Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
i ll COMMUNITY DEVELOPMENT Permit #: FPS2010 00147
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/17/2010
TIGARD 1 G ARL? Parcel: 1 S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 360
Project: Ameriprise Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
Project Description: Fire sprinkler modification of 17 heads.
Contractor: CROWN FIRE SYSTEMS INC Owner: LINCOLN CENTER LLC
7402 SE JOHNSON CREEK BLVD BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97206 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 777 -5030 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 11/30/2010 $88.75
12% State Surcharge - Building 11/30/2010 $10.65
Type of Use: COM Plan Review - Fire Life Safety - COM 11/30/2010 $35.50
Class of Work: ALT Type of Const: IIIB
Occupancy Grp: B Height: ft
Stories: 1
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: Hazard: LT
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 $134.90
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $1,900.00
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 a UNC by calling 503.232.1987 or 1.800.332.2344.
r 11111. Issued By: , `ermittee Signature: ( j
_mss
Ca' - e . S'" 5 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 ��( /y@�y`q, 4 10,1 tAi N P ` + ' 1 FOR O FFICEUSE ON 7 3 p� k ` ..
���a • �-+ �� t d"" �e &
, " �a `S
� ��' , Received n
iphi ''- City of Tigard Dat B : Q 31 Permit No.: fp I)
g NOV 3 0 2010 —c-Z •io d.
„Ear '1 13125 SW Hall Blvd., Tigard, OR 97223 Plan R eview ���
Phone: 503.639.4171 Fax: 503.598.1960 Date /B :J <L Other Permit:
Inspection Line: 503.639.4175 r/ Date Ready /By: / / Juris: H See Page 2 for
TIGARD. Internet: www.tigard- or.gov CITY b OF � otified /thud: `� / l 6? l �'' Supplemental Information
BUILDING DIVISIO , , f -�
" °� :: / RE UIRED DATA 1 AI\D2 FA ILY DWELL
TYPE OF WORK
❑ 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
"t ::-� ,' a i PO _ work indicated on this application.
I CAT EGORY : OF D CON ? * 1+
Valuation: $
❑ 1- and 2- family dwelling ® Commercial /industrial
El Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder 111 Other:
Number of bathrooms:
gt r - JOB S1 , TE INF ORMA TION AND t LiOCAT N , • Total number of floors:
Job site address: 10200 SW Greenburg Rd 3 Floor New dwelling area: square feet
City /State /ZIP: Tigard, Or. 97223 Garage /carport area: square feet
Suite /bldg. /apt. no. (J& Project name: Ameriprise T.I. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
a : -;era z'.at ltz s « as k _-
`REQUIRED,DATA @OMIVIERCIAL USE�CHEChLIST ,
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Fax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
, t u . t -
., * ESCR W ORL ; � . =t _ . work indicated on this application.
Adjust sprinkler heads for T.I. Valuation: $$1,900.00
Existing building area: square feet
New building area: square feet
3g - x as - 0. �;r4 �t c '.au muw "g. �k
PROPERT�Y!OWNER TENAN' ''4 Number of stories:
:��` ,.,�&:�:. .. 4 . nit _s ���. >a ?� :. �.<f�n lkiiiiekt
Name: Type of construction:
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
"' ' TXj APPLICANT ; 4d a " . CONTACT PERSON= h gt g i, . a - v a . 1 4 u :;,
Business name: Crown Fire Systems, Inc. All contractors and subcontractors are required to be
Contact name: David Kyllo licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 7402 SE Johnson Creek Blvd. jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP: Portland, Oregon
apply:
Phone: (503) 777 -5030 Fax: : (503) 777-0659
E -mail: dave @crownfiresystems.com
'' �' RZZ } CONTRAACTOR= i t l ' ilBU ILDINGPERMITFEES* - v`% � ` ;',
,.:_ T Oreid r efeeve feesclredid .„ -
Business name: Same as Applicant G, -,
Permit fee: O
Address:
State surcharge (12% of permit fee): /0. tps
City /State /ZIP: FLS plan review (40% of perinit fee): 5-0 Phone: ( ) Fax: ( ) (Due upon application.) ��
-
CCB lic.: 163820 Total permit fees: r
- Amount received: / 5/ 9°
Authorized signature:
D(�.....� This permit application expires if a permit is not obtained
Print name: David Kyllo Date: 11 -30 -10 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri- County Building Industry
Service Board.
t:\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 c KKone.. . . t,,. t . t, fll i9 b
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
® Alteration ® 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 17
Additional description of work:
'Type of System,(Complete A B Cor Das, applicable)'
A) Commerc>< S r ��
.� .��.., .:� �x >�� .� -mss, �.._.6 � ��.
® Wet El Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $ 1900.00
`B 'T e �_,,,HoodFireSuppresson, System,1 y � `�°� � �'�
Hood Project Valuation: $
yk
A sa
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
Residenti S r><nkler Stand Alone S stem
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.
tti ZSether rotcction,Pe *fkt es.. " ma ..: ...V ;,.. -
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.
http: / /www.tigard- or.gov /city_ hall / departments /ed /dots /FPS- PermitApp.doc 10/01 /[ l