Permit (42) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
■' COMMUNITY DEVELOPMENT Permit#: FPS2017-00159
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2017
T t c I t: g Parcel: 1S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 201
Project: Radiant Senior Living Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire alarm permit:Relocating(1)notification appliance. Affidavit submitted.
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-255-9488 PHONE:
FAX: 503-257-7121
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/13/2017 $80.68
12%State Surcharge-Building 10/13/2017 $9.68
Type of Use: COM Plan Review-Fire Life Safety-COM 10/13/2017 $32.27
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 10/13/2017 $0.50
Occupancy Grp: Height: ft 11x17)
Stories: Hourly Building Rate 10/13/2017 $180.00
Hourly Building 12%State Surcharge 10/13/2017 $21.60
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:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $324.73
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,600.00
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 questions to OUNC by calling 503.23.. •c or 1.800. _
s
Issued By: e thee Signature: f. > r
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.
1
Building Permit Application f
Fire Protection System FOR OFFICE USE ONLY
Cl of Tigard eived r .
et `J g .i .B k„)..LZS�rr1P� Permit No.: `1
III 13125 SW Hall Blvd.,Tigard,OR 97223 �
Phone: 503.718.2439 Fax: 503.598.1960 DatReview Other Permit:1 - .y,. /,....
T I G A Et D Inspection Line: 503.639.4175 y L �Q 1 Date Ready/By: ® H See Page 2 fm
Internet: tvww.tigard-or.gov 0 C T 1 Notified/Method: f Supplemental information
x ii tr r ° REQUIRED DATA 1-ANO 2 r Y DWELL1N
❑New construction • Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OP CONSTRUCTION- work indicated on this application.
❑ 1-and 2-family dwelling ® m
Comercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFO A ON Abp Q ATION ''. : Total number of floors:
Job site address:10220 SW Greenburg Road (3Lincoln) New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:201 Project name:Senior Radiant Living Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
,‘
REQUIRED°DATA,GQA CIAL..ijs!,RE-+ ,IST`
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no
equipment,materials,labor,overhead,and the profit for the
ESC ION OP OR1Z work indicated on this application.
Install fire alarm devices per submitted plans. Valuation: $1,600.00
Existing building area: square feet
b
New building area: square feet
[� -1 Z 1i14* ,. - 1 { :. # 'T'F AIV '- Number of stories:
Name:Shorenstein Realty Services Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
� -Q APP ICANT- i 7 O C'3'1 !i SON .�. , ,l rP - iOTIGE
�k,.:r M,i-., r .xti:,._mow.: ..._..r,� e ..� � .r_�,-�,.. ,.. ._. .�.. ;�. �.�.��. - - �^
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:
Business name:Capitol Electric Company,Inc. (Pfense;releito�eE elredule1
Permit fee: 80.68 f
Address:11401 NE Marx Street
City/State/ZIP:Portland,OR 97220 State surcharge(12%of permit fee): 9.68
FLS plan review(40%of permit fee): 32 27
Phone:(503)255-9488 Fax:(503)255-1966 (Due upon application submittal) -4•--.2v
CCB lie.:48748 Total permit fees: 122'63-)� j 3
Authorized signature: U.*I\p/17 p.n.&
Amount received:
This permit application expires if a permit is not obtained
Print name:Shane Tercek Date:10/11/17 within 180 days after it has been accepted as complete,
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\BuitdingWermas1FPS-PcnnitApp 031016.doc 440-4613T(11/02/COMAVEB) /.+j
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
) fi ni o 'oxk#o'b'c done , : y .: <y -- ..f , _
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
0 New system Number of sprinkler heads: Number of alarm devices: 1
® 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
0 11+heads: Plan review required and ❑ 6+ devices: Plan review required and
(3)sets of plans. (3) sets of plans.
Additional description of work:
wr vB U � . u
yleR,BC or sa picab 4. ) ,3 i, '� - -,`u �.wrte `? �
a ` .r
6 i e W z,-:. is vx v ri ...< '''';',....12.t„..757%-k.1-,;4.:,'-,' ' s
4.1.A;- a e0 ab ' i�e� s N, . `s `. A.
Sprinkler Type ❑ Wet
❑ D
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes 0 No
Hazard Group
Density
Design Area
K.Factor
Sprinkler Project Valuation: $
B ��pp T ^ 'y1� 7y W/� �[a� x-,��.--�4�� ��v� �:, c .max 4 �:
"R� \?�-+ tretiJt - ! ilii eAll iii-i . . ....,..... ...`3..?.....V-:'- w,,: ".-. ,:...,.... :.
Hood Project Valuation: $
:rte. X -n 4
Submittal shall Battery Calculations ii Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1600
31 `="? .a, .24W3-;-;',.::- T r`'",`„ s`= fx:."Q 3 ` rt r u '3* y 'r''
't� --} -sem � ,n �. 'x. ��tv�'��a»a.. .x �` �' � � 4 �� ,€� �„ �s
. . Residential S rider(Stand gone System) .
ic
Square Footage: Permit Fee: . . .. `'. Wit,
q .� -:I
0to2,000 $198.75 , . F ,, , ".
