Permit (141) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
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111 ' . COMMUNITY DEVELOPMENT Permit#: FPS2019-00115
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/09/2019
T t i,A I n9 Parcel: 1 S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 110
Project: MiaDonna Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: Fire alarm. Relocating(3)devices for TI.
Contractor: POINT MONITOR CORPORATION Owner: LINCOLN CENTER LLC
5863 LAKEVIEW BLVD STE 100 BY SHORENSTEIN PROPERTIES LLC
LAKE OSWEGO, OR 97035 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Permit Fee-COM 09/09/2019 $64.54
12%State Surcharge-Building 09/09/2019 $7.74
Type of Use: COM Plan Review-Fire Life Safety-COM 09/09/2019 $25.82
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 09/09/2019 $1.00
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 $99.10
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $1,000.00 _
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 0 1.800 32.2344. c jj�� '7'�/,
Issued By: /',� /d r #7 'ermittee Signature: �)� /� CG/GGf7
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.
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Building Permit Application
Fire Protection System l oR OFFI(F, I 'F O\L1
E P C G 1 Received •
City of Tigard Da/ = [�� g
a 13125 SW Hall Blvd.,Tigard,OR 97223( Plan Review1111
�aC"0`'" L 9 7i 0
f Phone: 503.718.2439 Fax: 503.598.1:t 1 . � Date/B ; •
I 1, I,I Inspection Line: 503.639.4175 Date Ready:By: Auris:
Internet: www.tigard-or.gov Notified/Method: IEEFEIEBII
,� ..
TYPE OF WORK REQtJ RED DATA:1-AND<2-FAMILY DWELLING
0 New construction 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY*OF
=s'sTRuc-nON a work indicated on this application.
tx m
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
# 1T. -NItoRMAnoN kV OCATIOI Total number of floors:
Job site address:10250 SW Greenburg Rd New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:110 I Project name:MiaDonna Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
Q J t '!A A:COM r IA,L-USE;CbECKLIST
Subdivision: I 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
1l RIFTON OF WOE - work indicated on this application.
FIRE ALARM-RELOCATES ONLY Valuation: $S1,000.00
Existing building area: square feet
New building area: square feet
• " O toPE1tTT!SA
lifAmaz,rTEP{ Number of stories:
Name:MiaDonna Type of construction:
Address:10250 SW Greenburg Rd Suite 110 Occupancy groups:
City/State/ZIP:Tigard,OR 97224 Existing:
Phone:( ) Fax:( ) New:
PLC
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4 + .,.. ANr a z ,TACT PERSlDN ; 7==i,
` , NO 19F ,
Business name:Point Monitor Corp. All contractors and subcontractors are required to be
Contact name:Brooke Williams licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address:5863 Lakeview Blvd#100 jurisdiction in which work is being performed.If the
City/State/ZIP:Lake Oswego,OR 97035 applicant is exempt from licensing,the following reasons
Phone:(503)b27-0100` F k::T )
any'
E-mail:bwilliams@pointmonitor.com
s"
Business name:Point Monitor Corp. .-. (Please iejei tutee sc
Address:5863 Lakeview Blvd#100 Permit fee:
State surcharge(12%of permit fee):
City/State/ZIP:Lake Oswego,OR 97035 FLS plan review(40%of permit fee):
Phone:(503)627-0100 Fax:( ) (Due upon application submittal.)
CCB lie.:135901 Total permit fees:
Amount received:
Authorized signature:
This permit application expires if a permit Is not obtained
Print name:Ben Breit Date:9/5/19 within 180 days after It has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board
I.BuildiatePetmitsFPS-PermitApp_031016.doe 440-46131(11=0_=COM'WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2-Supplemental Information
L) Type of Work 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: Number of alarm devices: 3
® Addition or ❑ 1-10 heads: Affidavit required and ® 1-5 devices: Affidavit required and
Alteration (3) copies of.sketch showing area (3)copies.
opies of.
f sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and 0 6+devices: Plan review required and
(3)sets of plans. (3)s::::'If.
ts of plans.
-
Additional description of work: Fire Alarm Notification Devices
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Sprinkler Type 0 Wet 0 Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes 0 No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
$) e I I_Mood Fire Su t r ssr<on Syste n �,.w te'
xHood Project Valuation: $
'� y as,,, '" x*ky�.`�, ', 4.a.,
Pied S. � �`
•
Submittal shall Battery Calculations 0 Yes
include: Individual Component
0 Yes
Cut Sheets
Fire Alarm Project Valuation: $ 1,000
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Square Footage: Permit Fee:
0 to 2,000 $198.75
,On j
3,601 to 7,200 $310.05 x
7,201 and greater _ $404.39 x° E • ft.
Sprinkler Project Square Footage: sq. ft.
Fire Protec u—'-' rnaut Feed
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: $
C:\Users\bailhams\Desktop\PERMIT'IY)RMS\Tire permit-city of tigard.doc 2
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City of Tigard Permit No.:
I 13125 SW Hall Blvd.,Tigard,OR 97223 S E P 5 2019
Phone: 503.718.2439 Fax 503.598.1960 Date Received:
Inspection Line: 503.639.4175 C •
I I L) Internet: www.ti and-or. ov 4 a "
g g uvs �, By: AWL.
FIRE ALARM SYSTEM AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(MAXIMUM OF.5 DEVICES WITHOUT PLANS)
Project Name: MiaDonna Occupancy: Same
Job Address: 10250 SW Greenburg Rd. Suite: 110
Contractor: Point Monitor Corp. Phone: 503-627-0100
Valuation of work: $1,000
Type of System: (check one) t■Required ['Non-required
(check one) ['Automatic []Manual OBoth
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( .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 c.sl /To be Relocated(max 5) 3
1, Ben Breit Oregon Construction Contractors Board No. 135901
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.
0 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 docum t with a copy of the sketch attached shall be available for all inspections.
Signature: Date: 9/5/19
Print Name: Ben Breit
I:1Building\Fonns\FireAlarmAffidavit_071514.docx Page 1 of I