Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
■ COMMUNITY DEVELOPMENT Permit it: FPS2021-00039
Date Issued: 4/13/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD
Project: Lincoln Center Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire sprinkler permit-modify(6)sprinkler heads for new gypsum ceiling-toilet room 5L-2nd floor.AFFIDAVIT
SUBMITTED.
Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON STREET SUITE 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO,CA 94104
PHONE: 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Description Date Amount
Specifics: Permit Fee-COM 04/12/2021 $61.85
12%State Surcharge-Building 04/12/2021 $7.42
Type of Use: COM Plan Review-Fire Life Safety-COM 04/12/2021 $24.74
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 04/12/2021 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
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 Reg:
Battery Calcs Provided: Cut Sheets Required:
Total $94.51
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $900.00
Residential Square Footage: 0
Fire Alarm Valuation: $0.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specially Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 0VV f�pp l%c cti trot
}folly Va.w'�e,Wege
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application '$- 41 elzi
Fire Protection System RECEIVED
Received
City of Tigard! APR 8 2071 Dnteive D¢ 1 ZoLI If Permimo.:FR52021 00 39
1111 v 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review r-�
Phone: 503.718.2439 Fax: SD3.54$.196 DaM/I3y: 14 Dthe`P=iteuP Zf-a,b7I
Inspection Line: 503.639.4175 Y OFTIUAFED Uare Reedy/By: ,�0 r ' Q See Page 2 for
T.GARLt Internet: www.tigard-or.gov BUILDING DIVISION Nonhed/Method. 779,- Supplemental reformation
redizq fltrft - edrax-a
TYPE OF WORK REQUIRED DATA: I-AND 2-FAMEL' DWELLING
0 New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
a[]Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTIONwork indicated on this application.
❑ I-and 2-family dwelling 0 Commercial/industrial
Valuation: S
❑ Accessory building
ID Multi-familyLumber of bedrooms:
❑ Master builder 0 Other: Number of bathrooms:
JOB SITE I.NFORM.ATION AND LOCATION Total number of floors:
Job site address: (o etc 50 oce IgiA el New dwelling area: square feet
City/State/ZIP: - l ,I b i otz girt 3 Garage/carport area: square feet
Suitelbldg.-apt.no.: Project name: Todd. izebok SI• -yr i,har Covered porch area: square feet
Cross street/directions to job sire: Deck area: square feet
Other structure area: square feet
REQUIRED DATA;COMI tERCIAL-USE CHECKLIST
Subdivision: J Lot no.: Permit fees*arc based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax mapiparcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
��I� Valuation: $ -It00
�,t
leWGvl (b} moratAtc Maas. Vec Ati.) iltifte.u.W1 LeittVI
Existing building area: square feet
New building area: square feet
G] PROPERTY O%%2,ER I 0 TENANT Number of stories:
Name: ShatetnskeAla Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
Q APPLICANT 0 CONTACT PERSON NOTICE
Business name: tiltdcw6kiAll contractors and subcontractors are required to be
Contact name: Meg_ F�rkt.>r licensed with the Oregon Construction Contractors Board
under ORS 701 and may he required to be licensed in the
Address: (`1v0 Alt Pt*F,tpyt CV• (IA1VC 160 jurisdiction in which work is being performed.If the
City'StatcrZIP: {� applicant is exempt from licensing,the following reasons
flodkikt+ i O ct'1 Z3P apply:
Phone:Ali ) {�'j0 -156 0 Fax::( )
E-mail: 044,4 e Q„'LCLttH,rt'„•(.sMt
CONTRACTOR BUILDING PERMIT FEES`
(Neare refer to fee irkedale
Business name: kldtsigifi Permit fee:
Address: ILoga AK 64,Afr, sk,
Slate surcharge(12%of permit fee):
City/StateiZIP: %Milli et AltjQ FLS plan review(40%of permit fee):
Phone:(So ) 31,6134 Fax:( ) (Clue upon application submittal.)
CCBlie.: ;72iiii Total permit fees:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name: lied Date:44151702i within In days after It has been accepted as complete.
• Fee methodology set by Tri-County Building Industry
Service Board.
I`Building Permfn rPS•PcrmitApp-0310i6doe 410-46liT(I10'.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:
❑ New system Number of sprinkler heads: Co 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:
Type of System(Complete A,B,C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ® Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line 0 Yes ❑ No
Hazard Group
Density
Design Area
K. Factor r.0
Sprinkler Project Valuation: $ s €o-
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:\Building\Permits\FPS_PemvtApp_031016.doc 2
City of Tigard RECEIVED Permit No.: FPS 2O2-I-0003J
• 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 APR 8 Y021 Date Received: 04/0 S/202-I
Inspection Line: 503.639.4175 /� ��j /
T I G A R D Internet: www.tigard-or.gov 111-6
B C t-( OF 1 6
��((CIIITY OFcc TIGARD
I��//SgNN y C1
FIRE SPRINKL I�AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) OFFICE COPY
Project Name: Toilet Rooms 5L 2nd Floor Occupancy:
Job Address: 10200 SW Greenburg Rd. Type of Construction:
Suite:
Contractor: McKinstry Co. Phone: 503-331-0234
Number of Proposed or Altered Heads: 6
Type: Hazard: Light Density:
I Alex Forker Oregon Construction Contractors Board No. 172811
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.
t) 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.
Signature: Date: 04/05/2021
Print Name: Alex Forker
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