Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
111111
'11 COMMUNITY DEVELOPMENT Permit#: FPS2021-00023
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/24/2021
T I i;;ti li 17 9 Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 700
Project: Integrated Healthcare Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire sprinkler permit-add/relocate 6 sprinklers as needed.Affidavit submitted.
Contractor: VIKING AUTOMATIC SPRINKLER CO Owner: LINCOLN CENTER LLC
3245 NW FRONT AVE BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97210 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-227-1171 PHONE:
FAX: 503-227-1552
FEES
Description Date Amount
Specifics: Permit Fee-COM 02/22/2021 $77.99
12%State Surcharge-Building 02/22/2021 $9.36
Type of Use: COM Plan Review-Fire Life Safety-COM 02/22/2021 $31.20
Class of Work: ALT Type of Const: IB Info Process/Archiving-Lg$2.00(over 02/22/2021 $2.00
Occupancy Grp: B Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
i Standpipe Required: Hazard: LT
Density: 0.1 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $120.55
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,500.00
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: \_\\_a\ vy\\)uz_, c,5,,e__ Permittee Signature: /y�� ����l n ( , `y,.\L�1 1 `
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 - Z ie LI
Fire Protection System RECEIVED l
City of Tigard ReReceiv y(/ '� ?/ / PermitNo.: ,��— 23
eed
13125 SW Hall Blvd.,Tigard,OR 97223 �E� 2��1 Plan Review /� n/��Q'/y of/ /vyl3��
■ Other Permit `✓s—i 9e0
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: 2/e El See Page 2 for
Internet: www.tigard-or.gov BUILDING UIVI .,_, Notified/Meth d: ICI Supplemental Information
e,
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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 ❑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: $
0 Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 102 0 0 SW Greenburg Rd. New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: 7 00 Project name: Integrated Health Solutions 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: 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
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
add/relocate 6 sprinklers as needed Valuation: $ 1, 500.00
for tenant improvement. Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER TENANT Number of stories:
Name: Integrated Health Solutions - Road Scholar Type of construction:
Address: 10200 SW Greenburg Rd. Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Viking Automatic Sprinkler All contractors and subcontractors are required to be
Contact name: Dave Bateman licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 3245 NW Front Ave jurisdiction in which work is being performed.If the
City/State/ZIP: Portland, OR 97210 applicant is exempt from licensing,the following reasons
apply:
Phone:( 503) 227-1171 Fax::(503 ) 227-1552
E-mail: dave.bateman@vikingsprinkler.net
CONTRACTOR BUILDING PERMIT FEES*
Business name: Viking Automatic Sprinkler (Please refer to fee schedule)
Permit fee: I20,0S
Address: 3245 NW Front Ave
City/State/ZIP: Portland, OR 97210 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(5 0 3) 2 2 7-1171 Fax:(5 0 3) 2 2 7-15 5 2 (Due upon application submittal.)
CCB lie.: 6 4 8 3 7 Total permit fees:
Qab Esa.�ev�<� Amount received:
Authorized signature: Dave Bateman E c:.E-a..,7m.173��. ,—a
This permit application expires if a permit is not obtained
Print name: Dave Bateman Date: 2/18/2 0 21 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 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
[1] New system Number of sprinkler heads: 6 Number of alarm devices:
❑X Addition or ❑X 1-10 heads: Affidavit required and El 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
El 11+ heads: Plan review required and El 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work: Add/Relocate 6 sprinklers for tenant improvement.
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type [] Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line El Yes ❑ No
Hazard Group Light Hazard
Density
Design Area
K. Factor 5.6k
Sprinkler Project Valuation: $ 1, 500.00
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: $
I:A Building\Permits\FPS_PermitApp_031016.doc 2
City of Tigard ECEIVE Permit No.: FPS2O2/ Od23
'I 13125 SW Hall Blvd.,Tigard,OR 9R
Phone: 503.718.2439 Fax: 503.598.1960
� Date Received: OM g�2a2/
Inspection Line: 503.639.4175FEB �' 2I�21 A/ of 77yA5 '✓
t I c,:,I:1, Internet: www.tigazd-oc (i[ 7gov By:
CITY OF TIGARD
FIRE SPRINRLItICOTMAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) OFFICE COPY
Project Name: Integrated Healthcare Solutions Occupancy: B
Job Address: 10200 SW Greenburg Rd Type of Construction: 1-B
Suite: 700
Contractor: Viking Sprinkler Phone: 503-227-1171
Number of Proposed or Altered Heads: 6
Type: Pendent Hazard: Light Density: •10
1, Dave Bateman Oregon Construction Contractors Board No. 64837
certify the following is true and reasonably defines the scope of work for this project:
a) All work is limited to drops and armovers in a light-hazard occupancy.
b) Positions of sprinkler heads relative to architectural features such as soffits, beams, partitions, walls, etc.
complies with current adopted edition of NFPA 13.
c) The proposed work does not require hydraulic calculations.
d) Only one sprinkler head will be installed from one drop (exception: up to two heads from one drop may be
installed when each head is in a separate fire area).
e) The area covered per sprinkler head is limited to the spacing requirements of NFPA 13.
f) Tenant improvements in a new building shall be equipped with Quick Response heads (see 2002 NFPA 13,
Section 8.3.3.1 for exceptions).
g) The installation shall comply with the requirements of the current adopted edition of NPFA 13.
h) Piping shall not be concealed until hangers and bracing are inspected.
i) Final approval shall be subject to onsite tests and inspections.
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.
• A copy of this document with a copy of the sketch attached shall be available for all inspections.
DI y'WW.,M o...e.t.m°"
Dave Bateman 2/18/2021
Date:Signature: DM z�,�,a„az,��
Print Name: Dave Bateman
I:\Building\Forms\FireSprinklerAffidavit_071514.docx Page I of 1