Permit 111 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1 2 - COMMUNITY DEVELOPMENT Permit#: FPS2015 00052
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/25/2015
Parcel: 1S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 101
Project: Bike Storage Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: Adding(1)sprinkler head. Affidavit submitted.
Contractor: PACIFIC FIRE SYSTEMS LLC Owner: LINCOLN CENTER LLC
6704 RIVERIA CT BY SHORENSTEIN PROPERTIES LLC
WEST LINN, OR 97068 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO,CA 94104
PHONE: 503-710-6646 PHONE:
FAX:
FEES
Description Date Amount
Specifics:, Permit Fee-COM 03/25/2015 $51.09
12%State Surcharge-Building 03/25/2015 $6.13
Type of Use: COM Plan Review-Fire Life Safety-MF 03/25/2015 $20.44
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 03/25/2015 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type: Wet
Standpipe Required: Hazard: LT
Density: 0 Design Area:
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $78.16
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 Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may •bt-in a copy of the rules
or direct questions to OUNC by calling 503.232.19 7 800.332.2344.
Issued By: Permittee Signature:
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Call 50 . 9.4175 by 7:00 a.m.for the next available inspection e.
This permit card shall be kept in a conspicuous place on the job site until co pletion 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 RECEIVED Date/B Permit No =nC be—14 ' 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review " P✓ -
= Other Permit / ,.
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : %A S •
MAR 2 5 2015 ® See Page 2 for
TIGARD
Inspection Line: 503.639.4175 ^IT, DateReadyBy. Supplemental laformation
Internet: www.tigard-or.gov C I 1 Notified/Method
- r--,•,,oF TIGARD
�`•r_x. rrw t.� I J' '''"1�� REQUIRED DATA:1-AND 2-FAMILY DWELLING
TYPE OF V6'ORK Q
Permit fees*are based on the value of the work performed.
❑New construction ❑Demolition Indicate the value(rounded to the nearest dollar)of all
j4ddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: S
❑ 1-and 2-family dwelling ,Commercial/industrial
Number of bedrooms:
❑Accessory building ❑Multi-family
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION ,/� / Total number of floors:
Job site address: /0A.L$ 5'GiJ �kttc,e pu„,.., ,' ? New dwelling area: square feet
City/State/ZIP: lC. fa.N 012 1 7 ' / Garage/carport area: square feet
�uite Idg./apt.no.: l/0/ (Project name: A'Y Sf 60.4_, _e 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.
ad G' / ,4 Z r�J Valuation: S 5‘ 0 .c.,........,.c.,........,Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( 1 New:
❑ APPLICANT ❑ CONTACT PERSON —' ,
NOTICE
Business name: ��.)6, 5 All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board
Contact name: under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: apply:
Phone:( ) Fax: :( )
E-mail:
' ' CONTRACTOR BUILDING PERMIT FEES*
r t
(Please refer to fee schedule)
Business name: al.Gc �jt,e
S� mss,•--g Permit fee:
Address: Q L( � ft��'GFiG� -'
State surcharge(12%of permit fee):
City/State/ZIP: LC/,1,3 ,Z__.f tie, / /L 1 7 0‘ FLS plan review(40%of permit fee):
Phone:(fd.3) 7/O—ICS G Fax:( ) (Due upon application.)
CCB lic.: /go/ Total permit fees: 7a. /I,.
�U
/ Amount received:
Authorized signature: /
This permit application expires if a permit is not obtained
Print name:( �, �' �L��` Date: �?— l� —/r
within 180 days after it has been accepted as complete.
2 • Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Permits\FPS•PermitApp.doc 10/01/09 440-4613T(11/02/COM/WEB)
w6
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
Vet ❑ I)ry
Additional Standpipes
Information: Hazard Group L-f-
Density
Design Area
K. Factor rj, .
Sprinkler Project Valuation: $ "l
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 $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.
I:\Building\Permits\Permit Forms 10-01-09\FPS-PermitApp.doc 10/01/09 2
City of Tigard Permit No.: f°3 J/S=600 5-0Z
• 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: 3725-45-
H i, Inspection Line: 503.639.4175
Internet: www.tigard-or.gov By: gii•)� f
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS �J"'
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: 4 ke 5-7 -ie j.c. Occupancy:
Job Address: /p,& 5v SUS (-7 n ecA.t/" '/-y Xcl Type of Construction:
Suite: l0/
Contractor: �e•rt,; C4c Sfif7t*�`S Phone: 5'03— 7/0 -‘‘e-eiC
Number of Proposed or Altered Heads: /
Type: Hazard: L/14 T Density:
I,_142-c i;c7> if---i22.e Sys T(A-A-5- Oregon Construction Contractors Board No. /3O/410
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 this docu t with a copy of the sketch attached shall be available for all inspections.
Signature: /�� .-- Date: 7--,y2 17 - / 5'
Print Name: .04,f/ Ae.-,(_3361.........
1:\Building\Forms\FireSprinklerAffidavit_071514.docx Page I of 1
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