Permit (50) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
• COMMUNITY DEVELOPMENT Permit#: FPS2019-00038
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/21/2019
7 t'' ' I<,l} g Parcel: 1S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD
Project: Lincoln Center Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: Fire alarm. Relocating(2)notification devices in 4th floor bathroom.
Contractor: JOHNSON CONTROLS FIRE PROTECTION LP Owner: LINCOLN CENTER LLC
6305 SW ROSEWOOD ST. BY SHORENSTEIN PROPERTIES LLC
LAKE OSWEGO, OR 97035 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-683-9000 PHONE:
FAX: 503-675-6521
FEES
Description Date Amount
Specifics: Permit Fee-COM 03/21/2019 $112.96
12%State Surcharge-Building 03/21/2019 $13.56
Type of Use: COM Plan Review-Fire Life Safety-COM 03/21/2019 $45.18
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 03/21/2019 $4.00
Occupancy Grp: Height: ft 11x17)
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 $175.70
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,378.08
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. o ay obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i 'ermi` '/i?
/s./lilt_
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 oft projec
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Fire Protection System ' FOR OFFICE USE ONLY
Received
City of Tigard : _
13125 SW Hall Blvd.,Tigard,OR 97223 � 7" r) - ; Plan Review ��
11 C. Phone: 503.718.2439 Fax: 503.598.1960"''_" Date/B : Other Permit: /
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: Iuris: ® See Page 2 for
Internet: www.tigard-or.gov
L.j���� Notified Method: Supplemental Information
_f
TYPE OF;WORK , •1 REQUIRED DATA 1 AND 2-FAMILY DWELLING
El New construction El 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 O `CONSTRUCTION ' work indicated on this application.
El1-and 2-family dwelling Commercial/industrial Valuation: $
ElAccessory building 0 Multi-family Number of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
JOB SITE:.INFORMATION AND LOCAtIO
Total number of floors:
Job site address: ()C.; ;..,,__)C.) s- 3 New dwelling area: square feet
City/State/ZIP: �tC� ('t� �� � �� � Gara a/ca ort area: squareuare feet
lSuite/bldg./apt.no.: Project name: L,a c C `_- ,,r
Vie Q. (L Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
4• 6 i i'.a DATA:OQ •IMEItGIAI,,*USE CHEC ® _*T
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
'''''-r'''-'-''''''j su '.ION.OF W R ' work indicated on this application.
y
‘--)"\'‘75,-.0- .... \RQ_. )()c�VC��\-.) Valuation: $ 2j . C
Existing building area: square feet
New building area: square feet
O.PROI& . R Mk l7 yTF 4AN'r 417; Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
..APPLICAN' . '`. ONTACT i ``
; �: ' v. w; Nutlet,
Business name: -\ciSe. 'A..- C - .. All contractors and subcontractors are required to be
Contact name: c C L\`'� � licensed with the Oregon Construction Contractors Board
r � under ORS 701 and maybe required to be licensed in the
Address: /' z` r^i, \ 'O l `--A- .�=-.'s\f jurisdiction in which work is being performed.If the
City/State/ZIP: J c t'( a' t' applicant is exempt from licensing,the following reasons
C-$� 1 . 3 . i ( .., d_, 1 -�j.,:; 7 apply:
Phone:(S-.,;.....1) _2)16..-j '°'47.7,C `l Fax::( )
E-mail: A, c)c',-„\s tit C\\l',,57.,%\', 4\ -C:)-'` C(., \/::\
. .. CT 61.434 I
NG PERMIT FEF
a
% R, z a ,--1.- }'' , refer tofee dufe)Business name: 7c)cY A\ C
C.( \G� (-7;\--e �A Permit fee:
Address: ( < ~ -'`� } A
�(3.,,--,,,,,,.e,
'�F,� `� "` �� State surcharge(12%of permit fee):
City/State/ZIP: Cil c�(�! �J:}(��.i' , o t'y\<�-- 6-11-c.;._ !--:-.) o
Phone:(:,-,-.....i..); ""'-'� �-�' � 7 �-.- Fax: FLS plan review(40/o of permit fee):
) C? ( ) (Due upon application submittal.)
CCB lic.: V:it C'(`(z( Total permit fees:
Authorized signature: /2/7/24(_,......_c_____ --
....,, '. Amount received:
- This permit application expires if a permit is not obtained
Print name: OL" Date: within 180 days after it has been accepted as complete.
�� G U `C ( � ' * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPSPerrnitApp \_031016.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be don+ k '' fx
�.,5 Ati i4; w M'
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) •Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: CNumber of alarm devices:
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:
Tgyp pf System (Complete or D a plicable , t A iif
x Wit . ' Dr .
•'" Co p � al Sper `r <<'xt.
Sprinkler Type ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
® :T , Hoore Suppression em
y.
Hood Project Valuation: $
,7,,,,,,.,.,,, ir. ,,,,,,,a0,
3 R A'
,,A:.„,,,'„.4.„,,,,,,.,,,,,07,.,,,,,,, ,,,,,,,,,,:--
Submittal shall Battery Calculations Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ _ 3-4F- `-CSG
r
.Y x' F S
i identxa S unkler(Stan one 7 ”"
Square Footage: Permit Fee: .r7 :le 114'1'44:;'
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 ”. , , � : t
Sprinkler Project Square Footage: sq. ft.
. . a ProtectPerm
Project valuation subtotal (see A,B &C above): $
Permit fee based on project va $
Permit fee based on sfo(12otage (see D above): $
State Surchquarearge %of permit fee): $luation (see fee schedule):
FLS Plan Review(40% of permit fee): $
TOTAL: $
2
I:\Building\Permits\P'PS_PernutApp_031016.doc
Cityof Tigard Permit No.: "r5 C CCy/
O.fof--
a
74
13125 SW Hall Blvd.,Tigard,OR 7� 3-) 0 1 W n
0 Phone: 503.718.2439 Fax: 503.598.40-Y ' Date Received: . /.,2//,
Inspection Line: 503.639.4175
/74.
TtO }Zn Internet: www.tigard-or.gov By: f
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF 5 DEVICES WITHOUT PLANS)
vi
Project Name: �`"t`�� Y'\ ( C =-- re 1 o Occupancy:
Job Address: 10250 SU C---trec�.vj09 Rd Suite:
Contractor: iOt' &(\ 6,44...1_,,,,�: Phone: ;03.._fig*} - 9 Z31
Valuation of work: $-C) `�
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(max 5) /To be Relocated(max 5)
Number of Proposed Manual Alarm Stations: To be Added(max 5) /To be Relocated(max 5)
Number of Proposed Notification Appliances: To be Added(max 5) /To be Relocated(max 5)
I5PAA.) \ i. Oregon Construction Contractors Board No. /iii Ql 2
certify the following is true nk(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 do v ment with a copy of the sketch attached shall be available for all inspections.
vh -;)// i
`I i/ 17, Dater4- t
,
Signature: �i��
Print Name:
v
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