Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1111 COMMUNITY DEVELOPMENT Permit#: FPS2017-00151
T[G\ft 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/03/2017
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 375
Project: Spec Space Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire sprinkler permit:Relocating(1)sprinkler head.
Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON ST., STE. 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/03/2017 $51.09
12%State Surcharge-Building 10/03/2017 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 10/03/2017 $20.44
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 10/03/2017 $0.50
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .10 Design Area: 0
K Factor: 5.6
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Gales Provided: Cut Sheets Required:
Total $78.16
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $500.00
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 952-001-00 00. 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: Permittee Signature: �.
Call 13.639.4175 by 7:00 a.m.for the next available inspec on 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.
" w
Building Permit Application
Fire Protection System FOR OFFICE USE ONLY
City of Ti and Received `�
g DateB ��/ Permit No.: _ "
III 't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review » j a? S
Phone: 503ii
.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: PM Supplemental Information
xTYP' OF WO ',4,,,,'
T i, REQIRED 1 tND2A,- .. DWEI IGz
❑Newconstruction ... ❑'Demolition''''
emolition ,... a ' .,,a,-,,,,,,,
Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
/Z/ Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
'''C..;:.CATEGORYgC N T U� ' work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: S
0 Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
‘'''' ''''' SITE lNFORNIATI \&.\D+LO(A'1IO �\\\\` . '4-%''''', Total number of floors:
Job site address:10260 SW Greenburg Rd, New dwelling area: square feet
City/State/ZIP:Tigard OR,97223 Garage/carport area: square feet
Suite/bldg./apt.no.:375 Project name:Vacant Space Prep Ste 375 "I
/ti t Covered porch area: square feet
Cross street/directions toob site:
� Deck area: square feet
Other structure area: square feet
RECD D DATA roii^ IERCIAI3- `BECKLIST
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
v w � equipment,materials,labor,overhead,and the profit for the
p
t
• �FSGRIPTIO\OF WORK \ ` work indicated on this application.
Valuation: $ ' -'
Relocate(1)Fire Sprinkler Head �j j
Existing building area: square feet
New building area: square feet
D ❑ T ANF Number of stories:PPR pFRI OWNER v , � fie�
Name:Shorenstein Company Type of construction:
Address:235 Montgomery Street,166 Floor
Occupancy groups:
City/State/ZIP:San Francisco CA,94104 Existing:
Phone:(415)772-7000 Fax:( ) New:
Business name:McKinstry Co. All contractors and subcontractors are required to be
Contact name:Joe Slom 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)331-0234 Fax: :(503)331-6906
E-mail:joes@mckinstry.com
, `\\ _ \ CCN \ '�`R \���
�...... ? ,\... \`a... .., ,.: .:���.. .S'':' IIUILI)ING\ II`I'� ' \\ \ \ G ,,
,;.,
Business name:McKinstry Co. � egi lej \ �\\E...•:
Permit fee:
Address: 16790 NE Mason Street,Suite 100
State surcharge(12%of permit fee):
City/State/ZIP:Portland,OR 97230
FLS plan review(40%of permit fee):
Phone:(503)331-0234 Fax:(503)331-6906 (Due upon application submittal.)
CCB lic.:172811 Total permit fees: 117?'. j to
Amount received:
Authorized signature:
This permit application expires if a permit is not obtained
Print name:Joe Slom Date:10/3/2017 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Buiiding\Permiis\FP5-PermitAppO7i 514.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
each e W)rk t door e�
,�• .,. Abe.�,.... � ` a --� \ ,� „,„M1111101111011111111•1101'
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
El New system Number of sprinkler heads: 1. Number of alarm devices:
Addition or ® 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
Alteration (3) copies of sketch showing area (3) copies of sketch showing area
to existing of work within building structure of work within building structure
system
❑ 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
'Type of stein(Complete ,B;C or I)as a�tplic 4 e}
A) Comr�rier"tial Spunkier �r
, .; N... ��Ems„ a��.. ��` \,,,.r,, rix.... ��. €. ��� ��``��. �Y�• .. �\ \`r,.,
® Wet El Dry
Additional Standpipes
Information: Hazard Group t't
Density . 7
Design Area
K. Factor 5.6
Sprinkler Project Valuation: $ 500.00
Hood Project Valuation: $
MmgNdlgtlkOrNLANipIr55
Fir Alarm \ �
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
l� Reden S rinkl Std .lo S e
Square Footage: Permit Fee: \ `
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05 ill �A k \
7,201 and greater $404.39 .
Sprinkler Project Square Footage: sq. ft.
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: $
W:\Construction\Bid Proposals\2017\8-August\2017-08-0018 Russell Construction-Incoln Tower Ste 375\FPS-PermitApp.doc
City of Tigard Permit No.: f/)5 o 17-00/51
• 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Date Received: C /3//7
Inspection Line: 503.639.4175
T I G A R D Internet: www.tigard-or.gov By: to- 703 pf--
FIRE SPRINKLER AFFIDAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: a'�_.,141 (,t, vc-c',1- V SQ 5,.. 4 3,75 Occupancy: (/1-[AA
Job Address:/0SG✓ 67L-c- -,vb,.„ /ZS Type of Construction:
Suite:
Contractor: 7141 K/v.%/12-
1 Phone: (6--(:)>)3'3 I O c)-3 L i
Number of Proposed or Altered Heads: I
Type: / 5" Hazard: � k t" Density: . / ('
I, C r--3. )'I 0 rvl Oregon Construction Contractors Board No. J 7 d' ( �
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 o his document with a copy of the sketch attached shall be available for all inspections.
Signature: Date: (Op ' J-O 17
Print Nam . GE SI (
I:\Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10260 SW GREENBURG RD 375, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Fire Protection System FPS2017-00151
Inspection Type: Inspector:
999 Sprinkler final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor