Permit 1111 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
Perm FPS2011 -00076
2 COMMUNITY DEVELOPMENT Date Issued: 09/30/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 2S113AD01700
Jurisdiction: Tigard
Site address: 16850 SW 72ND AVE
Project: Bridal Exclusive Subdivision: ROSEWOOD ACRE TRACTS Lot: 30
Project Description: Fire alarm. Adding horn strobes to existing system.
Contractor: METRO SAFETY & FIRE INC Owner: BRIDGEPORT LAND LLC
PO BOX 33650 3939 NW ST HELENS RD
PORTLAND, OR 97068 PORTLAND, OR 97210
PHONE: 503 - 231 -2999 PHONE
FAX 503 - 256 -4691
FEES
Description Date Amount
Specifics: Permit Fee - COM 06/22/2011 $86.06
12% State Surcharge - Building 06/22/2011 $10.33
Type of Use: COM Plan Review - Fire Life Safety - COM 06/22/2011 $34.42
Class of Work: ALT Type of Const: IIIB Info Process /Archiving - Lg Sheet (over 06/22/2011 $2 00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm Sheet (up to 06/22/2011 $7.50
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: Smoke Detectors Req•
Battery Calcs Provided Yes Cut Sheets Required Yes
Total $140.31
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0 00
Residential Square Footage 0
Fire Alarm Valuation. $1,800 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 ques 'ins to O by call' g 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 da e.
This permit card shall be kept in a conspicuous place on the job site until completion of the proje
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
I
Fire Protection System FOR OFFICE USE ONLY
ill City of Tigard DateB _ Wm Permit No - �
a 13125 SW Hall Blvd., Tigard, OR `L0� Plan Revi � f!!
Phone. 503 718.2439 Fax 503 5960 �\ �1 DateB .�Th ill Other Permit j a , oil �� r�7
Inspection Line: 503 639 4175 ,v1v
\U P�� Date Ready/By � ® See Page 2 for
TIGARD Internet' www.tigard -or O`� ,1 \S\�� Notified/Method. ti �L. Supplemental Information
0\ 1 ` 0\ ` 0\ 4 S Iv fA
TYPE OF W11 REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. No
Indicate the value (romded 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 A 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:
Job site address: �Lif' 6'GaJ 72 dpe New dwelling area: square feet
City /State /ZIP: 7:440 d,✓. .979aj ‘' 6 1 Exc1ks Fvt Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: tl y +• Covered porch area square feet t
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (romded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
A i Valuation: $ i r o ')
.4, , ;.b.J 1(' J AN l, $ f—$ 71 �/� Existing building area square feet
Fide-__ 474PRiri New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax. ( ) New:
'APPLICANT ❑ CONTACT PERSON NOTICE
X.
Business name: � ., S;11:6',1; $- "t/ e All contractors and subcontractors are required to be
Contact name: in - , 1 - -� / licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: /y$? y j° - s7 , .E5'' jurisdiction in which work is being performed. If the
City /State /ZIP: ,,� �72.S�s applicant is exempt from licensing, the following reasons
C,0/�, n e.c apply:
Phone. ( p ^ ) ) 9 9 q ' Fax :. (S ,.-� V /G<9/
E -mail: //a e iP3S.b es ,drill F,e Lo-0
�9
CON BUILDING PERMIT FEES* r
Business name: � r (Please refe to fee schedule)
�� t`� ^-� , e" ? 1Y/ Permit fee: vV
Address:
City /State /ZIP: State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Due upon application.)
CCB lie.: 4 3(r 5 i Total permit fees:
Authorized signature: c" Amount received: / not \ .3
y to
This permit application expires if a permit is n n
Print name: s �„� �c� Date: 470 2 J,, * within 180 days after it has been accepted as complete.
/ `�� Fee methodology set by Tri -County Building Industry
Service Board l
1 \ Building \Permits\FPS- PermitApp doe 02/01/2011 440- 4613T(11/02/COM/WEB) 1 -1 31
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: $
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 three (3) sets of plans at submittal.
Plan review fees are required at submittal.
