Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2010 -00100
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 600
Subdivision: LINCOLN CENTER/FIVE LINCOLN Lot: 0
Project: Axium
Project Description: Fire sprinkler modification, relocate (7) heads and add (3) heads.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL Permit Fee - COM 09/14/2010 $83.37
12% State Surcharge - Building 09/14/2010 $10.00
PHONE:
Contractor:
AFP SYSTEMS INC
19435 SW 129TH
TUALATIN, OR 97062
PHONE: 503 - 692 -9284
FAX: 503 - 692 -1186
Type of Use: COM
Class of Work: ALT 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 $93.37
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 1700
Residential Square Footage: 0
Fire Alarm Valuation: 0
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
issuan - • ' suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Ut'' Notification Center. pose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
direct questions to OUNC b c- ' g .03.246.6699 or 1.800.332.2344.
ssued By: � j1/ Permittee Signature: t1
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
4 1 ,
Building Permit Application
Fire Protection System RECEIVED H)R t)hI ICI•, llSls ONl. \'
City of Tigard v Received / Permit i
tY g Datc/B : _ / 194 Ol/ O , / 4 1
1 14 q 13125 SW Hall Blvd., Tigard, OR 972t3c 1 4 7.0 Plan Review
I Phone: 503.639.4171 Fax: 503.598.1460' Date/13 : Other Permit:
t1 � i tt t Inspection Line: 503.639.4175 � , T1G Date Ready/By: ® See Page 2 for
A Internet: www.tigard- or.gov CYIN i, iviSIO Notified/Method: _ Supplemental Information
nU1LDIMI D V J 1`t
TYPE erF WORK REQUIRED DATA: 1- AND 2- FADIILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work perfonned.
Indicate the value (rounded 10 the nearest dollar) of all
lig Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ l- and 2- family dwelling li( Commercial / industrial Valuation: ....1--Ree-----'
❑ Accessory building ❑ Multi- falnily Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE ; INFORMATION AND LOCATION °. Total number of floors:
Job site address: 10200 5 L (ti s+ (,� - '� New dwelling area: square feet
City /S1ate/LIP:�jp�A� 2 �O �" Garage/carport area: square feet
Suite/bldg. /apt. no.: 00 Project name: 14,1V M Covered porch area: square feel
Cross street/directions to job site: 211 N TO A J _ A ..th Dcck area: square feet
1 St TC Other stnicture area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I 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.
g A A s S P - ss P Valuation: S 1'700 i a"'
Existing building area: jI d e (90 square feet
New building area: 6000 square feet
❑ r PROPERTY OWNER _ I • - : 0-TENANT Number of stories: 7
Name: p t Type of construction:
Address: ' 0100 SW L f� %-� Lob Occupancy groups:
City /State /ZIP: Trr,� � D ! Existing:
Phone: ( ) `�"� Fax: ( ) New:
R APPLICANT " ; 0 , CONTACT ONTAC : - - NOTICE
Business name: hr P S, J 1 OTC. All contractors and subcontractors are required to be
Contact name: JIB licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 114 SS S t~) �a 9 'y Av-G jurisdiction in which work is being performed. if the
City /State /ZIP: I U eht.14•1-•1 N Q F applicant is exempt from licensing, the following reasons
MAT
ly:
Phone: ( ) (O 9 )_- q2.95(1 q I Fax: ( ) (, 9 2 —I, 1 6
E -mail: ,..1%1,,,, C.. A EP Ws • cov\--
CONTRACTOR BUILDING PERMIT FEES*
Business name: (Please refer lo fee schedule)
Permit fee:
Address:
State surcharge (12% of pennit fee):
City /State/ZIP: e
FLS plan review (40% of permit fee):
Phone: ( ) Fax: ( ) (Dire upon application)
CCB lic.: (.9_D 5 3 LA Total permit fccs:
Amount received:
Authorized signature:
This penult application expires If a permit Is not obtained
I Print name: j (v 11 I Date: ( 1-13 -10 within 180 days after It has been accepted as complete.
v • Fee methodology set by Tri•County Building Industry
Service Board.
IABuilding1PermitAFPS •PermitApp.doe 05/21/06 440 4613T(11/02/COWWER)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) ❑ Ncw 2.) Modification to sprinkler heads only:
® Addition 141-1 -10 heads: No plan review required.
❑ Alteration D I1+ heads: Plan review required.
❑ Repair
Number of sprinkler heads: 10
Additional description of work: e 1 J - _ ai A 7
Type of System (Complete A, B, C or 'D as applicable):
A.) Commercial Sprinkler
Q- Wet ❑ Dry
Additional Standpipes
Information: I- Lazard Group
Density 110
Design Area 1S0
K. Factor 5 ,b
Sprinkler Project Valuation: $ f70
B.) Type L- Hood Fire Suppression System
Hood Project Valuation: 1 $
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.
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