Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
2 ' COMMUNITY DEVELOPMENT Permit #: FPS2010 -00107
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/21/2010
TIGARD Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 500
Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0
Project: Concero
Project Description: Relocate (5) sprinkler heads, plug (1) sprinkler head, and add (3) sprinkler heads.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL Permit Fee - COM 09/21/2010 $59.16
12% State Surcharge - Building 09/21/2010 $7.10
PHONE: Plan Review - Fire Life Safety - COM 09/21/2010 $23.66
Contractor:
MCKINSTRY COMPANY
12021 NE AIRPORT WAY SUITE G
PORTLAND, OR 97220
PHONE: 503 - 331 -2461
FAX: 503 - 331 -6906
Type of Use: COM
Class of Work: FPS Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm Svstem:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $89.92
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 0
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 i es adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. • u ma obtain a copy of the s
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:
X61. Permittee Signature: b
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 ApplicatioRprF
Fire Protection System FOR OFFICE USE ONLY
City of Tigard S E P 21 2.010 oar /Bld r i,/10 Permit No.: ,2/0 — eV /D 7
° 13125 SW Hall Blvd., Tigard, OR 972A— Plan Review
Phone: 503.639.4171 Fax: 503.598 . 0 , OF TIG RD Date /By: Other Permiteuf'egi /Q —eag
T I G n R D Inspection Line: 503.63 9.4175 BUILDING DIVISION Date Ready /By: .1 uris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: 776:- Supplemental lnformation
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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this ap
r
Valuation: $
❑ 1- and 2- family dwelling ® Commercial /industrial • --
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10220 SW Greenburg Rd. New dwelling area: square feet
City/State /ZIP: Tigard, OR 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: 500 Project name: Concero Expansion Covered porch area: square feet
Cross street/directions to job site: Lincoln Center - Lincoln 2 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 5 fire sprinkler heads, plug 1 fire sprinkler head, and add 3 Valuation: $
fire sprinkler heads. Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: Shorenstein Realty Services Type of construction:
Address: One SW Columbia Street Suite 300 Occupancy groups:
City/State /ZIP: Portland, OR Existing:
Phone: ( ) Fax: ( ) New:
ID APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Mckinstry Co. All contractors and subcontractors are required to be
Contact name: Diane Parke licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 16790 NE Mason St #100 jurisdiction in which work is being performed. If the
City/State /ZIP: Portland, OR 97230 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 331.0234 Fax: : (503) 331.6907
E -mail: dianep @mckinstry.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: Mckinstry Co. (Please refer to fee schedule)
Permit fee: ��, /6
Address: 16790 NE Mason St. #100
City/State/ZIP: Portland, OR 97230 State surcharge (12% of permit fee): .7 l n
FLS plan review (40% of permit fee):
P sne: (503) 331.023' F. 13) 331.6907 (Due upon application.) 3, (o 6
i CCB lic.: . � i Total permit fees:
/ - / Amount received: 6P9', I e2
Auth 'zed sit a AVM
This permit application expires if a permit is not obtained
Prin name: / '' t Kee Date: 9/241)//6 * within 180 days after it has been accepted as complete.
Fee methodology set by Tri -County Building Industry
• Service Board.
l:\ Building\Permits \FPS- PermitApp.doc 10 /01/09 440- 4613T(11/02 /COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ New 2.) Modification to sprinkler heads only:
El Addition ® 1 -10 heads: No plan review required.
® Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 9
Additional description of work:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Z Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $ 800.00
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 Sprinter (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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
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