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Permit
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT I COMMUNITY DEVELOPMENT Permit #: FPS2013 -00043 T t GA D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/01 /2013 Parcel: 1S134BC00401 Jurisdiction: Tigard Site address: 12442 SW SCHOLLS FERRY RD 101 Project: Providence Health Systems Subdivision: GREENWOOD TERRACE CONDO Lot: 17 Project Description: (1) Emergency fire alarm panel replacement due to catastrophic failure Contractor: METRO SAFETY & FIRE INC Owner: PROVIDENCE HEALTH SYSTEM - OREGO PO BOX 33650 ATTN: REAL ESTATE & PROPERTY PORTLAND, OR 97068 MANAGE 4400 NE HALSEY BLDG 1 STE 160 PORTLAND, OR 97213 PHONE: 503 - 231 -2999 PHONE: FAX: 503 - 256 -4691 FEES Description Date Amount Specifics: Permit Fee - COM 04/01/2013 $112.96 12% State Surcharge - Building 04/01/2013 $13.56 Type of Use: SF Plan Review - Fire Life Safety - COM 04/01/2013 $45.18 Class of Work: ALT Type of Const: IIB Info Process /Archiving - Sm $0.50 (up to 04/01/2013 $5.50 Occupancy Grp: B Height: ft 11x17) Stories: 2 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: No Cut Sheets Required: Yes Total $177.20 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $3,100.00 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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 95 - 001 -0090. You may • . . a copy of the rules or direct questions to OUNC by calling 503.232. or 1.800.332.2344. Issued By: / 441 . I / i , 1 Lt / Permittee Signature: 1/ I A I I / 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 It )it ( )1•1•ICE USE ONLY Received City of Tigard P erm it • No. " 13125 SW Hall Blvd., Tigard, OR 97223 APR 01 2 013 Plan Revie �'L ® r Permit: Phone: 503.718.2439 Fax: 503.598.1960 DateB : � � TI GARD Ins Line: 503.639.4175 CITY �f p Date Re. • ".7 J ' : ® See Page 2 for OF Internet: www.tigard- or.gov C il j ilVt]1lL Notified/Method: t Ca Supplemental Information TIT ILDING DIVISION TYPE OF WORK 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. ❑ 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: F�^^ New dwelling area: square feet 1Z�� Z sw 51'r�o�`S T�eR�� City/State /ZIP: 71 o41tD � I 4 , . 9 7 Z23 Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: p I..,,,,,, t /4 f+t S. ei (J 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. sae) • / / 1 / Valuation: $ 3 100 ivit i.LcY o l d. Al1iQM P ,..1 t�� y ,',,4Cd'�11.v'T 1DV e _. 1 ' , C Al- A5 t i2 , , r n1t t tr Pi l ✓ 2;f , Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: TW O Name: 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 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: ( ) Fax:: ( ) E -mail: CONTRACTOR BUILDING PERMIT FEES* Business name: m gnu) SAF 4_ F I T (Please refer to fee schedule) Permit fee: Address: 1,1324, SE. srAok sr. City/State/ZIP: 6 tc'4 - Iro.N J O (. 7 za 3 State surcharge (12% of permit fee): FLS plan review (40% of pennit fee): Phone: ( ) a3 1.Zg Gil Fax: (s—b3) Zo - y/`/ / (Due upon application) CCB lic.: / 3f / Total permit fees: Authorized signature: Amount received: f 77_ This permit application expires if a permit is not obtained Print name: m AkL CAse / Date: 3- 3 , -a% 0 within 180 days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board. I:\Build ng\Permits \FPS - PermitApp.doc Rev 0/05 /2012 440- 4613T( I I /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 El Addition ❑ 1 -10 heads: No plan review required. El 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 Yes include: Individual Component l Yes Cut Sheets Fire Alarm Project Valuation: $ 3 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. Q\ Users \ MARC — 1.MET\AppData \ Local \ Temp \ FPS-Pe rmitApp.doc Rev 01/05/2012 Fire Alarm System e0/3- • Record of Completion Name of Protected Property: Providence Health Systems - Scholls Ferry MOI �3 Address: 12442 SW Scholls Ferry Rd., Tigard, Oregon 97223 Representative of Protected Property (Name /Phone) Frank - 503 - 849 - 0449 Authority Having Jurisdiction: City of Tigard Building Department Address/Telephone Number: 13125 SW Hall Blvd. , Tigard, Oregon 97223 Organization Name /Phone Representative Name /Phone Installer: METRO Safety & Fire, Inc. Enrique Vallejo 503- 231 -2999 Supplier: METRO Safety & Fire, Inc. Marc Casey 503 - 231 -2999 Service Organization: METRO Safety & Fire, Inc. Tim Hand 503 - 231 -2999 Location of Record (As- Built) Drawings. At FACP Location of Operation & Maintenance Manual(s). At FACP Location of Test Reports: At FACP A Contract for Test & Inspection in Accordance with NFPA standards: Contract No(s): 1 Effective Date: 3/25/2013 Expiration Dai 3/25/2013 System Software: a.Operating system(executive)software revision level(s): # b. Site - Specific software revision date: 3/25/2013 c. Revision completed by: Timothy Hand METRO Safety & Fire, Inc. Name Firm 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: Trouble: