Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
I 2 COMMUNITY DEVELOPMENT Permit #: FPS2012 -00022
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/21 /2012
Parcel: 1 S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 201
Project: Radiant Senior Living Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Relocating (3) sprinkler heads, plugging (2) existing heads and adding (6) sprinkler heads.
Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON ST., STE. 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 331 -0234 PHONE:
FAX: 503 - 331 -6907
FEES
Description Date Amount
Specifics: Permit Fee - COM 02/21/2012 $102.20
12% State Surcharge - Building 02/21/2012 $12.26
Type of Use: COM Plan Review - Fire Life Safety - COM 02/21/2012 $40.88
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: 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 $155.34
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
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 Notific- . -nter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire • uestions to O ' . by g 503.232.1987 or 1.800.332.2344.
Issued By: �� Permittee Signature: r
1
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 FOR OFFICE USE ONLY
City of Tigard �� DatcBed /
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598. �1-%\l- DateB r
: Other Permit: Li • - `. �1
T I G A R D �y — T� Inspection Line: 503.639.4175 p, Date Ready/By: ® Su See Page 2 for
Internet: www.tigard or.gov � V A �� Notified/Method: pplemental loformatioo
TYPE OF WORK O� 0 \ REQUIRED DATA: I- AND 2- FAMILY DWELLING
❑ New construction ❑ Demork\P Permit fees* are based on the value of the work performed.
�(jj 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 application.
Valuation: $
❑ 1- and 2- family dwelling ® CommerciaUindustrial
❑ Accessory building El 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 Road New dwelling area: square feet
City/State /ZIP: Tigard, OR 97233 Garage /carport area: square feet
Suite/bldg. /apt. no.: 201 Project name: Radiant Senior Living 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.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Relocate (3) existing sprinkler heads. Plug (2) existing sprinkler heads. Valuation: $52,220.00
Add (6) new std resp heads. Existing building area: 5408 square feet
McKinstry Job #70747 Russell Construction Job# 112074 New building area: 0 square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 1
Name: Radiant Senior Living Type of construction: II -B
Address: Occupancy groups:
City/State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
® APPLICANT 0 CONTACT PERSON NOTICE
Business name: McKinstry Company, LLC All contractors and subcontractors are required to be
Contact name: Janel Lipe licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 16790 NE Mason Street, Suite 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) 278.3954 Fax: : (503) 331.6907
E -mail: janell @mckinstry.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: McKinstry Company, LLC (Please refer to fee schedule)
Permit fee: /0 ), ,
Address: Same as applicant
City/State /ZIP: State surcharge (12% of permit fee): /d . )..
FLS plan review (40% of permit fee): v b /
Phone: ( ) Fax: ( ) (Due upon application.) `
CCB lic.: 172811 Total permit fees: / 57:31
Authorized signature: Amount received:
V� This permit application expires if a permit is not obtained
Print name: Janel Lipe Date: 0?. ■ i 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 03/23/06 440-4613T(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:
❑ Addition ® 1 -10 heads: No plan review required.
Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: _
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: $
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 Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 $292.50
7,201 and greater $381.50
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.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
W: \PDX - Mechanical Construction \SPG -Dept 705 \ Projects \ -- SPG SERVICE- HARILCARD PROJECTS \70747 Radiant Senior Living\ Permit \FireProtection - PermitApp.doc