Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
- COMMUNITY DEVELOPMENT Permit #: FPS2010 -00140
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/12/2010
• Parcel: 1S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 601
Project: Matrix Absence Management Subdivision: LINCOLN THREE Lot: 0
Project Description: Add (2) new and relocate (3) existing fire sprinkler heads for TI
Contractor: MCKINSTRY COMPANY Owner: LINCOLN CENTER LLC
12021 NE AIRPORT WAY SUITE G BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 331 -2461 PHONE:
FAX: 503 - 331 -6906
FEES
Description Date Amount
Specifics: Permit Fee - COM 11/12/2010 $61.85
12% State Surcharge - Building 11/12/2010 $7.42
Type of Use: COM Plan Review - Fire Life Safety - COM 11/12/2010 $24.74
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 System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $94.01
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $900.00
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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: y(/ Permittee Signature: D A/
� "lll »?CCC
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.
11/10/2010 16:06 5033316907 MCKINSTRY PAGE 04/07
BuildingPermit Application
Fire Protection System Mk 011 tISII tiNi, \
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City of Tigard 1 6 6 1°
' 1312g SW HMI Blvd. Tigard, OR 97223 \ .1.° Da cluY 1_1 .'
1 1 .. Phon 503.639.4171 Fax: . 503.598.1960 \I - (1 . P tjlt n e ra evie :
ti w
111
c; , -, 14.1) inspectioa Line: 503.639.4175 r „ . 1 ,,,' c Rcady/By:
Vi`'' ' t ' -t.tied/Mettiod: tur07 /e/ s la See:s for infonnition
■ . ; ,r,r 4.0-st Cii........rAS
CX 1 1. / AACiV ‘
V 1 :! ; ,::: r I :
0 New construction 0 Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the ncarst dollar) of all
El Addition/alteration/replacement 0 Other: equipment, materials, labor, overhead, and the profit for the
1 ;;:j work indicated on this application.
Valuation: $
12 1- and 2-fainily dwelling 0 Commercial/industrial
Number of bedrooms:
D Accessory building 0 Multi-family .
0 Master builder 0 Other: Number of bathrooms:
' '.: : ; . •.l'ii . ';' . 1q41 : PINO : ' ;:i.l '... 11 #41WliiiiiiliiiiiiiiiiiiiiiiiiI3iti41iiilitiiiii.••:.:. :. :':h: : .; . .:P:i : ;llP;' .. i;I: Total number of floors:
, ; , ,, , !..,•,.! , ... , :,.. n o,l , ' , .'!•:.: ,4 ' , ..:: . •!•• • '•:. !.•."' •• .,,,,•?.., iii,• ,, •.. ,•, - .,....,..• . , - • .,. ., ,,, , • ., - .•,.,•• :', : •:•....,)....;.-....:.,,(.,,;-•.. .; •
Job site address: 10220 SW Greenburg Road New dwelling area square feet
City/State/ZIP: Portland, Oregon 97233 Garagc/carport area: square feet
Suite/bldgJapt. no.: 601 Project name; Matrix fetpmesion-- Covered porch area: square feet
Cross street/directions to job site /9 AIALAT#6 Deck area: square feet
Other atructure arca: square feet
*
Subdivision: Lot no.: 01004 Permit fees* arc based on the value of the work performed.
Indicate thc value (rounded to the nearest dollar) of all
Tax map/parcel no.: 1S135AB
equipment, materials, labor, overhead, and the profit for thc
l ;'" 41t4001/1 i 1i. , ,:&..W . '.. work indicated on this applicatior.
Add (2) new fire sprinkler heads and relocate (3) fire prink Valuation: 8900.00 ler heads per new
office layout Existing building area square feet
° 1
62 /fedi le- .R 0 10 - oo73 New building area;
* .
rz
Number of stories: square feet
40
Name: Matrix Expansion Type of construction:
Address: Occupancy groups:
.
City/Statc/ZIP: Existing:
Phone: ( ) Fax: ( ) New:
ii:6::*t.(#0,50:':.j.li:ili:'..g'!.R:1:-I'.;*.':i.:.,Ygl I.„l.0,1,1ig,i..';',.....'1''':.'.:,:.':.::::;:;:i';‘,;;'.1;ili
Business name: McKinstry Company. LLC All contractors and subcontractors arc required to be
Contact name: Dian Parke licensed with the Oregon Construction Contractors Board
e
under ORS 701 and may be required to be licensed in the
Address: 16790 N.E. Mason Street, Suite 100 jurisdiction in which work is being performed. Tf the
City/State/ZIP: Portland. OR 97230 applicant is exempt from licensing, the following reasons
, apply:
Phone: (503) 331.2465 Fax: : (503) 331-6907
E-mail: dianep@mckinntry.com
M .. ''z'e;:•' -”--
Business name: Sa ;svgapppGrERIvirtingEstf. ';erii: . iii;
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me AS Applicant
_
Permit fee:
Address:
- -
Ci ty/State/ZIP State surcharge (12% of permit fee):
:
FLS plan review (40% of permit fee):
Phone: ( ) F ) (Due upon application.)
CCB lie.: 172811
Total permit fees: 9r, o,
Authorized signature Amount received: 0 44o LI
This permit application expires if a permit is not obtained
Print name; Diane Pa • ', Date: 11/10/10 within 180 dap; after It has been accepted as complete.
• F dee metho ()Ivy net by Tri-Cotmly Building industry
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11/10/2010 16:06 5033316907 MCKINSTRY PAGE 05/07
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
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1.) ❑ New 2.) Modification to sprinkler heads only-.
❑ Addition ® 1 -10 heads: No plan review required.
® Alteration ❑ 1.1+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
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❑ Wet ❑ Dry ,
Additional Standpipes
Information: Hazard Group
Density
• Design Area
K. Factor
Sprinkler Project Valuatilom: $
Hood Project Valuation: $
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Submittal shall Battery Calculations ❑ Ycs
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Protect Valuation: $
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Square Footage: Permit Pee:
0 to 2,000 $198.75
2,001 ., � �GIL:';.':1::') j�� 11�Ir::::!:� r:';. il:l!, �I� Ilil �l,�:i: �I�rl•,:!''','IUI
. to 3,600 $246.45
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3,601 to 7,200 _ $310.05
' i''1' ;ill 4 i @:`i ,j t' j( " ° .il'r; �ii;'Ji i ".ai
7,201 and greater, $404.39
,2 $404• ;;I � ;.1�. •:I; ,�I �,•'i
Sprinkler Project Square Footage: sq. ft.
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Project valuation subtotal (see A, B & C above): $
Permit fee based on project valuation (see fcc schedule): $
Permit fee based on square footage (see D above): $
State Surchar. 12% of •errnit 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.
W: \PDX - Special Projects Cimup \Pmjccrs \2010 • PR.OJECTS \940( Matrix Exraitgion 'crriricc \FPS-FctrnitApp.doc 10/01/09