Permit a CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I COMMUNITY DEVELOPMENT Permit#: FPS2021-00132
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/2/2021
Parcel: 1 S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 200
Project: Spec Space Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: Fire sprinkler permit-relocate(6)and add(1)sprinkler heads.AFFIDAVIT SUBMITTED.
Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON STREET SUITE 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Description Date Amount
Specifics: Permit Fee-COM 11/01/2021 $102.20
12%State Surcharge-Building 11/01/2021 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 11/01/2021 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 11/01/2021 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area: 144
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:
Tota I $155.84
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,430.00
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
Issued By: Ho. Vaw De,WE.3e Permittee Signature: 014 A,^,^JI`^GL1't, - .
Irlr
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 RECEIVED tO 2
CC
Fire Protection System ,...OFH ICE USE()NIA
City of Tigard OCT 2 6 2021 Received / 2'21 elf Permit No.:
Date/By: 1 V, 2(J�-0v
13125 SW Flail Blvd.,Tigard,OR 97223 Plan Review rlv p n�t ��Q
mie
11 Phone: 503.718.2439 Fax: 503.598.196IIN
7s Other Permit f G(.(�a �j /
CITY OF TIGARD Date/By:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris 0 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/method; Ol/LI —net— Supplemental Information
er 440
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(rounded to the nearest dollar)of all
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling „Commercial/industrial Valuation: $
Number of bedrooms:
❑Accessory building ElMulti-family
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10250 SW Greenburg Road New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: 200 Project name: VS P Suite 200 4 L Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
4 Lincoln Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Relocate (6) Fire Sprinkler heads and add (1) Valuation: $ 21-1`0
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Shorenstein Realy Services Type of construction:
Address: 5335 Meadows Road, Suite 275 Occupancy groups:
City/State/ZIP: Lake Oswego, OR 97035 Existing:
Phone:(5 0 3) 412-4 8 6 4 Fax:( ) New:
0 APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: MC K i n s t r y Co . LLC All contractors and subcontractors are required to be
Contact name: Alex Fork e r licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 16790 NE Mason S t . Suite 100 jurisdiction in which work is being performed.If the
City/State/ZIP: Port l and, OR 97230 applicant is exempt from licensing,the following reasons
apply:
Phone:(9 71) 4 2 0-7 5 5 0 Fax: :( )
E-mail: AlexF@mckinstry. com
CONTRACTOR BUILDING PERMIT FEES*
Business name:McKinstry Co . LLC
(Please refer tojee schedule)
Permit fee:
Address: 16790 NE Mason St . Suite 100
City/State/ZIP: Portland, OR 97230 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application submittal.)
CCB lic.: 172811 Total permit fees:
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: Alex Fork e r Date: 10/2 5/2 0 21
within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
[:Building.Permits`FPS-PermitApp_031016.doc 440-4613T(I1'02'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:
El New system Number of sprinkler heads: 7 Number of alarm devices:
El Addition or g 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:
Type of S stem (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type ❑X Wet El Dr\
Additional Standpipes
Information: Sprinkler Supply Line El Yes El No
Hazard Group l Light
Density
Design Area 14 4
K. Factor 5 . 6
Sprinkler Project Valuation: $ $2, 4 30
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_PermitApp_031016.doc 2
CityTi RECEIVED
of Tigard Permit No.: FP32492/ 00 1 YZ
q 13125 SW Hall Blvd.,Tigard,OR 97223 OCT 2 6 2021
li Phone: 503.718.2439 Fax: 503.598.1960 Date Received: // Ol",2O2i
Inspection Line: 503.639.4175 ��
T I G A R D Internet: www.tigard-or.gov LI 1 Y OF TIGARD By: `"/ 6 ,o f rl�� zo
'l..IILDING DIVISION "� [/�
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) ) IC '
ovY
'1
Project Name: VSP Suite 200 4L Occupancy: B
Job Address: 10250 SW Greenburg Rd. Type of Construction: Type I-B
Suite: 200
Contractor: McKinstry Co. LLC Phone: 971-420-7550
Number of Proposed or Altered Heads: 7
Type: Hazard: Light Density: 1
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.
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.
Alex Forker 7itally signed by Alex Forker 10/25/2021
Signature: Date:2021.10.25 15:01:50-07'00' Date:
Print Name: Alex Forker
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