Permit CITY OF TIGARDIIIII FIRE PROTECTION SYSTEM PERMIT
1` . COMMUNITY DEVELOPMENT Permit#: FPS2016-00133
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/01/2016
Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 200
Project: Farmers Insurance Subdivision: METZGER,TOWN OF Lot: 9
Project Description: TI-downsizing,includes minor demolition&new demising wall.
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 08/01/2016 $51.09
12%State Surcharge-Building 08/01/2016 $6.13
Type of Use: COM Plan Review-Fire Life Safety-COM 08/01/2016 $20.44
Class of Work: ALT Type of Const: Info Process/Archiving-Lg$2.00(over 08/01/2016 $2.00
Occupancy Grp: Height: ft 11x17)
Stories: Info Process/Archiving-Sm$0.50(up to 08/01/2016 $2.00
11x17)
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 $81.66
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 N. - -• 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 d' -ct questions to C !ling 503.232.1987 or 1.800.332.2344.
I-sued By: K Permittee Signature: x Ct/
•
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. Or
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
1, City of Tigard ' r DateB d be� (p �r� PermitNo.: /� - i/610
Qo /3
- 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19r:,_' 2016 Date/B : Other Permit: (9.0/6
it
TIGARD Inspection Line: 503.639.4175 Date Ready/By: kris. El See Page 2 for
Internet: www.tigard-or.gov .,_. tet;. • a r' Notified/Method: Supplemental Information
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❑New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
°\ CAGOi2•2, � y' work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
yl. qii SIT,; NF 1R TI€? AND 0400N-'- \\ Total number of floors:
Job site address:10200 Greenburg Road New dwelling area: square feet
City/State/ZIP:Tigard,OR Garage/carport area: square feet
Suite/bldg./apt.no.:200 Project name:Farmers Insurance Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
'44)1,11 l p ATAMOIVRYIERCkik4S EGKL
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
work indicated on this application.
Relocate(2)heads Valuation: $500
Existing building area: square feet
New building area: square feet
e 1 r ❑ TY OW1 ER �` �,z� - \l`,®1 TEr;NANT .�
�"; Number of stories:
Name:Farmers Insurance Type of construction: Qoty) i c i c O
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax ( )
CONTACT N r,
Business name:McKinstry Co. All contractors and subcontractors are required to be
Contact name:Tria Day 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::( )
E-mail:triad@mckinstry.com
.�. • „_. �si„, .\ \,,,. '1' ,'> •\ \ ,; .,*,\ma.:• '.., .,/✓, / \ x, r 1 ® ,lEaF \�
Business name:McKinstry Co. .01
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:
,tet
Amount received: gl
Authorized signature: C
�( C✓'1/4 This permit application expires if a permit is not obtained
Print name:Tria Day Date:7/28/16 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\FPS-PermitApp_071514.doe 440-4613T(11/02/CONI/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
�' �;'. . r,, NW"
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: 2 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
El 11+ heads: Plan review required and ❑ 6+ devices: Plan review required and
(3) sets of plans. (3) sets of plans.
Additional description of work:
- / @\w / � /i r / tri _ j j F�
l� 0 teiCc1tA,B ° '(�k .a� ttlte4�'e)c �� V`""\ o j
u ®® p
® Wet ❑ Dry
Additional Standpipes
Information: Hazard Group Light
Density
Design Area
K. Factor 5.6
Sprinkler Project Valuation: $ 500
i O/
� ) e �� Dd.F1 �,t pte it 4 Flood Project ct Valu atl' .,
on
411144,E"47,F
B .. .. /o
!'.,� „ „ny ., � ,,, ..,'
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
\ \
s s, Spth er
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.
444
. , , .;
, .,
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:\Projects\N-R\Russell Construction\108587 Farmers-Ste 200,5L\001 Mech Constlermits\FS\FPS-PermitApp.doc
City of Tigard � � ° ° �' Permit No.: f/�P.Dp/v/(o—�/3.3
4
NI 13125 SW Hall Blvd.,Tigard,OR 97223
' �i Phone: 503.718.2439 Fax: 503.598 1960 Date Received: $/I //(p
Inspection Line: 503.639.4175 t U U 1 2016
TIGARD Internet: www.tigard-or.gov By: CMClka4t1A-4--f
FIRE SiRAI,eLER'AFFIIYAVIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: G�Y � �- A-111-6.L)N `e t r' CSL Occupancy:
Job Address: I 20G 3t-. 6 2j'V\16., :::) Type of Construction:
Suite: 20.0
0
Contractor: ,kA c:A(‘isks:sPhone: 3--(_)- ,_S I -0 2._s
..........)
Number of Proposed or Altered Heads: Z
Type:s s k--GvAcicisPc/k Hazard: \I ny\A--- Density: .5.(43
I, -17(-- . DA Oregon Construction Contractors Board No. f -7 I
certify the following is tand 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 document with a copy of the sketch attached shall be available for all inspections.
Signature: —7 957:41.,N Date: S' I f (47
Print Name: / �J,
I:\Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10200 SW GREENBURG RD 200, TIGARD, OR,
97223
Commercial - Fire Protection System
999 Sprinkler final
PASS - No C of O
FPS2016-00133
Jeff Grove
Violation Summary:
Inspector Contractor