaukie, OR 97222 State surcharge (12% of permit fee): FLS plan review (40% of permit fee): Phone: (503) 462 -5248 I Fax: (503) 659 -2765 (Due upon application) CCB lie.: 44823 Total permit fees: Authorized signature: _ Amount received: r This permit application expires if a permit is not obtained Print name: Dave Litzenberg Date: 2/12/2013 within 180 days after it has been accepted as complete. * Fee methodology set by Tri- County Building Industry Service Board. I:) Buildn4\Pamits\FPS-PeimiiApp.doc Rev 01 /05/2012 440 -4613T(11/02/COM/WEB) a City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Describe work to be done: 1.) El New 2.) f\lodification to spunkier heads only: ❑ Addition El 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 ❑ L)n 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 ® Yes include: Individual Component ® Yes Cut Sheets Fire Alarm Project Valuation: $ 4,529.00 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 tee based on project valuation (see fee schedule): $ Permit fee based on square footage (see D above): $ State Surcharge (12° o of permit fee): $ FLS Plan Review (40° o 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. O: \STS\ Accounts \Apex S \FA Permit App.doc Rev 01/05/2012 2 4 tAM r NE q FUNDAMENTALS OF FIRE ALARM SYSTEMS b r?''c-6°' . 13 CERTIFICATIONS AND APPROVALS S 2 V 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: Date: Organization: Title: Phone: 13.2 System Service Contractor This system as specified herein been installed and tested according to all NFPA standards cited herein.. i , Signed: /� �G� `} // .a, • '' ; r L. P rinted name: l l'-`-i i / Date: 3/ �/ 17 Organizati � y, M.i f snk )‘ Title: : s'- ' 4 4 -c..-> Phone: - ( ' 3 - C 6 T - ocv • v 13.3 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: 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 approv ''plans and specifications, its approved sequence of operations, and with all NFPA standards cited he 'n Signed: 1 / \ 1 —...-- - ‘.----. Printed name: \ J c_ ( (.(,-) -L Date: /.` " Organization: V /)( ; --1- (-1 , r P / %G, /J- Title: S ,•7K c/rr Phone: ! Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002,'National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. • © 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.5 of 5) NATIONAL FIRE ALARM CODE • 8. ALARM NOTIFICATION DEVICES AND CIRCUITS (continued) 8.4 Types and Quantities of Nonvoice Notification Appliances Installed - Bells: With visual device Horns: S With visual device: Chimes: With visual device Bells: With visual device: s Visual devices without audible devices: Other (describe): 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 I� v '' ri ''— Amps ( " Overcurrent protection: Type {:r ^ } 4- ^ r Amps c' Location (of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power Location: r. f,_ C \ t?" i'r Type: f ^' = U. _4- L i Nominal voltage: 6-i - c - Current rating: r r Number of standby batteries: � " Amp hour rating: -') Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system t i In standby mode: `�" "`� In alarm mode: .� ry t ., \ C\ 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, National Electrical Code, Article 760 ❑ Manufacturer's published instructions ❑Other (please specify): . System deviations from referenced NFPA standards: Signed: Printed name: Date: Organization: Title: Phone: - 12. RECORD OF SYSTEM OPERATIO 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: 0 NFPA 72 ❑ NFPA 70, National Electrical Code, Article 760 ❑ Manufacturer's published instructions ❑ Other (please specify): ❑ Documentation in accordance with Inspection and Testing Form (Figure 10.6.2.3) is attached Signed: Printed name: Date: Organization: Title: Phone: Reprinted with-permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.4 of 5) FUNDAMENTALS OF FIRE ALARM SYSTEMS 6. SUPERVISORY SIGNAL - INITIATING DEVICES AND CIRCUITS 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded 0 Transmitter ^ IJ N/A 6.2 Fire Pump • of fire pump: ❑ Electrical ❑ Diesel Type of pump supervisory devices: 0 Addressable 0 Conventional . 