Permit (50) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
'' 31: COMMUNITY DEVELOPMENT Permit#: FPS2016 00180
TtGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/13/2016
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 600
Project: Maccoll, Busch,Sato Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Relocating(7)sprinkler heads. Affidavit submitted.
Contractor: PACIFIC FIRE SYSTEMS LLC Owner: LINCOLN CENTER LLC
6704 RIVERIA CT BY SHORENSTEIN PROPERTIES LLC
WEST LINN, OR 97068 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-710-6646 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 10/13/2016 $102.20
12%State Surcharge-Building 10/13/2016 $12.26
Type of Use: COM Plan Review-Fire Life Safety-COM 10/13/2016 $40.88
Class of Work: ALT Type of Const: Info Process/Archiving-Sm$0.50(up to 10/13/2016 $1.00
Occupancy Grp: Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Yes Sprinkler Type: Wet
Standpipe Required: No Hazard: LT
Density: .10 Design Area: 1500
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 $156.34
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $2,430.00
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 m. .,tain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
/4111,
Call 503.639.4175 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 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 ISE ON LI
City of Tigard eceived
4--- Permit No.: C�j�ed`09r
II e 13125 SW Hall Blvd.,Tigard,OR 97223 telly: �� �� !tel
■ � �Alan Review �y
Phone: 503.718.2439 Fax: 503.598.1960 .J _" s Date/By: Other Permit:gjelAbit,.�t�
T I G A K D Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov 3 2016 Notified/Method: 72.7t Supplemental Information
TYPE OF WORK r ' �"IGARD REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction/
❑Demo tti r �� Oe Permit fees*are based on the value of the work performed.
�� i .L— Indicate the value(romded to the nearest dollar)of all
ddition/alteration/replacement 0 O equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 1-and 2-family dwelling ,"commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND/_ LOCATION Total number of floors:
Job site address: /IJ-Z�0 5--,4)5--,4) C 12z{oih�tL4a'°1_J /2 ) New dwelling area: square feet
City/StaZIP: 'r f t � ( , �t� Garage/carport area: square feet
uite/bl s_./apt.no.: 4P Ov Project name: / / 1 I A 5� Covered porch area square feet
Cross street/directions to job site: I 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(romded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
> DESCRIPTION OF WORK�/ J work indicated on this application.
l f7 C.'ct_T / $`,DO2t,t �,z� /'7`C Ct S Valuation: $ f /7/3�
Existing building area square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( )
New:
0 APPLICANT 0 CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed.If the
City/State/ZIP: applicant is exempt from licensing,the following reasons
apply:
Phone:
( ) Fax::( )
E-mail:
CONTRACTOR BUILDING PERMIT FEES*
I � /eo,-j
(Platte refer Mike seltedute)
Business name:
GLCi,rC F ,,„ � /
Address: Y Permit fee:
City/State/ZIP: L„C 1��u' z of 9 7U GS' State surcharge(12%of permit fee):
` FLS plan review(40%ofpermit fee):
Phone:
(56,3) 7�(�'C,44� Fax:( ) (Due upon application submittal.)�
CCB lic.: /. 0/L�L� Total permit fees: /
Authorized signature: Amount received:
This permit application expires if a permit is not obtained
Print name: (ift�, �� t�>f z--� Date:/p,_/3,.--, /
� 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.doc 440-4613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2- Supplemental Information
Describe work to be done:
1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices:
❑ New system Number of sprinkler heads: 7 Number of alarm devices:
(Addition or g 1-10 heads: Affidavit required and ❑ 1-5 devices: Affidavit required and
t 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
0 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 System(Complete A,B,C or D as applicable):
A.) Commercial Sprinkler
Wet ❑ Dry
Additional tandpipes
Information: Hazard Group L i:?icr
Density ) j a
Design Area /6o0 ipFr
K. Factor '5,
Sprinkler Project Valuation: $
B) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations El Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
I).) 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: $
I:\Building\Permits\FPS_PermitApp_071514.doc 2
RRIIVP11
City of Tigard
11 Permit No.: FPSQf --�y�,l�o
13125 SW Hall Blvd.,Tigard,OR 97223 w
Phone: 503.718.2439 Fax: 503.598.1960 0 ¢)� Date Received: CLI/;3/ ,
Inspection Line: 503.639.4175 r 0 1 /
ricnEz p tSL—
Internet: www.tigard-or.gov By: 6�E/'te
CIT gIGARD
FIRE SPRIG , fr + A1VIT FOR ALTERATIONS
OR TENANT IMPROVEMENTS
(1 to 10 SPRINKLER HEADS WITHOUT PLANS)
Project Name: m ac(o /1 eu5 c 1' — 5a Occupancy:
Job Address: /(0,2 o 0 j(.t,2 lecs) Type of Construction: 7 ?�
Suite: (Q6
Contractor: r/Fr [7> Sy- 5" 5 Phone: 5-03 7/0- y
Number of Proposed or Altered Heads: 7
Type: 91-dir Hazard: L i h Density: t/U
I,
46."(1, ---,t SYS"T,- -S Oregon Construction Contractors Board No. /yo/z(0
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 doc�t with a copy of the sketch attached shall be available for all inspections.
Signature: Date: /0-- /? -/c
Print Name: 4442,/
I:\Building\Forms\FireSprinklerAffidavit 071514.docx Page 1 of 1