Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1,
COMMUNITY DEVELOPMENT Permit #: FPS2013 -00019
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/30/2013
Parcel: 1S127DD01200
Jurisdiction: Tigard
Site address: 10031 SW CASCADE AVE
Project: Orchard Supply Hardware Subdivision: NIMBUS INDUSTRIAL PARK Lot: PT 21, 2
Project Description: Fire Alarm
Contractor: STANLEY SECURITY SOLUTIONS INC Owner: KRAUSZ PUENTE LLC
15495 SW SEQUOIA PKWY SUITE 100 BY THE KRUASZ COMPANIES INC
PORTLAND, OR 97224 44 MONTGOMERY ST STE 3300
SAN FRANCISCO, CA 94104
PHONE: 503 - 968 -3353 PHONE:
FAX: 503 - 968 -3398
FEES
Description Date Amount
Specifics: Permit Fee - COM 01/30/2013 $451.76
12% State Surcharge - Building 01/30/2013 $54.21
Type of Use: COM Plan Review - Fire Life Safety - COM 01/30/2013 $180.70
Class of Work: ALT Type of Const: VB Info Process /Archiving - Lg $2.00 (over 01/30/2013 $12.00
Occupancy Grp: M Height: ft 11x17)
Stories: 1 Info Process /Archiving - Sm $0.50 (up to 01/30/2013 $7.00
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 $705.67
Valuations:- Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $39,000.00
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. ,1 //
Issued By: . %n , I ,/ Permittee Signature: PPL/ C, 'gad )211.241ey 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 RECEIVED FOR OFFICE USE ONLY
Received �Q� y, /1
City of Tigard Date/By: f - — 3 J Per
City t � 3 -� /3oi
1 3125 SW Hall Blvd., Tigard,OR 97223
� g � Plan Review
: Phone: 503.718.2439 Fax: 503.598.1960 JAN 8 O�� DateBy: ! O r 1 I Z1 re; Other
1 0
I' I G n R D CITY Inspection Line: 503.639.4175 / v �/ p� Date Ready El See Page 2 for
Internet: www.tigard - or.gov I l 1 OF lTIGARD Notified/Method: I , 3 Sr luri ( O Supplemental Information
BUILDING DIVISION o (ct et.o 1 f
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 (roinded to the nearest dollar) of all
ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CO work indicated on this application.
❑ 1- and 2- family dwelling �( omercial/industrial Valuation: $
�� NS ST� TRUCTION m
El Accessory building ❑ Multi - family Number of bedrooms:
El Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: New dwelling area: square feet
City/State/ZIP: Gr„4.2 j Q 4... .-- 9 7 Z( Garage /carport area: square feet
Suite/bldg. /apt. no.: Project namOtN ,5u Q PL ilk t ow42 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.
Tax map /parcel no.: Indicate the value (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application. ���� /
f/ ,, A-G M c5 V, rn 1 77-2,7,5 Valuation: $ '''( -)
Existing building area square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: O !✓ E
Name: Type of construction: S' 13
Address: Occupancy groups: M
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: .S pr✓L c y 3 - a — .CU 2 I . 7 - 1 ,5 (.- T) wJ S All contractors and subcontractors are required to be
Contact name: Sc. a 77 / — i�� licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: / j Y9 S S. l tl S ! t101 14 Pi2 w `� jurisdiction in which work is being performed. If the
City/State/ZIP: •� J applicant is exempt from licensing, the following reasons
Cit
y / / G 02cs 9 • z 2.je apply: _
Phone: ( 503 tfis L9 4r/ Fax:: ( )
E -mail: 5c 72 ?,.." .-1/. & S a D / A/c , Co/Y1
CONTRACTOR BUILDING PERMIT FEES*
Business name: S iA �L�� S ` C v /L ; --/X 5C uT c,,.l S (Please refer to fee schedule)
_ C� Permit fee:
Address: / j (�V 5 5 . , S& C/ )O 1 A fp /ZWy
City/State/ZIP: U State surcharge (12% of permit fee):
Ci
ty 77 022- 97izy
FLS plan review (40% of permit fee):
Phone: (5"03 %t -- 7 3 6 Z I . ( ) (Due upon application.)
