Permit 71 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
1E
COMMUNITY DEVELOPMENT Permit#: FPS2021-00078
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/12/2021
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9681 SW WASHINGTON SQUARE RD C06
Project: Fabletics Subdivision: None Lot: None
Project Description: Addition of(7)notification devices for new tenant.
Contractor: SIEMENS INDUSTRY INC Owner: PPR WASHINGTON SQUARE LLC
15201 NW GREENBRIER PKWY BY MACERICH RET
SUITE A4 PO BOX 4085
BEAVERTON, OR 97006 SANTA MONICA, CA 90411
PHONE: 503-207-1839 PHONE:
FAX: 503-207-1901
FEES
Description Date Amount
Specifics: Hourly Building Rate 07/09/2021 $180.00
Hourly Building 12%State Surcharge 07/09/2021 $21.60
Type of Use: COM Permit Fee-COM 07/09/2021 $112.96
Class of Work: ALT Type of Const: VB 12%State Surcharge-Building 07/09/2021 $13.56
Occupancy Grp: B Height: ft Info Process/Archiving-Lg$2.00(over 07/09/2021 $6.00
Stories: 11x17)
Info Process/Archiving-Sm$0.50(up to 07/09/2021 $6.00
11x17)
Commercial Sprinkler System: Plan Review-Fire Life Safety-COM 07/09/2021 $45.18
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Yes Alarm Type: Automatic
Pull Station Required: Yes Smoke Detectors Req: No
Battery Gales Provided: Yes Cut Sheets Required: Yes
Total $385.30
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,433.88
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
1 •
y/7
Issued By:/ /1 /`�L., Permittee Signature:
Call 503.639.4175 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.
BuildingPermit Application
Up on
Fire Protection System HECEIVED FOR OFFICE, USE oNlN
�) ,1 ) 1 Received / �is/2 City of Tigard i x t LO�I Date/By: W Permit N°S�GZ` 71'
N • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503598,146ll U1' TIGARD Date/By: 7,6.. al Other Permit:
Inspection Line: 503.639.4175 I I l i f 1 Nl r;n l\Ii S I O Date Ready/By: Jur: ® See Page 2 for
T I�'A R n N edMlethod• / I Supplemental Information
Internet: www.tigard-or.gov � � - -
: _ TYPE OF WORK REQUIRE ATA: 1 AND 2rFrU7►L1'DWW 'EING
Permit fees*arc based on the value of the work performed.
❑New construction ❑Demolition Indicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGOR'_OF.CONSTRUCTION work indicated on this application.
-_ -. Valuation: $
❑ 1-and 2-family dwelling 123 Commercial/industrial
❑Accessory building Number of bedrooms:
❑Multi-family
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
U. Job site address9681 SW Washington Square Road New dwelling area: square feet
City/State/ZIP:Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:C06 Project name:WSQ Fabletics 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
7f DESCRIPTION OF WORK tie work indicated on this application.
Addition of�otification devices for tenant moving into space.
Valuation: $ 3,433.88
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ 'IINANT Number of stories:
Name: Maria Halstead Type of construction:
Address:9585 SW Washington Square Road Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Existing:
Phone:(503) 639.8865 Fax:( ) New:
❑APPLICANT Li CONTACT PERSON
.- _ _ NOTICE.
Business name:Siemens _ All contractors and subcontractor are required to he
Contact name: Ashley Smallwood licensed with the Oregon Construction Contractors Board
y under ORS 701 and may be required to be licensed in the
Address:152012 NW Greenbrier Parkway Suite A4 jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: Beaverton, OR 97006 apply:
Phone:(971)998.4551 Fax: :(503) 207.1901
E-mail. ashley.smallwood@siemems.com
CON I RACTOR � , l+r • BUILDING PERMIT FEES*
(Please refsr to fee schedule) _
Business name: Siemens Permit fee:
Address: 15201 NW Greenbrier Parkway Suite A4
State surcharge(12%of permit fee):
City/State/ZIP: Beaverton, OR 97006 FLS plan review(40%of permit fee):
Phone:(971)998.4551 Fax:(503) 207.1901 (Due upon application submittal)
CCB lie.: 133041 Total permit fees:
Smallwood °Soni,o�°ods5o°°^ �'er 0 fl 1 Stied by bnkr. Amount received:
Authorized signature: B1 ionone,
Ashley o� z'e 7.„^,z®°'o,ar=— This permit application expires if a permit is not obtained
Print name: Ashley Smallwood Date: 6.9.2021 within 180 days after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry
Service Board.
I:Building\Permits\FPS-PcrmiApp_0310ib.doe 440-46131(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:
devices:
❑ New system Number of sprinkler heads: Number of alarm devices:,_/
® Addition or ❑ 1-10 heads: Affidavit required and -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 System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
Sprinkler'1'ype I ❑ Wet ❑ Dry
Additional Standpipes
Information: Sprinkler Supply Line ❑ Yes ❑ No
Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type;I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Pin ter Calculations [A Yes
include: individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 3,433.88
D.) 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): $ 3,433.88
Permit fee based on project valuation (see fee schedule): $ 344.00
Permit fee based on square footage (see D above): $
State Surcharge (12%of permit fee): $41.28
FLS Plan Review (40%of permit fee): $137.6
TOTAL: $3956.76
I:\Building\Permits\FPS_PermitApp_031016.doc 2
Aos#e„Ey 6- „is/coy evivs-
Dianna Ornelas
From: #Building Permit Technicians
Sent: Monday, June 21, 2021 12:38 PM
To: ashley.smallwood@siemens.com
Subject: 9681 SW Washington Square Rd - Fabletics
Attachments: FireAlarmAffidavit_071514.pdf
Importance: High
Hello Ashley,
We received an application and plans for(5) alarm devices for the Fabletics project at Washington Square. I believe Tina
Escalera from our office notified you on 6/15/2021 that the application was missing a signature.
After further review, we find the application materials are incomplete and we cannot accept them for the following
re ons:
• Incorrect address: The address on the application and plans of 9585 is for the mall management office. Each
enant space has their own address and the correct address for this space is 9681 SW Washington Square Rd.
Signature: Fire protection system application is missing a signature.
\\• Fire Alarm Affidavit: Missing completed affidavit form (see attached).
We have placed the application and plans in the lobby of the Permit Center for you to pick up and resubmit with the
correct address on ALL application materials and plans. The application packet will be on the table in the conference
room just inside and to the right inside the lobby.
Please note that we tried to contact you by phone and it goes directly to a vmail message however the mail box was full
and we could not leave a message.
Thank you and please let me know if you have any questions.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
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