Supervisory: if alarms are transmitted to public fire service communications centers or others, indicate location an telephone numbers of the organization receiving alarn Indicate how alarm is transmitted NFPA 72, Chapter 8 - Proprietary: Telephone numbers of the organization receiving alarm: Alarm: Trouble: Supervisory: if alarms are transmitted to public fire service communications centers or others, indicate location an telephone numbers of the organization receiving alarm Indicate how alarm is transmitted X NFPA 72, Chapter 8 - Central Station: Prime Contractor: Metro Safety & Fire, Inc. Central Station Location: Alarm Central Station - Beaverton Oregon Means of transmission of signals from protected premises to the central station: • McCulloh • Two -Way Radio © Digital Alarm Communicator ❑ One -Way Radio Multiplex Li Others Means of transmission to the public fire service communications center: a. b. System Location: NFPA 72, Chapter 9 - Auxilliary: 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 imp branching, but prior to conducting operational acceptance tests). This system has been installed in accordance with the NFPA standards as shown below, was inspect( Timothy Hand and Enrique Vallejo on, 3/26/2013 , includes the devices shown in 5 and 6, and has been in service since 3/26/2013 1 NFPA 72, Chapters: 1 2 3 10 12 17 18 21 23 (circle all that apply) X NFPA 70, National Electrical Code, Article 760 X Manufacturer's Instructions. Other (specify): Signed: Date: Organization: METRO Safety & Fire, Inc. 3. Record of System Operation: Documentation in accordance with Inspection Testing Form, is attached X All operational features and functions of this system were tested by Timothy Hand Date: 25- Mar -13 and found to be operating properly in accordance with the requirements of: NI LU1U 1,2,3,10,1 NFPA 72, Chapters: 1 2 3 10 12 17 18 21 23 (circle all that apply) X NFPA 70, National Electrical Code, Article 760 X Manufacturer's Instructions. Other (specify): Signed: Date: Organization: METRO Safety & Fire, Inc. 4. Signaling Line Circuits: Quantity and class of signaling line circuits connected to system ( see NFPA 72, Table 6.6.1): Quantity: 1 Style: 4 Class: B 5. Alarm Initiating Devices & Circuits: Quantity and class of Initiating Device circuits ( see NFPA 72, Table 6.5): Quantity: 6 Style: 4 Class: B Manual (a) Manual Stations Noncoded 3 Transmitters Coded Addressal (b) Combination manual fire alarm & guard's tour coded stations: Automatic Coverage: Complete X Partial Selective Nonrequired X (a) Smoke Detectors: Ionization 14 Photelectric 5 dressable 1 (b) Duct Detectors: Ionization Photelectric 4 dressable (c) Heat Detectors: FT 4 RR RC Coded dressable (d) Sprinkler Water indicators: Coded Noncoded 1 Transmitters dressable (d) The alarm verification feature is disabled X or enabled , changed from seconds seconds. (f) Other ( list ) 6. Supervisory Signal- initiating devices & circuits ( use blanks to indicate device quantity ) Guard's Tour (a) Coded Stations (b) Noncoded Stations (c) Compulsory guard's tour system comprised of transmitter stations & intermediate stations. Note: Combination devices are recorded under 5(b), Manual, and 6(a), Guard's Tour. Sprinkler System Check if provided (a) 2 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 (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 function(s) ( specify ): 7. Annunciators Number: 1 Type: LCD Location: Front entry by drinking fountian 8. Alarm Notification Appliances and Circuits NFPA 72, Chapter 6 - Emergency Voice /Alarm Service Quantity of voice /alarm channels Single Multiple -- of speakers installed Quantity of speaker zones Quantity of telephones or telephonejacks included in system Quantity and the class of notification appliance circuits connected to system ( see NFPA 72, Table 6.7 ): Quantity 6 Style 4 Class B Types & Quantities of Notification Appliances Installed: • (a) Bells 1 with visible (b) Speakers with visible (c) Horns 21 with visible 21 • (d) Chimes with visible (e) Other with visible (f) Visible appliances without audible 22 9. System Power Supplies (a) Fire Alarm Control Panel: Nominal Voltage: 120 v Current Ratinc 5 amp. Overcurrent Protection Type Circuit Breaker Current Ratinc 20 Location: Panel L1A #3 (b) Secondary (standby) Storage Battery 12 v Amp -hour rating 7 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 desribed in NFPA 70, Article 700 10. Comments Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s): None System Deviations from the referenced NFPA standard(s) are: None A f (v, Men -.2_._ 4/ - for installati-- . tractor /supplier Title (date) N Irned) for alarm service company le (date) (signed) for central station Title (date) Upon completion of the ' stem(s satisfactory test(s) witnessed (if r quired by the Authority Having Jurisdiction : , 17ao - t / ' (sighed) represe to A uthority Having Jurisd Tale (date) .l