CCB lic.: /: z5-4 7 Total permit fees:
Authorized signature: 7�jf �- Amount received:
`'"�''������ This permit application expires if a permit is not obtained
Print name: 5' 4 a7 7 C , /3 �L / I Date: 1..2, -13 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:\ Building \Permits\FPS-PermitApp.doc Rev 01/ 05/2012 440- 4613T(11 /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.
El Alteration El 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: $ l
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: I $
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: \Building \Permits \FPS - PermitApp.doc Rev 01 /05/2012 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10031 SW CASCADE AVE, TIGARD, OR, 97223
Commercial - Fire Protection System
998 Alarm Final
03/25/2013 00:00
FPS2013-00019
PASS - No C of O
Monitored multiple pull stations
Strobes sinked
Duct detection activated
Violation Summary:
Inspector Contractor
21 _rps 'SO /3 , 64no /s
Ci1/4,1L-17 INSPECTION, TESTING, AND MAINTENANCE 72 - 101
(
INSPECTION AND TESTING FORM
DATE: 3 -ZS -03
TIME:
SERVICE ORGANIZATION PROPERTY NAME (USER)
Name: 5 IA N y Name: O M A t R. 05
Address: Address: / 0 0 1 5 vJ C4 s C.4 D
Representative: Owner Contact: CAA I &
License No.: Telephone: 50'; (4 / 3 6250
Telephone:
MONITORING ENTITY APPROVING AGENCY
Contact: Contact:
Telephone: Telephone:
Monitoring Account Ref. No.:
TYPE TRANSMISSION SERVICE
❑ McCulloh ❑ Weekly
❑ Multiplex ❑ Monthly
Digital
CI Quarterly
❑ Reverse Priority ❑ Semiannually
❑ RF ❑ Annually
❑ Other (Specify) ❑ Other (Specify)
Control Unit Manufacturer: FI P1 r L I TIE Model No.: e i 050
Circuit Styles: also a
Number of Circuits: 7
Software Rev.:
Last Date System Had Any Service Performed: 3 -2.5-i3
Last Date that Any Software or Configuration Was Revised:
ALARM - INITIATING DEVICES AND CIRCUIT INFORMATION
Quantity Circuit Style
9 p I U i14 `. Manual Fire Alarm Boxes
0 c CID Ion Detectors
Photo Detectors
7 I I Duct Detectors
Heat Detectors
Z I Waterflow Switches
5 " Supervisory Switches
Other (Specify):
Alarm verification feature is disabled enabled
(NFPA Inspection and Testing, 1 of 4)
FIGURE 10.6.2.3 Example of an Inspection and Testing Form.
2002 Edition
72 -102 NATIONAL FIRE ALARM CODE
ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION
Quantity Circuit Style
0 Bells ��p
Z �i CLAS 5 13 Horns/5 / I� 0 8 6..5
Chimes
z
• • Strobes
Speakers
Other (Specify):
No. of alarm notification appliance circuits:
Are circuits monitored for integrity? ❑ Yes ❑ No
SUPERVISORY SIGNAL - INITIATING DEVICES AND CIRCUIT INFORMATION
Quantity Circuit Style
Building Temp.
Site Water Temp.
Site Water Level
Fire Pump Power
Fire Pump Running
Fire Pump Auto Position
Fire Pump or Pump Controller Trouble
Fire Pump Running
Generator In Auto Position
Generator or Controller Trouble
Switch Transfer
Generator Engine Running
Other:
SIGNALING LINE CIRCUITS
Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
Quantity Style(s)
SYSTEM POWER SUPPLIES G
(a) Primary (Main): Nominal Voltage r Z c7 Amps I cJ
Overcurrent Protection: Type Amps
Location (of Primary Supply Panelboard): �(_&T I( 12.0 0 vfl S IA)
Disconnecting Means Location:
(b) Secondary (Standby):
Storage Battery: Amp -Hr. Rating
Calculated capacity to operate system, in hours: 24 60
_Engine-driven generator dedicated to fire alarm system:
Location of fuel storage:
TYPE BATTERY
❑ Dry Cell
❑ Nickel- Cadmium
4T Sealed Lead -Acid
❑ Lead -Acid
❑ Other (Specify):
(c) Emergency or standby system used as a backup to primary power supply, instead of using a secondary power supply:
Emergency system described in NFPA 70, Article 700
Legally required standby described in NFPA 70, Article 701
Optional standby system described in NFPA 70, Article 702, which also meets the performance
requirements of Article 700 or 701.
