Permit (188) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
2 . ` COMMUNITY DEVELOPMENTTer Permit#: FPS2017-00061
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.24 .ont: \ :,!7,5_, ,IF,=11
7 a` .i Date Issued: 11/13/2017
w ,
Parcel: 1S135DA02400
irJ\' \. (�- Jurisdiction: Tigard
Site address: 11045 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Fire supply line for new residential care facility. 10/25/18:REPRINTED to correct address from 11035 to 11045.
Contractor: PR DESIGN&GENERAL CONTRACTORS LLC Owner: BROOKSIDE RCF LLC
919 NE 19TH AVENUE SUITE 155 5987 SE ROBHIL DR
PORTLAND, OR 97232 MILWAUKIE, OR 97222
PHONE: 530-625-8461 PHONE:
FAX:
FEES
Description Date
Amount
Specifics: Permit Fee-COM
11/13/2017 $540.42
12%State Surcharge-Building 11/13/2017 $64.85
Type of Use: COM Plan Review-Fire Life Safety-COM 11/13/2017
Class of Work: NEW Type of Const: VA $216.170
yPAdditional Plan Review 03/15/2018
Occupancy Grp: 1-2 Height: ft $45.00
Stories: 2
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No 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 $866.44
Valuations:
Required Items and Reports(Conditions)
Sprinkler Valuation: $50,000.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
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.
Issued By:
\,r� c 1 Permittee Signature: o �� c�` -�t l(sc)
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.
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2017-00061
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2017
Parcel: 1 S135DA02400
Jurisdiction: Tigard
Site address: 11035 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Fire supply line for new residential care facility.
Contractor: PR DESIGN&GENERAL CONTRACTORS LLC Owner: BROOKSIDE RCF LLC
919 NE 19TH AVENUE SUITE 155 5987 SE ROBHIL DR
PORTLAND, OR 97232 MILWAUKIE, OR 97222
PHONE: 530-625-8461 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/13/2017 $540.42
12%State Surcharge-Building 11/13/2017 $64.85
Type of Use: COM Plan Review-Fire Life Safety-COM 11/13/2017 $216.17
Class of Work: NEW Type of Const: VA
Occupancy Grp: 1-2 Height: ft
Stories: 2
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No 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 $821.44
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $50,000.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
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.
,LPIssued By: / Permittee Signature: +';
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.
blinding Permit Application
'
Fire Protection Systemi
" FOR OFFICE USE ONLY
iCONa
City of Tigard 4 Received
11 w 13125 S W Hall Blvd.,Tigard,OR 9 Date By: A--
�s /7
I Permit No.: �S�D 7-QQQ`„/
11. Phone: 503.718.2439 Fax: 503.598.1960 ry f1 Plan Revi k , cL((
Ins ection Line: 503.639.4175 LU Date Re ,µ(R ._ Other Permit: lTo�Page(2 for 7_00005-
Inspection
T I G A R D p ' l\ 9 Date Read : r(7 , 7uris:
Internet: www.tigard-or.gov i Notifi-. ethod. 7 ) I Supplemental See for
t'��G I /4 Information
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®New construction L► 1.'o tion Permit fees*are based on the value of the work performed.
❑Addition/alteration/replacement ❑Other Indicate the value(rounded to the nearest dollar)of all
'i r r- equipment,materials,labor,overhead,and the profit for the
12 m 4, - 'i: ;r H, i` "i '1 .o tl- tx�.%.,,i ,: of a�( =!4 G - y, , 4 oa work indicated on this application.
CI1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder CI OtherNumber of bathrooms:
41.45' {a m -art 4; 6',,,' go
$ T iIORINAND
O A i ., G v4-.1i- %4 Total number of floors:. .. ". , - INFORMATION .
Job site address: 11035 SIV Hall Blvd New dwelling area: square feet
City/State/ZIP:Tigard,Oregon
Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:Brookside Memory Care
Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
Subdivision: R QUI VA = 1AAA S U �15 w
I 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
�� A ' � !G 4 equipment,materials,labor,overhead,and the profit for the
' 4 �' i d r,'. aA a E C Gx 14 st work indicated on this application.
