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Permit
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT 11 a COMMUNITY DEVELOPMENT Permit#: FPS2021-00118 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/5/2021 Parcel: 1 S 135AB00900 Jurisdiction: Tigard Site address: 10200 SW GREENBURG RD Project: 5 Lincoln-Common Area Subdivision: METZGER,TOWN OF Lot: 9 Project Description: Fire sprinklers permit-plug(1)redundant sprinkler head.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 09/30/2021 $51.09 12%State Surcharge-Building 09/30/2021 $6.13 Type of Use: COM Plan Review-Fire Life Safety-COM 09/30/2021 $20.44 Class of Work: ALT Type of Const: IIA Info Process/Archiving-Sm$0.50(up to 09/30/2021 $0.50 Occupancy Grp: B Height: ft 11x17) Stories: Commercial Sprinkler System: Sprinkler Required: Sprinkler Type: Wet Standpipe Required: Hazard: LT Density: 0.1 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: Total $78.16 Valuations: Required Items and Reports(Conditions) Sprinkler Valuation: $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 Issued By: Permittee Signature: Flo-LW V aw De,W e`y e O w App-1 i,C-ct'fic-vti. 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 ApplicationR EC E IVE cq 22,I Fire Protection System SEP ry ` FOR OFFICE USE ONLY City of Tigard 2 2 b C1 Da eBed��/O 2z2/ girl, Permit No. �� '% n Y • 13125 SW Hall Blvd.,Tigard,OR 97223 t`11�!OF I IGARV Plan Review n Other Permit: Phone: 503.718.2439 Fax: 503.598.196u Date/By: '! T WARD Inspection Line: 503.639.4175 3U►1_DING DIVISION Date Ready/By: / g,,,,, �j�� 1 0 See Page 2 for Internet: www.tigard-or.gov Notified/Method.(/® l�G(/GL I ei Supplemental Information ..unatca' ,4ki0 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 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ElI-and 2-family dwelling 0 Commercial/industrial Valuation: $ ElAccessory building El Multi-familyNumber of bedrooms: ❑Master builder ElOther: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: `OZo0 �JW C91e@/t\OLK V.-c. New dwelling area: square feet City/State/ZIP: —rityr, or q-zzz1 Garage/carport area: square feet Suite/bldg./apt.no.: roject name:(cMW%tAA a.eot ct Covered porch area: square feet Cross street/directions to job site: Deck area: square feet 5- ,.Is11G6 tv\ / t.IN t:okhl (Gila 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 ` DESCRIPTIONp OF WORK work indicated on this application. Oil� ( ) f{0 tt640$4,1 f c Sgctv►ILI e( AI) Valuation: $ 5 Q,UO Existing building area: square feet New building area: square feet Q PROPERTY OWNER 0 TENANT Number of stories: Name: S -ko 04414 , krVetres Type of construction: Address: I ZZO MUD Grc lcvec ea cmt e no Occupancy groups: City/State/ZIP: 1-110. iD 472Z-5 Existing: Phone:( - ) 6t�t. slob 7 Pax:( ) New: ® APPLICANT ® CONTACT PERSON NOTICE Business name: 14164,1049 6,/i t. All contractors and subcontractors are required to be Contact name: V 3e k.e licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: l e/k0 /it yylets 't 0.... v„<v e )d Q jurisdiction in which work is being performed.If the City/State/ZIP: 0(1.4 t a12 41j O applicant is exempt from licensing,the following reasons apply: Phone:4i I )qzb_ 70-0 Fax: :( ) E-mail: 41t.<I%Q ttiu),,t,,tr4r.�„tow CONTRACTOR BUILDING PERMIT FEES* Business name: cid05,},,/ ( ��L (Pleasere/erto fee schedule1 ` `"�� Permit fee: Address: (6-no 11 &cov cl• �.^l be mu 1-IHKd de41Z30 State surcharge(12%of permit fee): City/State/ZIP: �( FLS plan review(40%of permit fee): Phone:( ) Fax:( ) (Due upon application submittal.) CCB lie.: 17Z in( Total permit fees: Authorized signature: Amount received: This permit application expires if a permit is not obtained Print name: M Date:C�Zl lTL within 180 days after it has been accepted as complete. n 1/ / * Fee methodology set by Tri-County Building Industry Service Board. I:Building\Permits\FPS-PermitApp_031016.doc 440-4613T(I I'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: ❑ New system Number of sprinkler heads: t Number of alarm devices: © Addition or El 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: n Cl l spfiAlv( Type of System Complete A, B, C or D as applicable): A.) Commercial Sprinkler Sprinkler Type Wet ❑ Dry Additional Standpipes Information: Sprinkler Supply Line ❑ Yes ❑ No Hazard Group G w Density Design Area 1t{� K. Factor 5-;(e Sprinkler Project Valuation: $ '5'00�- 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:\Building\Permits\FPS_PermitApp_031016.doc 2 CityTi RECEIVED of Tigard Permit No.: rps2 P ooit lig 13125 SW Hall Blvd.,Tigard,OR 97223 SEE 2 2 2021 ?/0 / Phone: 503.718.2439 Fax: 503.598.1960 Date Received: ! Zp2/ Inspection Line: 503.639.4175 � / "'�� r I G A RI) Internet: www.tigard-or.gov l�l�f`(OF TIGAFiU C�By: / O f BUILDING DIVISION FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS OR TENANT IMPROVEMENTS (1 to 10 SPRINKLER HEADS WITHOUT PLANS) OFFICE COPY Project Name: Common Area Upgrade 5L Occupancy: B Job Address: 10200 SW Greenburg Road Type of Construction: II Suite: 1 st/2nd Floor Lobby Contractor: McKinstry Co. LLC Phone: 971-420-7550 Number of Proposed or Altered Heads: 1 Type: Hazard: Light Density: 1.0 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 ; itally signed by Alex Forker 09/21/2021 Signature: Date:2021.09.21 10:10:47-07'00' Date: Print Name: Alex Forker I\Building\Forms\FireSprinklerAffidavit_071514.docx Page 1 of 1