Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2022-00070
Date Issued: 5/12/2022
TIGA :D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 200
Project: Bates Group Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Fire sprinkler permit: Relocating(2)and adding(1)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 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Specifics:
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: Permit Fee COM 05/12/2022 $77.99
12/o State Surcharge-Building 05/12/2022 $9.36
Occupancy Grp: Occupancy Load: Plan Review-Fire Life Safety-COM 05/12/2022 $31.20
Dwelling Units:
Info Process/Archiving-Sm$0.50(up to 05/12/2022 $0.50
Stories: Height: ft 11x17)
Bedrooms: Bathrooms:
Value: $1,500
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $119.05
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 Ce ter. Those rules are set forth in OAR
952-001-0010 through OAR 952 01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 19 or 1.800.332.2344.
Issued By: _�J n ate/U. 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
Fire Protection System RECEIVE I FOR OFFICE USE ONLY
City of Tigard : Received permit No.:
114 • 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 402 Date/By: 5/'a ,� — r-�S t om- 7�7
g Plan Review
_ Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit: /jj/fd29^ Z
TIGARD Inspection Line: 503.639.4175 CITY��TIGARC Date Ready/By: Juris: I See"Page 2 for
Internet: www.tigard-or.gov Notified/Method: j�j /fir— � Supplemental Information
Bl.1!!. ING oIVISIG 1006,�.7 , /�
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 ommercial/industrial Valuation: -40"-i_, 5 U tf"
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10 2 2 0 SW Greenburg Rd. New dwelling area: square feet
City/State/ZIP: Tigard,. OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: 20 0 Project name:Bates Group 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.
Relocate (2) fire sprinklers and add (1) Valuation: $ i c-vj, —
c
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Shorenstein Realty Services Type of construction:
Address: 10220 SW Greenburg Rd. Suite 310 . Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Existing:
Phone:(5 0 3) 412 4844 Fax:( ) New:
❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: MCKirist 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: 16 7 9 0 NE Mason S t . Suite 100 jurisdiction in which work is being performed.If the
City/State/ZIP: p O rt 1 and, OR 9723 0 applicant is exempt from licensing,the following reasons
apply:
Phone:( 97D-420-755 0 Fax: :( )
E-maiLAlexF@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
City/State/ZIP: P o r t l a n d, OR 9723 0 State surcharge(12%of permit fee):
FLS plan review(40%of permit fee):
Phone:(9 7 D—4 2 0—7 5 5 0 Fax:( ) (Due upon application submittal.)
CCB lic.: 172811 Total permit fees: 1 M,45-
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
s-/ /i ce * within 180 days after it has been accepted as complete.
Print name: it,,,,r�✓!�I' Date: Q
Fee methodology set by Tri-County Building Industry
Service Board.
I.Building Permits`.FPS-PermitApp_03 10I6.doc 440-4613T(11,02 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:
® 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
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 System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler Type 12f Wet El Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes El No
Hazard Group Light
Density 1
Design Area 22 5 s g f t
K. Factor 5 . 6K
Sprinkler Project Valuation: $ 1, 5 0 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: $
1:\Building\Permits\FPS_PermitApp_031016.doc 2
City of Tigard Permit No.: i-20 _ z
13125 SW Hall Blvd.,Tigard,OR 97223 (� �0
3 Phone: 503.718.2439 Fax: 503.598.1960 Date Received: sYijh1
Inspection Line: 503.639.4175
TIGARD Internet: www.tigard-or.gov By:
RECEIVED
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONSSAY 1 l 202Z
OR TENANT IMPROVEMENTS CITY OF TIGARD
(1 to 10 SPRINKLER HEADS WITHOUT PLANS) BUILDING DIVISION
Project Name: Bates Group Tenant Improvement Occupancy: B
Job Address: 10220 SW Greenburg Rd. Type of Construction: 1-B
Suite: 200
Contractor: McKinstry Co. LLC Phone: 971-420-7550
Number of Proposed or Altered Heads: 3
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 t is document with a copy of the sketch attached shall be available for all inspections.
Signature: - Date: 05/03/2022
Print Name: Alex Forker
L:\Building\Forms\FireSprinklerAffidavit_071514.docx Page 1 of 1