Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 s COMMUNITY DEVELOPMENT Permit#: FPS2014-00169
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2014
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 250
Project: Sodexo Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire alarm with affidavit
Contractor: SAFE TECHNOLOGY GROUP INC Owner: LINCOLN CENTER LLC
6400 NE HWY 99 STE G375 BY SHORENSTEIN PROPERTIES LLC
VANCOUVER,WA 98665 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 360-699-2130 PHONE:
FAX: 360-719-1527
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/16/2014 $112.96
12%State Surcharge-Building 10/16/2014 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 10/16/2014 $45.18
Class of Work: ALT Type of Const: Hourly Building Rate 10/16/2014 $180.00
Occupancy Grp: Height: ft Hourly Building 12%State Surcharge 10/16/2014 $21.60
Stories:
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 $373.30
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,855.00
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 952-001-0090. You may obtain a copy of the rules
or direct que - • C by calling 503.232.1987 or 1.800.332.2344.
Issued c y: / Permittee Signature:
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.
City of Tigard Permit No.: / 5 cei4/'a M.
1111 I • 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: /6//61/l�
ii ,it Inspection Line: 503.639.4175 /r(
Internet: www.tigard-or.gov By: �.�.
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: So ct/el(o Occupancy:
Job Address: /0a2o ,5a Greeo burs Pi Suite: 523
Contractor: Sa 4 . T c6 c,S c, 6 rn,,<, �rt L Phone: 3 GO - C95 - .21 3 O
Valuation of work: $ .��Ss, 00
Type of System: (check one) }Required ❑Non-required
(check one) [Automatic Manual ['Both
Total number of devices added or moved under this permit process is 5 total per tenant space.
Number of Proposed Smoke/Heat Detectors: To be Added(max5) /To be Relocated(max5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(msx 5)
Number of Proposed Notification Appliances: To be Added(max 5) 3 /To be Relocated (max 5)
(-3 s n $i. eet Oregon Construction Contractors Board No. / 7 37 3
certify the following is true and defines the scope of work for this project:
a) All work complies with the current state-adopted NFPA-72 and the authority having jurisdiction.
b) All notification appliances are located in accordance with the current state-adopted NFPA-72.
c) Smoke/Heat detector spacing complies with current state-adopted NFPA-72 and the authority having
jurisdiction.
d) Exposed wiring will not be covered until inspected.
e) Final approval shall be subject to on-site tests and inspections.
f) Voltage drop is adequate to operate all appliances.
g) Battery supplies are capable of supporting the system modifications.
h) Compatibility of appliances and devices are in accordance with the FACP manufacturer's specifications.
In addition, I understand the following is required:
• Submit(3)copies of a sketch showing the area of work within the building's structure.
• Building fire protection system permit.
• Electrical permit.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
Signature: � Date: 70
Print Name:
I:\Building\Fonns\FireAlarmAffidavit_071514.docx Page 1 of 1
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
fECffl/Ff).. Received
Cl of Tigard - / Permit No.:
City ICT 16 , Date/By: i �4, �v. c � kiss/�00/(0 9
" 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Permit: t� P�!,/�Q� /
Phone: 503.718.2439 Fax: 503.598.1 DateBy: L `i
T 1 G A R D Inspection Line: 503.639.4175 CITY(1€,+� ' 1 Date Ready/By: Juris: B See Page 2 for
Internet: www.tigard-or.gov V T d/f 1 LJ Notified/Method: 1 Supplemental Information
/UMW nr KIM
TYPE OF WORK REQUIRED DATA:1-AND 2-PAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(minded to the nearest dollar)of all
S,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 ECommercialfmdustrial Valuation: S
❑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: /0aa p I,J 64,ed,09 tip) New dwelling area: square feet
City/State/ZIP: -r -d 6 l q-7?-31 Garage/carport area: square feet
Suite/bldg./apt.no.: 442 Project name: 30 4 ex 0 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: l.ot 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.
�
��^Q /914't Valuation: $ 3g5;
Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups: a
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
$.APILICANI' ❑ CONTACT PERSON NOTICE
Business name: SA-k f&G,r AD(09 y ( tb ' €_ All contractors and subcontractors are required to be
Contact name: �'�s s�^K� T licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be lizensed in the
Address: &'fO0 NE f y 99 # G'3-7- jurisdiction in which work is being performed.If the
1 1 applicant is exempt from licensing,the following reasons
City/State/ZIP: V A t1 co 0 N vrr (..4)A S?it&S apply:
Phone:(3Gd) C9c35- a(30 Fax::(3(00) 719- l s-,27
E-mail: . 4 le s 6 Slink lt.c1446109 y.At
CONTRACTOR T BUILDING PERMIT FEES*
Business name: et (O 9(/ 6 c cf4 TAC- Ip ^fie.toffee Permit/ Permit fee:
Address: (.94,0 0 NE' ii,nr, Q1 06.3
State surcharge(12%of permit fee):
City/State/ZIP: UAnco„we- Wef 9 GU C FLS plan review(40%ofpermit fee):
Phone:(3j,6) 664_ ,213c, Fax:(3G6 ) 7/9- /S-2 7 (Due upon application submittal)
CCB lie.: /73 731 Total permit fees:
��� Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: ff ea77 ei -j Date: /�I-A, �c� within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board
I:'Bui mitssFPS-PermitApp_071514.dee 440-4613T(II/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) 'Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
El New system Number of sprinkler heads: Number of alarm devices:
El Addition or ❑ 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3)copies of sketch showing area (3)copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet El Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
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: $
I:\Buil ding\Permits\FPS_PermitApp_071514.doc 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10220 SW GREENBURG RD 250, TIGARD, OR,
97223
Commercial - Fire Protection System
998 Alarm Final
PASS - No C of O
FPS2014-00169
Jeff Grove
Violation Summary:
Inspector Contractor