2,001 to 3,600 $246.45 '* ,�4-, �
3,601 to 7,200 $310.05
.,,
7,201 and greater $404.39
Sprinkler Project Square Footage: sq.ft.
f n . TFire Protection Permit F , ,,` .,1,1 'g, i
Project valuation subtotal(see A,B &C above): $ 1600 1
Permit fee based on project valuation(see fee schedule): $ 80.68 1
Permit fee based on square footage(see D above): $
State Surcharge(12%of permit fee): $ 9.68 I
FLS Plan Review(40%of permit fee): $ 32.27
TOTAL: $ 122.63 i
I
1
\\CE-FS01\RedirectedFolders\Dan\FA Jobs\zz171499-45 Radiant Senior Living @ 3liicoln-201\1 FPS_PermitApp 2017.0126.doc
1111 City of Tigard EIV Permit No.: ff5f2 l7-OO`, -�
'I 13125 SW Hall Blvd.,Tigard,OR 972
L1/p/
f3 Phone: 503.718.2439 Fax: 503.5Date Received: A / 7
Inspection Line: 503.639.4175 OCT 11 2017
TIGARD Internet www.tigard-or.gov By:
CITY OF TiGAR
FIRE ALARMSI% AVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
Project Name: Radiant Senior Living Occupancy: B
Job Address: 10220 SW Greenburg Road (3Lincoln) Suite: 201
Contractor: Capitol Electric Co., Inc. Phone: 503-255-9488
Valuation of work: $1600
Type of System: (check one) •Required ❑Non-required
(check one) ❑Automatic DManual ['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(max 5) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(vwx 5)
Number of Proposed Notification Appliances: To be Added(mux 5) /To be Relocated(max 5) 1
I, Shane Tercek Oregon Construction Contractors Board No. 48748
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: 3,' ) Date: 10/11/17
Print Name: Shane Tercek
I:\Building\Forms\FireAlarmAffidavit 071514.docx Page 1 of 1
L
Branden Taggart
From: Shane Tercek <Shane@cepdx.com>
Sent: Thursday, October 12, 2017 6:50 AM
To: Branden Taggart
Cc: #Building Permit Technicians
Subject: RE: FA Affidavit
Attachments: FA Submittal Plans,pdf
Branden,
It is attached. Please add the early morning test fees.
Thanks,
Shane Tercek
Capitol Electric Co.,Inc.
11401 NE Marx St,Portland,OR 97220
T:(503)255-9488 I C:(503)516-2233 I D:503-262-0405
shane@cepdx.com I www.capitolelectricco.com
Ca Ito
Electric Co Inc
"Celebrating over 30 years of excellence and innovation"
The information contained in this electronic mail transmission is intended by Capitol Electric Co.,Inc.for the use of the named individual or entity to which it is directed and may
contain information that is confidential or privileged.If you have received this mail transmission in error,please delete it from your system without copying or forwarding it,and
notify the sender of the error by reply e-mail or calling(503)255-9488 so that the senders'records can be corrected.Thank you.
From: Branden Taggart [mailto:brandent@tigard-or.gov]
Sent: Wednesday, October 11, 2017 4:22 PM
To: Shane Tercek<Shane@cepdx.com>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: FA Affidavit
Shane,
We are missing the plan showing the area of work. Once we receive the plan,we will notify you and let you know when
you can pay the fees online. Would you like us to add the early morning inspection fees?
Thanks,
1
Branden Taggart
11 q City of Tigard
* Permit Technician
nll�
�r, Community Development
13125 SW Halt Blvd
Tigard,OR 97223
(503}718-2449
brandenttigard-o r.gov
From:Shane Tercek [mailto:Shane@cepdx.com]
Sent:Wednesday, October 11, 2017 3:11 PM
To: #Building Permit Technicians <TigardBuildingPermits@tigard-or.gov>
Subject: FA Affidavit
Permit Specialist,
Please submit the attachments for a fire alarm affidavit @ 3Lincoln-201. Please call me to pay the fees. Please either e-
mail or mail back the approved plans.
Thanks,
Shane Tercek
Capitol Electric Co.,Inc.
11401 NE Marx St,Portland,OR 97220
T:(503)255-9488 I C:(503)516-2233 I D:503-262-0405
shane@cepdx.com I www.capitolelectricco.com
c 1
E Co Inc
"Celebrating over 30 years of excellence and innovation"
The information contained in this electronic mail transmission is intended by Capitol Electric Co.,Inc.for the use of the named individual or entity to which it is directed and may
contain information that is confidential or privileged.If you have received this mail transmission in error,please delete it from your system without copying or forwarding it,and
notify the sender of the error by reply e-mail or calling(503)255-9488 so that the senders'records can be corrected.Thank you.
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
2
Capitol
Electric Co., Inc.
September 11, 20174``
OCT 1 12017
Plans Examiner
City of Tigard CITY OF I lc. PHL
Building Services BUILDING jMSIO '`
13125 SW Hall Blvd.
Tigard, OR 97223
Re: Tenant Fire Alarm System Additions
Radiant Senior Living, Suite 201 @ 3Lincoln
10220 SW Greenburg Road
Tigard, OR 97223
Please find attached building a permit application,three sets of plans for the fire alarm
tenant improvements at the address shown above.
Occupancy Group: B
The fire alarm system design includes the following:
1. Relocate ADA synchronized fire alarm notification devices in the tenant space
including(1) strobe.
2. We will pre-test the fire alarm devices prior to requesting a final fire alarm
inspection.
3. Fire alarm design by Simplex-Grinnell,installation by Capitol Electric Co.
Please contact me if you have questions or comments.
Re pectfull ,
-114Shane Tercek.
Project Manager/Estimator
Fire/Life Safety Division
Capitol Electric Company, Inc.
(503)262-0405 Direct
shane@cepdx.com
NICET Level II,Fire Alarm Systems#140599
11401 NE Marx • Portland, Oregon 97220-1041 • 503-255-9488 • Fax 503-257-7121
CCB# 48748 • www.capitolelectricco.com