(NFPA Inspection and Testing, 2 of 4)
FIGURE 10.6.2.3 Continued
2002 Edition
•
INSPECTION, TESTING, AND MAINTENANCE 72 - 103
PRIOR TO ANY TESTING
NOTIFICATIONS ARE MADE Yes No Who Time
Monitoring Entity ❑ ❑
Building Occupants ❑ ❑
Building Management ❑ ❑
Other (Specify) ❑ ❑
AHJ Notified of Any Impairments ❑ ❑
SYSTEM TESTS AND INSPECTIONS
TYPE Visual Functional Comments
Control Unit ❑ ❑
Interface Equipment ❑ ❑
Lamps/LEDS ❑ ❑
Fuses ❑ ❑
Primary Power Supply ❑ ❑
Trouble Signals ❑ ❑
Disconnect Switches ❑ ❑
Ground -Fault Monitoring ❑ ❑
SECONDARY POWER
TYPE Visual Functional Comments
Battery Condition ❑
Load Voltage ❑
Discharge Test ❑
Charger Test ❑
Specific Gravity ❑
TRANSIENT SUPPRESSORS ❑
REMOTE ANNUNCIATORS ❑ ❑
NOTIFICATION APPLIANCES
Audible ❑ ❑
Visible ❑ ❑
Speakers ❑ ❑
Voice Clarity ❑
INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS
Device Visual Functional Factory Measured
Loc. & S/N Type Check Test Setting Setting Pass Fail
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ • ❑ ❑
❑ ❑ ❑ ❑
Comments:
(NFPA Inspection and Testing, 3 of 4)
FIGURE 10.6.2.3 Continued
2002 Edition
72 - 104 NATIONAL FIRE ALARM CODE
•
EMERGENCY COMMUNICATIONS EQUIPMENT Visual Functional Comments
Phone Set ❑ ❑
Phone Jacks ❑ ❑
Off -Hook Indicator ❑ ❑
Amplifier(s) ❑ ❑
Tone Generator(s) ❑ ❑
Call -in Signal ❑ ❑
System Performance ❑ ❑
Device Simulated
Visual Operation Operation
INTERFACE EQUIPMENT
(Specify) ❑ ❑ �, ❑
(Specify) ❑ ❑ r•» ❑
(Specify) ❑ ❑ ❑
SPECIAL HAZARD SYSTEMS
(Specify) ❑ ❑ ❑
(Specify) ❑ ❑ ❑
(Specify) ❑ ❑ ❑
Special Procedures:
Comments:
SUPERVISING STATION MONITORING Yes No Time Comments
Alarm Signal ❑ ❑
Alarm Restoration ❑ ❑
Trouble Signal ❑ ❑
Supervisory Signal ❑ ❑
Supervisory Restoration ❑ ❑
NOTIFICATIONS THAT TESTING IS COMPLETE Yes No Who Time
Building Management ❑ ❑
Monitoring Agency ❑ ❑
Building Occupants ❑ ❑
Other (Specify) ❑ ❑
The following did not operate correctly:
System restored to normal operation: Date: _2 S - / I'ime: °L
THIS TESTING WAS PERFORM 'y CORDANCE WITH APPLICABLE NFPA ST DAR S. �J
Name of Inspector: it awl , Date: Time: / - C ' 7 Ai
I'�� I .. • Signature: ei♦� v _ 5 • -�E O
4� P I
Name of Owner or '-rp Yse,, 1�1 1 ti G1 �� 04 c o'S
Date: 3 Z - / 3 Time: C l '� l..J
Signatur
(NFPA Inspection and Testing, 4 of 4)
FIGURE 10.6.2.3 Continued
2002 Edition