Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
III a COMMUNITY DEVELOPMENT Permit#: FPS2013-00142
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2013
Parcel: 1 S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 750
Project: Axium Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Relocating(3)and adding(5)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 10/09/2013 $72.61
12%State Surcharge-Building 10/09/2013 $8.71
Type of Use: COM
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 Reg:
Battery Gales Provided: Cut Sheets Required:
Total $81.32
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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By .1' ee_Signature: Off /'
Call I .• .4 75 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 t FOR OFFICE USE ONLY
. Received
City of Tigard Date/B I i ( ' PermitNo.: -0' _`��LI 13125 SW Hall Blvd.,Tigard,OR SO 013 Plan Review
l t� Other Permit:` r�Ti — • -
Phone: 503.639.4171 Fax: 503.51960 ` Date/B
T I GA RD Inspection Line: 503.639.4175 O�- �� Date Ready/By: z. See Page 2 for
Internet: www.tigard-or.gov ®�'�1� a 14, Notified/Method: !. Supplemental Information
TYPE OF Wt v REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
- -- -- Indicate the value(rounded to the nearest dollar)of all
0 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 ®Commercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10200 SW Greenburg Road New dwelling area: square feet
City/State/ZIP:Tigard,OR 97233 Garage/carport area: square feet
Suite/bldg./apt.no.:750 Project name:Axium Expansion 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)heads and add(5)to accommodate the new floor plan Valuation: $1,295
Existing building area: square feet
McKinstry Job#71243 New building area: square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 7
Name:Axium Type of construction: 2-B
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
® APPLICANT - ® CONTACT PERSON
NOTICE- -
Business name:McKinstry Company,LLC All contractors and subcontractors are required to be
Contact name:Samantha Mack 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)331.2487 Fax::(503)331.6904
E-mail:samantham @mckinstry.com
CONTRACTOR BUILDING PERMIT FEES*
Business name:McKinstry Company,LLC (Please refer to fee schedule
Permit fee:
Address:Same as applicant — —
State surcharge(12%of permit fee):
City/State/ZIP: FLS plan review(40%of permit fee):
Phone:( ) Fax:( ) (Due upon application.) J.
CCB lic.: 172811 Total permit fees: n.3).
Authorized signature: �(n]tu 9/1/43,%.,„
Amount received: . 3,,,,fit'/� f�- This permit application expires if a permit is not obtained
.14 r Print name:Samantha Mack Date: 10/01/15 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PertnitApp.doc 03/23(06 440-4613T(I1/02/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
El Addition Xis 1-10 heads: No plan review required.
® Alteration El 11+heads: Plan review required.
El Repair
Number of sprinkler heads: <b
Additional description of work: Pe 3 d4 5
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
ZWet / ❑ Dry
Additional Standpipes N
Information: Hazard Group 14114-In azd►
Density G P1\11/(4-..-
Design Area l2_6
ft
K.Factor 5,(o
Sprinkler Project Valuation: $ .q
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations El Yes
include: Individual Component El 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.
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