4"underground fire line for the new building under permit#:SIT2017-00005 and $550,000.00
Valuation:
BUP2017-00068 Existing building area: square feet
New building area: square feet
,, -441,",i; I*R(.1PERl 'e O W.NER + G �', 1 r t ,i a G ' q
�. ,. I' a „' y h^'` d - Number of stories: 2
Name:Benny Damian
Type of construction: VA
Address:
Occupancy groups:
City/State/ZIP:Milwaukie,Oregon
Existing:
Phone:(503)998-4872 Fax:( )
i AAT y,' 'i ut New: 1-2/R 3
iE r® APPLIC"A I'' ,.. l to;
I'TA`=T'P'
,. u 9 .:k a, u1.,..�� I li '14-' IA S :hir "n ,! -1.$6."7,14- it " l_ ,.
Business name:EPR Design ,
All contractors and subcontractors are required to be
Contact name:Edward Radulescu licensed with the Oregon Construction Contractors Board
Address:919 NE 19th Ave.Suite 155 under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP:Portland,Oregon 97232
Phone:(503)679-2493 apply:
Fax::( )
E-mail:eddie@eprdesign.com
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to - [ l4 xt a Ar,''-''','1 1 U � fifA Ou ta" nS u A tt 1r ``
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A YBusiness name:PR Design&General Contractors
Address:919 NE 19th Ave.Suite 155 Permit fee:
City/State/ZIP:Portland,Oregon 97232 State surcharge(12%of permit fee):
Phone:(503)265-8461 FLS plan review(40%of permit fee):
Fax:( ) (Due upon application submittal.)
CCB lie,:183329
Total permit fees:
Authorized signature: / Amount receive
This permit application expires if a permit is not obtained
Print name:Edward Radulescu I Date:5.4.17 I within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_031016.doc
440-46131(11/02/COM/WEB)
•
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Vii'`- r _-'- i (" .� n ilii a-r" F a
D'iS be i?Urk iO df) • il w 6i ( �� Lt. `` - - �'
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
Z New system Number of sprinkler heads: Number 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:
utll ',� Ii u�.- rl GI' �'
' f S `jten (Co 1p1 try br , s a cab e): ,1;a
-'--et . wii 3h aii{ 4
ii16 111 ▪ r r y'11 I
'-'214111.4
trungrei
(
li
Sprinkler Type ❑ Wet ® Dry
Additional Standpipes 1
Information: Sprinkler Supply Line Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: I $ 50000
:11- `' ; {
i4ryyiN�i iluI-i.i :�:'i0.mG —., i,. -'djPY.ti.. X7 1❑¢; �- ��r is..m- r� �.iai:- rr..
8000.
Hood Project Valuation: I $
: �J h17,7
1 r 4 !11,117,-i;"C) " : Yes.
Submittal shall Battery Calculations
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $ 5000
Dry
air rip " '(StdAonstQr Square Footage: Permit Fee:
1411
0 to 2,000
$198.75
2,001 to 3,600 � �r �
$246.45 ��� �a1 �.
3,601 to 7,200 $310.05iSh moo{ � .
7,201 and greater $404.39 1 ,
Sprinkler Project Square Footage: sq. ft.
err iii ! W {4 rra `'"'I�iili a -"�'n r
�^ " �a �� �• t �; ��'4*���(3wf���+A�L� y� i1t� �I� ▪ r �����:
_
Project valuation subtotal (see A,B & C above): $ 63000
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: $
Macintosh HD:Users:EPRdesign:Desktop:EPR DESIGN:epr DESIGN:EPR DESIGN DRAWINGS FILES:COMMERCIAL PROJECTS:HALL BLVD MEMORY
CARE:FPS_PermitApp_Brookside Memory Care.doc
4
Tualatin Valley Fire & Rescue
Tttalatin Valley
Rural Water Supply Calculation Worksheet
Fire & Rescue
North Operating Center Central Operating Center South Operating Center
20665 SW Blanton Street 11945 SW 70th Avenue 8445 SW Elligsen Road
Aloha, OR 97078 Tigard, OR 97223 Wilsonville OR 97070
Phone: 503-259-1400 Phone: 503-649-8577 Phone: 503-259-1500
Fax: 503-259-1224 Fax: 503-642-4814 Fax: 503-259-1520
J Rural Water Supply Calculation Worksheet
This worksheet applies to commercial and residential structures where the total wall area of all floor levels within
exterior walls is greater than 3,600 square feet. Where an Alternate Material and Method (AM&M) is approved, the r€
fire flow may be reduced. Once the worksheet is completed, forward to the appropriate Operating Center. For furl
information or assistance, contact your local Operating Center.