0 Coded 0 Transmitter 9'1N /A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running 0 Fire pump phase reversal ❑ Selector switch not in auto O Engine or control panel trouble 0 Low fuel Other: 6.3 Engine Driven Generator. Type of generator supervisory devices: 0 Addressable 0 Conventional 0 Coded ❑ Transmitter 4-N /A ❑ Engine or control panel trouble 0 Generator running 0 Selector switch not in auto ❑ Low fuel Other: 7. ANNUNCIATORS 7.1, Annunciator 1 ❑ Local ❑ Remote Type: 0 Addressable 0 Directory ❑ Graphic 4,N /A Location: 7.2 Annunciator 2 0 Local 0 Remote Type: ❑ Addressable 0 Directory 0 Graphic ;, N/A Location: 7.3 Annunciator 3 0 Local 0 Remote Type: ❑ Addressable ❑ Directory ❑ Graphic O /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 0 Sound powered 0 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: b Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by.the standard in its entirety. © 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.3 of 5). NATIONAL FIRE ALARM CODE 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE (continued) If Chapter 8, note the means of transmission from the protected premises to the central station: • - 6- Digital alarm communicator ❑.McCulloh ❑ Multiplex ❑ 2 -way radio ❑ I -way radio ❑ N/A If Chapter 9, note the type of connection: 0 Local energy 0 Shunt ❑ N/A 3.1 System Software ,/ Operating system (executive) software revision level: I .� r I Site - specific software revision date: .V1 Revision completed by: 0 If 4. SIGNALING LINE CIRCUITS Characteristics of signaling line circuits connected to this system (see NFPA 72, Table 6.6.1): - 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: Style: Class: 5.1 Manual initiating devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of.devices: ❑ Addressable 0 Conventional ❑ Coded 0 Transmitter Li`N /A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: - Type of coverage: ❑ Complete area 0 Partial area ❑ Nonrequired partial area 041/A Type of devices: ❑ Addressable ❑ Conventional 0 Coded 0 Transmitter .0`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. 0 /A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.3 Heat Detectors Number of heat-detectors: Type of coverage: ❑ Complete area 0 Partial area ❑ Nonrequired partial area YN /A Type of devices: ❑ Addressable ❑ Conventional 0 Coded ❑ Transmitter ,■N /A • 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded 0 Transmitter ‘1-N /A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: ❑ Enabled disabled 0 Set for seconds Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.2 of 5) 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 pp Name of property: L + n A 7 _A • x r . \c. V O Address: /° 2 2 r " c . L` • (N C) . 5 7 .2z_ Description of property: c.)%. k ;c c j < Occupancy type: . Name of property representative:. c" e n 61,^ n •\ -r' i? c c Address: 10 r C,✓ , a.P.. �a c ire (< )lrlct ((. 7977 Phone: Fax: E -mail: Authority having jurisdiction over this property: Phone: Fax: E -mail: 2. FIRE ALARM SYSTEM INSTALLATION, SERVICE, AND TESTING INFORMATION Installation contractor for this equipment: C ‘ e ( ,�- Address: / ?o I rC 0 occ 7, A � <, GG'_ Phone: Fax: E -mail: Service organization for this equipment: n : . AG n n e Address: C3a `_5,,-• L r ti i,e. c ' 7c Phone: \67- 6J "idOC.. Fax:' E -mail: Location of as -built drawings: C n. c \ r e . c.0 Location of historical test reports: - Location of system operation and maintenance manuals: C : " . \ . \ : c -t k_ -A contract for test and inspection in accordance with NFPA standards is in effect as of.: N. 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: -` `` • `' ''•� Name of organization receiving alarm signals with phone numbers (if applicable): Alarm: .c\ f r •?( • . , 1`�r r Cc ` ► c�� Phone: • I tc Supervisory: �� Phone: % Trouble: Phone: . Entity to which alarms are retransmitted: Phone: Method of retransmission of alarms to that organization or location: Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association - SG24 -2 -014 Rev. (10/07) (p.1 of 5)