Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
= COMMUNITY DEVELOPMENT Permit#: FPS2022-00002
Date Issued: 1/13/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S 135A604500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 112
Project: Spec Space Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: Fire sprinkler permit-relocate(3)pendant sprinklers for new ceiling.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 01/11/2022 $67.23
12%State Surcharge-Building 01/11/2022 $8.07
Type of Use: COM Plan Review-Fire Life Safety-COM 01/11/2022 $26.89
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 01/11/2022 $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 $102.69
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $1,100.00
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: (-10-{ AJ Va-r^,De, We-ge, Permittee Signature:
OwA
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 Applicatio ' ,
n
Fire Protection System FOR OFFICE USE ONLY
Cityof Tigard JANq ReeeivedA Il 2� f,:l 0762022.0 02,
g 4 ��C� Date/By: � �' 1 Permit No.:
UPI 't 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review
ffi Phone: 503.718.2439 Fax: 503.598.1rY����UNaa DateBy: !� Other Permit:
TIGARD Inspection Line: 503.639.4175 v'LDI^' Date Ready/By: r ft .›, See Page 2 for
Internet: www.tigard-or.gov G DIVfS10nl Notified/Method1 "1 `61. Supplemental Information
TYPE OF WORK RE UIRED 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 El Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El1-and 2-family dwelling Valuation: $
ElCommercial/industrial
ElAccessory building El Multi-familyNumber of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10 2 5 0 SW Greenburg Rd. New dwelling area: square feet
City/State/ZIP: Portland, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: 112 Project name: VS P Suite 112 Covered porch area: square feet
Cross street/directions to job site: 4 Lincoln Center Deck area: square feet
Other structure area: square feel
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I 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 (3) pendant sprinklers for new ceiling Valuation: $ 1, 100
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 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 48 4 4 Fax:( )
New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: MCKinst.ry Co . LLC All contractors and subcontractors are required to be
Contact name: Alex F o r k 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 St . Suite 100 jurisdiction in which work is being performed.If the
City/State/ZIP: Portland, OR 97230 apply:
applicant is exempt from licensing,the following reasons
Phone:( 97D-420-7550 Fax: :( )
E-maiLAlexF@mckinstry . com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: MCKinst ry Co . LLC 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:( 9 71)—4 2 0—7 5 5 0 Fax:( ) (Due upon application submittal.)
CCB lie.: 172811
Total permit fees:
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
i�/• within 180 days after it has been accepted as complete.
Print name: d/?s eiv.44,' Date: Or/0>Aa2
* 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: 3 Number of alarm devices:
❑X Addition or X❑ 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 S S P ® Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line BS ❑ Yes ❑ No
Hazard Group L i ght
Density 1
Design Area
K. Factor 5 . 6
Sprinkler Project Valuation) $1 , 10 0
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
RECEIVE
City of Tigard Permit No.: F[ 02-o0007-
1111 13125 SW Hall Blvd.,Tigard,OR 97223 JAN 4 2022
_ Phone: 503.718.2439 Fax: 503.598.19 Date Received: O(/OI4/2.O
Inspection Line: 503.639.4175 Y VF I IGARD CITY
1 I.;AR I) Internet: www.tigard-or.gov BUILDING DIVISION By: GI T l 6F 71G rr -0
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS CO
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) ��
1/41
Project Name: VSP Suite 112 4 Lincoln Occupancy: B
Job Address: 10250 SW Greenburg Rd Type of Construction: 1-B
Suite: 112
Contractor: McKinstry Phone: 971-420-7550
Number of Proposed or Altered Heads: 3
Type: Hazard: Light Density: 1.0
1, 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 t is document with a copy of the sketch attached shall be available for all inspections.
/i 01/03/2022
Signature: Date:
Print Name: Alex Forker
I:\Building\Forms\FireSprinklerAffidavit_071514.docx Page 1 of 1