Permit (192) m b
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
4COMMUNITY DEVELOPMENT Permit#: FPS2018-00099
T E cjA D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ' ��i F A
Date Issued: 08/28/2018
Parcel: 1S135DA02400
\O`' Jurisdiction: Tigard
Site address: 11045 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Fire alarm permit for a new 16,327 square feet,32-bed residential care facility. 10/25/18:REPRINTED to correct
address from 11035 to 11045.
Contractor: INNOVA NW Owner: BROOKSIDE RCF LLC
PO BOX 1291 5987 SE ROBHIL DR
MCMINNVILLE, OR 97128 MILWAUKIE, OR 97222
PHONE: 503-435-9695 PHONE:
FAX: 503-435-2351
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/28/2018 $411.46
12%State Surcharge-Building 08/28/2018 $49.38
Type of Use: COM Plan Review-Fire Life Safety-COM 08/28/2018 $164.58
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 08/28/2018 $10.00
Occupancy Grp: 1-2 Height: 20 ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 08/28/2018 $17.50
11x17)
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: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $652.92
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $34,000.00
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 503.232.1987 or 1.800.332.2344.
Issued By: 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 FIRE PROTECTION SYSTEM PERMIT
: ' COMMUNITY DEVELOPMENT Permit#: FPS2018-00099
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2018
T t i_;;ti I<.I� g Parcel: 1S135DA02400
Jurisdiction: Tigard
Site address: 11035 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Fire alarm permit for a new 16,327 square feet,32-bed residential care facility.
Contractor: INNOVA NW Owner: BROOKSIDE RCF LLC
PO BOX 1291 5987 SE ROBHIL DR
MCMINNVILLE, OR 97128 MILWAUKIE, OR 97222
PHONE: 503-435-9695 PHONE:
FAX: 503-435-2351
FEES
Description Date Amount
Specifics: Permit Fee-COM 08/28/2018 $411.46
12%State Surcharge-Building 08/28/2018 $49.38
Type of Use: COM Plan Review-Fire Life Safety-COM 08/28/2018 $164.58
Class of Work: ALT Type of Const: VB Info Process/Archiving-Lg$2.00(over 08/28/2018 $10.00
Occupancy Grp: 1-2 Height: 20 ft 11x17)
Stories: 1 Info Process/Archiving-Sm$0.50(up to 08/28/2018 $17.50
11x17)
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: Yes Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $652.92
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $34,000.00
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 o thin a c. . of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 1_,d2h/Azalnittee 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.
Building Permit Application
Fire Protection System FOR OFFICE USE()NUN'
iif" "a 1 3 Received
City of Tigard ' • Date/B : / Permit No.: --- 1. /
IN • 13125 SW Hall Blvd.,Tigard,OR 9722Plan Review
C. Phone: 503.718.2439 Fax: 503.598.19W i 1 ,p J Date/B : 1 - i 1 I F Other Permit: /' LJ —
OiY
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: � la See Page 2 for
Internet: www.tigard-or.gov t a ' , a E" Notified/Method: i , 1ArAfIJlr r� Supplemental Information
s 6 1+ <``, " ,,.
TYPE OF WORK' REQUIRED DATA:1 AND V.`F.A.MI..Yi)WELLING
ew construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
C'4-4ATEGORY OF OONSTRUICTION work indicated on this application.
El1-and 2-family dwelling ❑Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
30B SITE; TION AND LOCATION Total number of floors:
11 '' ` tt
Job site address: ` I 0 t,,1S 5 W t'1,o..�\ 1 Yd. New dwelling area: square feet
City/State/ZIP: (i o,2 at'?' �"3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: OtkS; A J Q Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQU. w'`DAT = MMERC ' E CILIST.
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
DFS '444O e , r work indicated on this application.
.1-�<'17`+A/ . F A .5-.7.sA-e,v.... Valuation: $ f 100t�
Existing building area: l square feet
New building area: square feet
0 PROPERTY R4 .• ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
` r iPLICANT ' ''''''t3 C • w RSO/ _\ ,:,o
Business name: LKHO.IA Nt.A.) All contractors and subcontractors are required to be
(�_� licensed with the Oregon Construction Contractors Board
Contact name:
re "- �C.66under ORS 701 and may be required to be licensed in the
Address: a,D'3 " t.49 9.,, jurisdiction in which work is being performed.If the
City/State/ZIP: KL, ,.. ; ,Av L tZ Gi"'t 1'p applicant is exempt from licensing,the following reasons
��
Phone:(.1F00:„,') 4-/-J . 6 log 1 Fax: :( I►g'I l. i .06bS
E-mail: +l r GIZl Y �' t�vbNCgf✓1.‘ J • C.()NA."...
F
7 a * ONTRACTOR , -° t • t„ RIVIIT FEES
A t � ` ., : --.r... sato"fee schedulee) � ;z.
Business name: < QK/�A 0., .- Apputm‘nt- Permit fee:
Address: of� loitfi
City/State/ZIP: /1.)c";'JQ� `J- ,,�.�" State surcharge(12%of permit fee):
� �%`K � (7/ Y FLS plan review(40%of permit fee):
Phone:(53 )/ 7 5"-- /L ii. Fax:( ) (Due upon application submittal)
CCB lic.: ( 7a* _ Total permit fees:
�' �� � Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Date: ee within 180 days after it has been accepted as complete.
IL, " ��3 n * Fee methodology set by Tri-County Building Industry
Service Board.
I.\Buildmg\Permits\FPS-PermitApp_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done w
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
�i\lew system Number of sprinkler heads: Number of alarm devices: ��-F
((❑ Addition or ❑ 1-10 heads: Affidavit required and •�_ is ><davit - •_.nd
Alteration (3) copies of sketch showing area �i :' o s:owing area
to existing of work within building structure of ...,a. :ucture
system
❑ 11+ heads: Plan review required and6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
T" to Cft , � C or D as applicable # r. 7i::,-,31:-.
Sprinkler Type El Wet El Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type ;14004-.'''4.e Suppression System .kx :t.:.„-:,..,:i0.:, v
Hood Project Valuation: $
V
'') re
7:7"t
::- '''Sit-;:$1'"1-''.'C'44'7115.:;*:::1[1:1' '''''' t li':;Ir'
Submittal shall Battery Calculations I i
� Yes
include: Individual Component m/ Yes
Cut Sheets
Fire Alarm Project Valuation: $ �: 0( )
• s A a1 rinkl�k ptl �®nex
{ s s �'' p x ,. a.� ar ,i t ,. . :,;:t..,.:,,,,,,,,f...:
r
Square Footage: Permit Fee: ,
$198.75
0 to 2,000
2,001 to 3,600 .,e
$246.45 a� , t
3,601 to 7,200 $310.05 :'_ , r
7,201 and greater
$404.39 a $
Sprinkler Project Square Footage: sq.ft.
,4 n ." Fire 'r tia� ``.l w t il es" :°
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: $
2
I:\Building\Permits\FPS_PermitApp_031016.doc
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11045 SW HALL BLVD, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2018-00099
Inspection Type: Inspector:
998 Alarm Final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor