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Permit • CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT COMMUNITY DEVELOPMENT Permit#: FPS2014-00054 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/01/2014 Parcel: 2S102CC03301 Jurisdiction: Tigard Site address: 13950 SW 104TH AVE Project: Specialized Housing Subdivision: FRELEON HEIGHTS Lot: 1 Project Description: Fire alarm replacement. Contractor: LIMITED ENERGY NW Owner: SPECIALIZED HOUSING INC P.M.B. 190 4140 SW 109TH AVE 3439 NE SANDY BLVD. BEAVERTON,OR 97005 PORTLAND, OR 97232 PHONE: 503-810-7331 PHONE: FAX: FEES Description Date Amount Specifics: 1 Permit Fee-COM 03/25/2014 $112.96 12%State Surcharge-Building 03/25/2014 $13.56 Type of Use: COM Plan Review-Fire Life Safety-COM 03/25/2014 $45.18 Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 03/25/2014 $7.00 Occupancy Grp: R-3 Height: ft 11x17) Stories: 1 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: Yes Battery Calcs Provided: Yes Cut Sheets Required: Yes Total $178.70 Valuations: Required Items and Reports(Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $3,500.00 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 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 otification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or d'ect questions to OUNC by .Iling 503.232.1987 or 1.800.332.2344. Is ed By: / ' Permittee Sigma ure: z,(r/tcpi 4.1 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 01 1( 1 l SE 0\I.1 , Received City of Tigard Date/B : 1// Permit No.: 0 .iii 13125 SW Hall Blvd.,Tigard,OR 9 . Plan Revi0. O11 Phone: 503.718.2439 Fax: 503.59 'u CEIVED DateB ���r,(� i Other Permit: T I c;A It U Inspection Line: 503.639.4175 Date Ready/By: . AMEN Supplemental See Page 2 for Internet: www.tigard-or.gov Notified/Method: s7� Supplemental Information MAR 2 5 2014 ?,s ue vi TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction 1 dli i1'4(ARD Permit fees*are based on the value of the work performed. � Indicate the value(rounded to the nearest dollar)of all CI Addition/alteration/replacement "Ell�t �� t, c, L -Ze., equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. nd 2-family dwelling El Valuation: $ -a 12 Accessory building CI Multi-family Number of bedrooms: El Master builder 11 Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: /3?s° .fat.' 49 4/T! New dwelling area: square feet City/State/ZIP: 6.- , Z. Garage/carport area: square feet Suite/bldg./apt.no.: Project name: C� 1012L,WW Covered porch area square feet Cross street/directions to job site: A- A„.,sw 1 — "-X;.. (>0—C��-.../ Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I 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. t&lL42C,� �/,,c- r4zj9vv .. Valuation: $ Existing building area square feet New building area: square feet ❑ PROPERTY OWNER l ❑ TENANT Number of stories: 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 lcensed 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 PERMIT FEES* Business name: 7 �' (Please refer to fee schedule) AS! , i 9 i t.. .- '/ . /, . .. /f — _ . Permit fee: Address: pee', /f 3131 z'e- s oy dG City/State/ZIP: j,A 7,f/tki y71 Z State an rev ew(12%of permit fee): FLS plan review(40%ofpermit fee): Phone:(p3) ii ,g) 7JJ/ Fax:j&)) y-y6 .371 F (Due upon application.) CCB lie.: 87 f' 4/ 4. Total permit fees: Authorized signature: /t/" Amount received: �7o 7 J -` This permit application expires if a permit is not obtained ined Print name: bi, ,f,, Z. ��/Gf�,o Date, /Ac,/ j/ within 180 days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Service Board 7✓ 'Rif. 'U 1:\Building\PermitaWPS-PennitApp.doc Rev 01/05/2012 440-46131(11/02/COM/WEB) - - ga A.70 City of Tigard: Fire Protection Permit Checklist Page 2- Supplemental Information Describe work to be done: 1.) ❑ New 2.) Modification to sprinkler heads only: E] 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 ry 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 El" -Yes include: Individual Component es Cut Sheets Fire Alarm Project Valuation: $ 3S 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. I:\Building\Permits\FPS-PermitApp.doc Rev 01/05/2012 2 Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 13950 SW 104TH AVE, TIGARD, OR, 97223 Commercial - Fire Protection System 998 Alarm Final 2014-04-03 00:00:00 FPS2014-00054 PASS - No C of O Violation Summary: Inspector Contractor Fps Ocas-L( National Fire Alarm Code - Certificate of Completion Name of Protected Property: Permit#: Physical Address: , w /Q z- Suite#: Rep.Of Protected Property(namelphone): Z, /zyjl Authority Having Jurisdiction: 6-77/4 