I \ Budding \ Permits \FPS- PemvtApp doc 02 /01/2011 2
/
S Z6 ti—e, 0076
FIRE ALARM SYSTEM
RECORD OF COMPLETION
Name c f protected property: '/O '/ S.t/ GG.e.-SIVs
Address: .i. o /
Representative of protected property (name /phone):
Authority having jurisdiction: '
i j (jam 7)/A Z/]
1 Address /telephone number:
Organization name phone Representative name phone
Installer_ "ii,-A4-77i2, 3 %Y.17 f � 7� >' f
Supplier ....4" �T /2n relef f / - i 2 e
Service organization ...--- t , - iff , - 7 ( i/'1'
Location of record (as- built) drawings: oti d' !T"
Location of operation and maintenance manuals: p A./ .5 )7
Location of test reports: 4;2A- .S 1 i f
A contract for test and inspection in accordance with NFPA standard(s)
Contract No(s): Effective date: Expiration date:
System Software
(a) Operating system (executive) software revision level(s):
(b) Site- specific software revision date:
(c) Revision completed by:
(name) (firm)
1.Type(s) of Systeem or Service
NFPA 72, Chapter 6 — Local
If alarm is transmitted io 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 alarm:
Indicate how alarm is retransmitted:
NFPA 72, Chapter8— Proprietary •
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 alarm:
Indicate how alarm is retransmitted:
_NFPA 72, Chapter 8 — Central Station
I I Prime contractor:
Central station location:
(NFPA 72, of 4) -
Copyright NFPA
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Means of transmission of signals from the protected premises to the central station:
McCulloh Multiplex One -way radio I
X Digital alarm communicator Two-way radio Others
•
Means of transmission of alarms to the public fire service communications center:
(a) TSLfjp,c%.v ,r
(b)
System location:
• NFPA72, 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 kropens, 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 , includes the devices shown
in 5 and 6, and has been in service since .
''. NFPA 72, Chapters 5 ) ® ,3 e x9 11 (circle all that apply)
.r NFPA 70, National Electrical Code, Article 760
/r Manufacturer's instructions
1 •
Other (specify):
/iii '
• Signed: - �,e _ice D ate: 97i r,4 1l
Organization: �'�,� �9O - Ter - �,7 ? > � n f
7
3. Record of System Operation
Documentation in accordance with Inspection Testing Fbrm, Figure 10.6.2.5,
All operational features and functions of this system were tested by� date 9y70/
and found to be operating properly in accordance with the requirements of
!)NFPA Chapter sa _TCD 6v()0( (t7- (circle all that apply)
21 NFPA 70, National Electrical Code, Article 760
Manufacturer's instructions
Other (speciy): ,
Signed: -2 yi — Date: /�e, Pi
Organization: � 530707 / { /�f
7
4. Signaling Line Circuits
Quantity and lass of signaling line circuits connected to system (seeNFPA 72, &Me 66.1):
Quantity: Style: Class: •
(NFPA 72. of 4)
Copyright NFPA
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5. Alarm-Initialing Devices and Circuits
Quantity and class of initiating device circ is (see NFPA 72, Table 6.5):
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 / Addressable
(b) Duct detectors Ion Photo Addressable
(c) Heat detectors FT RR FT/RR RC Addressable
(d) Sprinkler waterflow indicators: Transmitters Noncoded Coded Addressable
(e) The alarm verification feature is disabled or enabled , changed from seconds to seconds.
(f) Other (list):
6. Supervisory Signal - Initialing Devices and Circuits (use blanks to indicate quantity of devices)
GUARD'S TOUR
(a)_ 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 Tout
SPRINKLER SYSTEM
Check if provided
(a)_ Valve supervisory switches
(b) Building temperature points
(c) Site water temperature points
(d)__ — Sits 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):
(NFPA 72, 3 o14)
Copyriglit NFPA
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7. Annunciator(s)
Nun iber: Type: Location:
8. Alarm Notification Appliances and Circuits
NFPA 72, Chapter 6 — Emergency Voice/Alarm Service
Quantity of voice/Alarm channels: Single: Multiple:
Quantity of speakers installed: Quantit 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: Style: Class:
Types and quantities of notification appliances installed:
(a) Bells With Visible
(b) Speakers With Visible
(c) horns With Visible
(d) Chimes With Visible
(e) Other: With Visible
(f) Visible appliances without audible: 4/
9. System Power Supplies
(a) Fire Alarm Control Panel: Nominal voltage: (G Current rating: -2' o
Overcurrent protection: Type: „ei2- 5 .e71 /y'/1 Current rating: - 4 1
Location: l A? # '70
(b) Secondary (standby):
Storage battery: -2 V _ Amp -hour rating: 7
Calculated capacity to drive system, in hours: 2 5/
Engine- driven generator dedicated to fire alarm system:
Location of fuel storage:
(c) Emergency system used as backup to primary power supply: I�-
Emergency system described in NFPA 70, Article 700:
i `—
�� 1 0_ 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:
9w ///
(si . .) for installation contractor supplier (title) (date)
(sig ".) for .arm service com.. (title) (da te U
9./r))1/-2C) (si d) or ca tral station (title) (dater'
Upon completion of the system(s) satisfactory test(s) witnessed (if required by the authority having jurisdiction):
(signed) representative of the authority having jurisdiction (title) (date)
(NFPA 72, 4 of 4)
Copyright NFPA
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