Permit y CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
' I • • COMMUNITY DEVELOPMENT Permit#: FPS2021-00138
Date Issued: 12/2/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 545
Project: Gallagher Bassett Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire sprinkler permit-Relocating(1)sprinkler head for a light. AFFADAVIT 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 11/30/2021 $59.16
12%State Surcharge-Building 11/30/2021 $7.10
Type of Use: COM Plan Review-Fire Life Safety-COM 11/30/2021 $23.66
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 11/30/2021 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: 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 $90.42
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $800.00
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: Holly Van De Wege PermitteeSignature: On Application
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 /1
Fire Protection System RECEIVEDFOR OFF.CE USE ONLY
City of Tigard Received ! ^�^ ..��,�ryry �� Permit No.: t� /� /y�
Date/By: /" :/�/ L<�� ��72tJ�'Ld/ 3
II l 13125 SW Flail Blvd.,Tigard,OR 97223 NOV 1 8 Plan Revie
= Phone: 503.718.2439 Fax: 503.598.1960 2021 DateBy: N��}' Other Permit((p�u�� 7
T t CARD Inspection Line: 503.639.4175 CI i y OF Date Ready/By: / 7uris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING TIUNR� Notified Method��', r ��. Supplemental Information
DIVISION .eat ? �
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
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling 0 Commercial/industrial Valuation: $ 800 . 00
❑Accessory building 0 Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10220 SW G r e e nbu r g Rd New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: 51-5 Project name: Gallagher Bassett Covered porch area: square feet
Cross street/directions to job site: 3 Lincoln Center 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.
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 (1) sprinkler head for a light Valuation: $
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Shorenstein Properties Type of construction:
Address: 5335 Meadows Road Suite 275 Occupancy groups:
City/State/ZIP: Lake Oswego, OR 97035 Existing:
Phone:(5 0 3) 412 4844 Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON
NOTICE
Business name: MCKi n st ry Co . LLC All contractors and subcontractors are required to be
Contact name: Alex Forker 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
applicant is exempt from licensing,the following reasons
City/State/ZIP: Portland, OR 97230
apply:
Phone:(9 71) 4 2 0—7 5 5 0 Fax: :( )
E-mail: AlexF@McKinstry . com
CONTRACTOR BUILDING PERMIT FEES*
fee
Business name:MCKinstry Co . LLC (Please refer termit Phedute)
Permit fee:
Address: 16790 NE Mason St . Suite 100
State surcharge(12%of permit fee):
City/State/ZIP:P o r t l a n d, OR 9723 0 FLS plan review(40%of permit fee):
Phone:(9 71) 4 2 0—7 5 5 0 Fax:( ) (Due upon application submittal)
CCB lie.: 172811 4 Total permit fees:
40
Authorized signature: ,
Amount received:
This permit application expires if a permit is not obtained
Print name: Alex Forker Date: 11/17/2 0 21 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
1:Building`'.Permits.FPS-PermitApp_031016.doc 440-4613T(I 102 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: Number of alarm devices:
El Addition or El 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
❑ 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 El Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
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°A) of permit fee): $
TOTAL: $
I:\Building\Permits\FPS_PermitApp_031016.doc 2
City of Tigard RECEIVE®Permit No.: FPS ZcZI-)13 S
II 1111 13125 SW Hall Blvd.,Tigard,OR 97223
I Phone: 503.718.2439 Fax: 503.598.1960 NOV 1 8 2021 Date Received: 1�3O/Zd 2-
Inspection Line: 503.639.4175
TIGARD Internet: www.tigard-or.gov CITY OF TIGARD By: G(� o r "1'1 y Pr2 lD
BUILDING DIVISION
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS )1;,7. 77} -
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: Gallagher Bassett Suite 545 Occupancy: B
Job Address: 10220 SW Greenburg Rd Type of Construction: I-B
Suite: 545
Contractor: McKinstry Co. LLC Phone: 971-420-7550
Number of Proposed or Altered Heads: 1
Type: Concealed 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 itally signed by Alex Forker 11/17/2021
Signature: te:2021.11.17 14:23:15-08'00' Date:
Print Name: Alex Forker
1:\Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1