0"--_ Address/Phone Number: 1. Type(s)of System or Service: 1.4.PA 72,Chapter 3—Local If alarm is transmitted to location(s)off premises, list where received: NFPA 72,Chapter 3—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 this System: _NFPA,Chapter 4—Auxiliary Indicate Type of Connection: Local Energy Shunt Parallel Telephone Location and Telephone Number for Receipt of Signals: _NFPA 72,Chapter 4—Remote Station Alarm: Supervisory: _NFPA 72,Chapter 4—Proprietary If alarms are retransmitted to public fire service communications center or others, indicate location and telephone number of the organization receiving the alarm: Indicate how alarm is retransmitted: NFPA 72,Chapter 4—Central Station The Prime Contractor: Central Station Location: Security Central—Statesville,NC Means of Transmission of Signals from the Protected Premise to the Central Station: McCulloh Multiplex One-Way Radio Two-Way Radio Digital Alarm Communicator Other: Means of transmission of alarms to the public fire service communications center: 1. 2. System Location: Organization Name/Phone Representative Name/Phone Installer LLoiy/1,0 f' 9 e/o 2,3.E Supplier 4/geti 72 Service Organization /00-i-- 4 Physical Address Location of Record(As Built) i"y Site. f /7? — Location of O n rs Manuals:.— Site. Location of Test ep rts: Site. f�'p-CJe- ,/ t 7 2. Certification of System Installation: (Fill out after installation is complete and wiring checked for opens,shorts,ground faults,and improper branching,but prior to conducting operational acceptance tests.) This system has been installed in accordance with the NFPA standards as listed below, was inspected by fl46 faa/Von , includes the devices listed below and has been in service since ,9/.24/r/iV v NFPA 72,Chapters 1 © 4 5 6 7 (circle all that apply) t.----NFPA 70,National Electrical Code,Article 760 ,..---Manufacturer's Instructions Other ect y): I Signed: 7z ,4 Date: J XX/c 1d7- s' Organization: 4//07g/ b.-20W/ A/ 11 a / 3. Certification of System Operation: All Operational. features and functions of this system were tested by on 1,6E/And found to be operating properly in accordance with the requirements of: .__, ..WPA 72,Chapters 1 3 4 5 6 7 circle all that apply) c/SIFPA 70,National Electrical Code,Article 760 ��----// c,...-- ivtanufacturer's Instructions Other pecify): Signed: Date 4 4, b a �� Organization: / i, a ri � — .... ..�J 4. Alarm Initiating Devices and Circuits(Use blank o indicate quantity of devices.): MANUAL a) i_Manual Stations AUTOMATIC a) 7_Smoke Detectors _Ion Photo b) -Duct Detectors Ion _Photo c) 2.--Heat Detectors _FT A RR _FT/RR _RC d) / _Sprinkler Water Flow Switches e) / _Other(list): Page 2 of 3 Form 7 Physical Address 17/0 (..1&-) 76 V 5. Supervisory Signal Initiating Devices and Circuits(Use blanks to indicate quantity of devices.): Sprinkler System: Electric Fire Pump: a) Tamper Switches e) _Fire Pump Power b) Building Temperature Points f) _Fire Pump Running c) Site Water Temperature Points g) _Phase Reversal d) Site Water Supply Level Points Engine-Driven Fire Pump: Engine-Driven Generator: h) _Selector in Auto Position k) Selector in Auto Position i) _Engine or Control Panel trouble I) _Control Panel Trouble j) _Fire Pump Running m) Transfer Switches n) Engine Running Other Supervisory Function(s)(specify):_ 6. Alarm Notification Appliances and Circuits: Quantity of indicating appliance circuits connected to the system:_ Types and Quantities of Alarm Indicating Appliances Installed: a) Bells b) Speakers c) Horns d) Horn/Strobes e) Speaker/Strobes f) Strobes 7. Signaling Line Circuits: Quantity and Style(See NFPA 72,Table 3-6.1)of signaling line circuits connected to system: Quantity: ?� Style0 8. System Power Supplies: // a)Primary(Main): Nominal Voltage: (/).4/A.-Current Rating:_ 7G-) Overcurrent Protection: T pe:_ .Current Rating:_ Location: fs`iG 4e_' fro/c.e - b)Secondary(Standby):!!!!""'' Storage Battery: Amp Hour Rating: Calculated Capacity to Drive System,in hou s: ! _60 Engine-Driven Generator Dedicated to Fire Alarm System: Location of fuel Storage:_ c)Emergency or Standby System used as back up to Primary Power Supply,instead of using a Secondary Power Supply: _Emergency System Described in NFPA 70,Article 700 Legally Required Standby System described in NFPA 70,Article 701 Optional Standby System described in NFPA 70,Article 702, which also meets the performance requirements of Articles 700 and 701. 9. System Software: /1//fr Operating System Software Revision Level(s): Application Software Revision Level(s): Revision Completed By: Date: Signature: Firm: Page3of3 Form ? L