!SECTION 1 -Preparer Information
a. Preparer Name: Edward Radulescu Date: 6,1.17
Phone: 5036792493 Fax: E-mail: eddie@eprdesign.com'
b. Architect/ Engineer of Record: Richard Turner,. PE.
Phone: 5039708807 Fax: E-mail: rturner@tenganddcomcast.net
!SECTION 2 -General Building Information
Project Name: Brookside Memory Care
Project Address: 11035 SW Hall Blvd
City: Tigard County: Washington Zip:
!SECTION 3 -Required Water Supply Calculation (Enter number in each box)
a. Length of building (in feet): I 246
b. Width of building (in feet): 95
C. Height of building (in feet): ( 9
d. Occupancy Hazard Classification number: I 7
(see section 4)
e. Construction Classification Number: I 2
( ee section 5)
f. Exposure Hazard (see section 6): f 2
(see section 6)
g. Calculated minimum water supply: €51r (3(]4E; gallons
fi
!SECTION 4 -Occupancy Hazard Classification Number(Enter number in section 3 d)
•
Enter:
Severe Hazard = 3
High Hazard = 4 Hover over classification number for description or refer to
Moderate Hazard = 5 Occupancy Hazard descriptions in tab 2.
Low Hazard = 6
Light Hazard = 7
(SECTION 5 -Construction Classification Number(Enter number in section 3 e)
Enter:
Type I = 0.5
Type ll = 0.75
Type III = 1
Type IV= 0.75
Type V = 1.5
!SECTION 6 -Exposure Hazard (Enter number in section 3 f)
Enter:
1 if no buildings are within 50 feet AND the proposed building has a hazard classification is 5, 6, or 7
1.5 if any buildings within 50 feet OR the proposed building has a hazard class of 3 or 4
SECTION 7 -NFPA 1142 Formula(if prepared manually)
Minimum Required Water Supply is:
Lx W x H /Occupancy Hazard Classification x Construction Classification x Exposure
FOR OFFICE USE ONLY—SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting info I ation.
Please complete this form when submitting information for plan review responses and revision
This form and the information it provides helps the review process and response to your proj= t.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTM 4T
ii
1111 I Transmittal Letter
r I i;A RI) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.24 • www.tigard-or.gov
TO: ON 1 DATE REC
DEPT: BUILDING DIVISION RECEIVED
M-�R132018
FROM: .e h� De\VA
�,, 1 f O IGA
COMPANY: '6 G `,
A e. VVIU,IM � C BUILDING DIVISION
�/
PHONE: Sst� �( R-Z By: /4�
RE: . Ih4)S c Ai S
\if � - r
(Site Address) � ermit Number
12Ook.ck t Mk CGtn -.
(Project name or subdi '.it name 10`,''m 1:
I.
ATTACHED ARE THE FOLLOW I•,
I Copies: I Description: '
� / �• ►'pies: I Description:
Additional set(s) of plans. # Revisions:
Cross section(s) and details./ Wall bracing and/or lateral analysis.
Floor/roof framing. ,r' Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain): /
REMARKS:
1��1` / ..--tk tl
kV � ��v- .
V--C
! FOR OFFICE USE ONLY
Routed to Permit Tec clan: Date: 3- I Li- 1 Q Initials:
Fees Duer'J Yes No Fee Description: Amount Due:
.s Hr p) am re.v �� $ ��'—
$
a $
Special
Instructions: ,--
Reprint Permit(per PE): ❑ Yes INo ❑ Done
Applicant Notified: Date: Zpitlilr Initials: 4'i
I:\Building\Forms\TransmittalLetter-Revisions 061316.doc
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
11045 SW HALL BLVD, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00061
Inspection Type: Inspector:
999 Sprinkler final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor