Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00116
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2010
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 130
Subdivision: Lot: 0
Project: State Farm
Project Description: Fire alarm
Owner: FEES
G &S FC LLC Description Date Amount
16850 SW UPPER BOONES FERRY RD SUITE Permit Fee - COM 10/08/2010 $112.96
A 12% State Surcharge - Building 10/08/2010 $13.56
PHONE: 503 - 639 -0108 Plan Review - Fire Life Safety - COM 10/08/2010 $45.18
Contractor:
LEAR ELECTRIC CO INC
PO BOX 573
GRESHAM, OR 97030
PHONE: 503 - 665 -9840
FAX:
Type of Use: COM
Class of Work: ALT Type of Const: IIB
Occupancy Grp: B Height: ft
Stories: 3
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: Manual
Pull Station Required: No Smoke Detectors Req: No
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $171.70
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 3238
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800. -
Issued By: Permittee Signature: 'G-
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 �] j�
Fire Protection System RECEIVED ED FOR OFFICE: USE ONLY
City of Tigard RDace/B : (C G
71 n ` O /O _,41/ Permit No.: PS o? ' — o6 / /�
q 13125 SW Hall Blvd., Tigard, OR 974'2 8 i 1' 1!' Plan Revie
C < Phone: 503.639.4171 Fax: 503.598.1960 Date/B : mart m ini Other Permit:
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready — : y: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: ` V L•_ ,,,. IQ 1 `I I Supplemental Information
T�� A I)
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ 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 OF CONSTRUCTION
work indicated on this application.
❑ 1- and 2- family dwelling ® Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors: it—
Job site address: 16083 SW Upper Boones Ferry Rd New dwelling area: square feet -�
City/State /ZIP: Tigard, OR 97224 Garage/carport area: square feet
Suite/bldg. /apt. no.: STE 104 Project name: State Farm Insuranse TI 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: 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
DESCRIPTION OF WORK work indicated on this application.
Extend Fire Alarm circuits for new tenant improvement Valuation: $3,238.00
Existing building area: 23712 square feet
New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 3
Name: State Farm Insurance Type of construction: office space
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Lear Electric Inc. All contractors and subcontractors are required to be
Contact name: Oleg Primachenko licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 5140 SE Circle Ave. jurisdiction in which work is being performed. If the
City/State /ZIP: Portland, OR 97236 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 849 -4723 Fax: : (503) 661 -6389
E -mail: op @learelectric.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: SAME AS ABOVE (Please refer to fee schedule)
Permit fee: /r ;Z - /
Address:
City/State /ZIP: State surcharge (12% of permit fee): / 3. tj �p
FLS plan review (40% of permit fee): 9s , S
Phone: ( ) Fax: ( ) (Due upon application.) T
CCB lic.: 52278 Total permit fees:
Authorized sign ! Amount received: � f 7 f . '(
co..... / j` "` /G!�'� �-- / This permit application expires if a permit is not obtained
Print name: Affivd 4,1i, fs9F6•2 Date: 10/08/10 * within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board.
I:\ Building \Pcrmits\FPS- PcrmilApp.doc 10 /01/09 440-4613T(I I/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only
® Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 3,238.00
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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
G \Documents and Settings \op\Desktop \FPS- PemritApp.doc 10/01/09 2
FIRE ALARM SYSTEM
RECORD OF COMPLETION 1FS Zvl 0- CC 1 t
Name of protected property: FANNO CREEK PLACE, BUILDING `B"
Address: 16083 S.W. UPPER BOONES FERRY ROAD, TIGARD, OR 97214
Representative of protected property (name /phone):
Authority having jurisdiction: CITY OF TIGARD BUILDING DEPT.
Address /telephone number:
(Organization name/phone) (Representative name/phone)
Installer: LEAR ELECTRIC / 503- 665 -9840 OLEG PRIMACHENKO
Supplier: GB MANCHESTER / 503- 287 -1112 NATHAN BUTZ
Service Organization: GB MANCHESTER / 503 -287 -1112 NATHAN BUTZ
Location of record (as- built) drawings: ONSITE / ON FILE
Location of operation and maintenance manuals: ONSITE / ON FILE
Location of test reports: A contract for test and inspection in accordance with NFPA standard(s): ONSITE
Contract No(s): N/A Effective date: N/A Expiration date: ANNUALLY
System Software VER. 2.50
(a) Operating system (executive) software revision level(s): N/A
(b) Site - specific software revision date: UNK.
(c) Revision completed by (name /firm): UNK.
1. Type(s) of System or Service
NFPA 72, Chapter 6- Local
If alarm is transmitted to location(s) off premises, list where received:
NFPA 72, Chapter 8- Remote station
Telephone numbers of the organization receiving alarm:
Alarm:
Supervisory:
Trouble:
If alarms are retransmitted to public fire service communications centers or others, indicate location and telephone
numbers of the organization receiving the alarm:
Indicate how alarm is retransmitted:
NFPA 72, Chapter 8- Proprietary
Telephone numbers of the organization receiving the alarm:
Alarm:
Supervisory:
Trouble:
If alarms are retransmitted to public fire service communications centers or others, indicate
location and telephone numbers of the organization receiving the alarm:
Indicate how alarm is retransmitted:
_XX_NFPA 72, Chapter 8- Central Station
Prime contractor: Central station location:
Means of transmission of signals from the protected premises to the central station:
McCulloh Multiplex One -way radio
_XX_Digital alarm communicator Two -way radio Others
Means of transmission of alarms to the public fire service communications center: N/A
(a):
(b):
System Location:
NFPA 72, Chapter 9- Auxiliary
Indicate type of connection: Local energy Shunt Parallel telephone
Location of telephone number for receipt of signals:
2. Record of System Installation
(Fill out after installation is complete and wiring is checked for opens, shorts, ground faults, and improper branching but prior
to conducting operational acceptance tests.)
This system has been installed in accordance with the NFPA standards as shown below, was inspected by :
on: 11/18/2010 , includes the devices shown in 5 and 6, and has been in service since: 11/18/2010
_XX_NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 10 11 (mark all that apply)
_XX_NFPA 70, National Electrical Code, Article 760
XX Manufacturer's instructions
Other (specify):
Signed: Date: 11/19/2010
Organization: LEAR ELECTRIC
3. Record of System Operation
Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3, is attached:
All operational features and functions of this system were tested by: MIKE WOODWARD date: 11/18/2010
and found to be operating properly in accordance with the requirements of:
XX_NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 10 11 (mark all that apply)
_XX_NFPA 70, National Electrical Code, Article 760
XX Manufacturer's instructions
Other (specify):
Signed: MA. Wo- aduw -un,cc Date: 11/18/2010
Organization: GB MANCHESTER
4. Signaling Line Circuits
Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
Quantity: 1 Style: 4 Class: B
5. Alarm- Initiating Devices and Circuits: NONE ADDED ON THIS PROJECT
Quantity and class of initiating device circuits (see NFPA 72, Table 6.5): N/A
Quantity: Style: Class:
MANUAL
(a) Manual stations Noncoded: Transmitters: Coded: Addressable:
(b) Combination manual fire alarm and guard's tour coded stations:
AUTOMATIC
Coverage: Complete: Partial:
Selective: Nonrequired:
(a) Smoke detectors: Ion: Photo: X Addressable:
(b) Duct detectors: Ion: Photo: Addressable:
(c) Heat detectors: FT: RR: FT/RR: RC: Addressable:
(d) Sprinkler waterflow indicators: Transmitters: Coded: Addressable:
(e) The alarm verification feature is disabled XX_ or enabled , changed from seconds to
seconds.
(f) Other (list):
6. Supervisory Signal- Initiating Devices and Circuits (use blanks to indicate quantity of devices): N/A
GUARD'S TOUR —N /A
(a) Coded stations
(b) Noncoded stations
(c) Compulsory guard's tour system comprised of transmitter stations and intermediate stations (Note:
Combination devices are recorded under 5(b), Manual, and 6(a), Guard's Tour.)
SPRINKLER SYSTEM - MONITORED, EXISTING
Mark if provided
(a) Valve supervisory switches
(b) Building temperature points
(c) Site water temperature points
(d) Site water supply level points
Electric fire pump:
(e) Fire pump power
(f) Fire pump running
(g) Phase reversal
Engine - driven fire pump:
(h) Selector in auto position
(i) Engine or control panel trouble
(j) Fire pump running
ENGINE - DRIVEN GENERATOR
(a) Selector in auto position
(b) Control panel trouble
(c) Transfer switches
(d) Engine Running
Other supervisory function(s) (specify):
7. Annunciator(s): 1 - EXISTING
Number: Type: Location:
8. Alarm Notification Appliances and Circuits: NEW DEVICES LISTED BELOW
NFPA 72, Chapter 6- Emergency Voice /Alarm Service: N/A
Quantity of voice /alarm channels: Single: Multiple:
Quantity of speakers installed: Quantity of speaker zones:
Quantity of telephones or telephone jacks included in system:
Quantity and the class of notification appliance circuits connected to system (see NFPA 72, Table 6.7):
Quantity: 4 Style: Y Class: B
Types and quantities of notification appliances installed:
(a) Bells: With Visible:
(b) Speakers: With Visible:
(c) Horns: 16 With Visible: 16
(d) Chimes: With Visible:
(e) Other: With Visible:
(f) Visible appliances without audible: 10
9. System Power Supplies:
(a) Fire Alarm Control Panel: Nominal voltage: 120VAC Current rating: 20A
Overcurrent protection: Type: BREAKER Current rating: 20A
Location:
(b) Secondary (standby): 24VDC
Storage battery: S.L.A Amp -hour rating:
Calculated capacity to drive system, in hours: 24 (MINIMUM)
Engine - driven generator dedicated to fire alarm system:
Location of fuel storage:
(c) Emergency system used as backup to primary power supply:
Emergency system described in NFPA 70, Article 700:
10. Comments
Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s):
System deviations from the referenced NFPA standard(s) are:
(signed) or installation contractor /supplier (title) (date)
Xollcv,, .J3u4 Project Manager, GB Manchester 11/19/2010
(signed) for alarm service company (title) (date)
(si _ ' et) for central station (title) (date)
U ∎ o ' ompletion of the sys (s) s isfactory test(s) witnessed (if required by the authority having jurisdiction):
I a,yi Cft � . / �ZZ
( gned) represenNtk of th ority having jurisdiction (title) (date)