Permit CITY OF TIGARD BUILDING PERMIT
_ COMMUNITY DEVELOPMENT Permit#: FPS2022-00049
Date Issued: 4/11/2022
T'GAR T) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S136DD03400
Jurisdiction: Tigard
Site address: 11740 SW 68TH PKWY 200
Project: Mindful Therapy Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Fire sprinkler permit-add and relocate(18)sprinkler heads.
Contractor: MCKINSTRY COMPANY LLC Owner: 11740 SW 68TH PARKWAY LLC
16790 NE MASON STREET SUITE 100 111 SW COLUMBIA ST STE 1380
PORTLAND, OR 97230 PORTLAND, OR 97201
PHONE: 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Specifics: Date Amount
Description
Type of Use: COM Permit Fee-COM 03/30/2022 $123.72
Class of Work: ALT Type of Const: VB 12%State Surcharge-Building 03/30/2022 $14.85
Occupancy Grp: B Occupancy Load: Plan Review-Fire Life Safety-COM 03/30/2022 $49.49
Dwelling Units: Info Process/Archiving-Sm$0.50(up to 03/30/2022 $10.50
Stories: 1 Height: ft 11x17)
Bedrooms: Bathrooms:
Value: $4,550
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $198.56
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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 or direct questions to OUNC by calling 501. 32.1987 or 1.800.332.2344.
Issued By:
Permittee Signature:
�-�� �_��
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 fj
Fire Protection System -'4E.-,..CEIVED FOR OFFICE USE ONLY
Received
Cityof Tigard MAR w, fiait / Permit No. 2O2Z-QOO4
g 2022 Receive �7
'I 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 2 Other Permi ��r; ��
' ■. Phone: 503.718.2439 Fax: 503.598.1960�i y G1 11GARD Date/By: _�
'.� J ® See Page 2 for
Inspection Line: 503.639.4175 Da Ready y: B
TIGARD g g 7�'IL_fllNG O VISIOri tified/Method: 0.Gfj 'i �t Supplemental Information
Internet: www.ti and-or. ov
TYPE OF WORK REQU ' I I ATA: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.
Valuation: S
❑ 1-and 2-family dwelling 0 Commercial/industrial
ElAccessory building
El Multi-family Number of bedrooms:
Number of bathrooms:
ElMaster builder ❑Other:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11740 SW 6 8 t h Parkway New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: 20 0 Project name: Mindful Therapy Covered porch area: square feet
Cross street/directions to job site: 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.
Add/relocate sprinkler heads for TI Valuation: $4, 550
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: Melvin Mark Properties Type of construction:
Address: 1500 SW 2nd Avenue Occupancy groups:
City/State/ZIP: P o rt l and, OR 97201 Existing:
Phone:( ) Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON NOTICE
Business name: Mc Ki n s t ry C o . LLC All contractors and subcontractors are required to be
Contact name: Alex Forke 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
OR 9 7 2 3 0 applicant is exempt from licensing,the following reasons
City/State/ZIP: Portland, apply:
Phone:(971)-420-755 0 Fax: :( )
E-mail: alexf@mckinstry . com
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: McKinstry Co . LLC Permit fee:
Address:16790 NE Mason St . Suite 100
State surcharge(12%of permit fee):
City/state/zrn:portland, OR 97230 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:
' 1 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: Alex F O k e r Date: * Fee methodology set by Tri-County Building Industry
Service Board.
I9BuildinglPermits\FPS-PermitApp_031016.dec 440-4613T(I Ii02/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: 18 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 0 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 ❑ Yes ❑ No
Hazard Group Light
Density 1 . 0
Design Area
K. Factor 5 . 6
Sprinkler Project Valuation: $ 4, 5 5 0
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El 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: $
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